Post-traumatic cerebral infarction (PTCI) is a complication of traumatic brain injury with an incidence of 1.9-10.4% of all patients with traumatic brain injury 1. It is associated with a very high mortality rate of 75%.
Aside from the initial traumatic mechanism, patients may also present with neurological signs consistent with the area of infarction.
The most common pattern of PTCI is that of posterior cerebral artery infarction. This has been postulated to be due to compression of the PCA against the the tentorium as the medial temporal lobe herniates caudally 1,2.
Management of PTCI is controversial. Ham et al suggested that aggressive interventional management should be considered in patients with non-malignant (non-MCA region) PTCI, as well as patients with a GCS higher than 5. Patients with malignant PTCI or a GCS lower than 5 invariably do poorly, and Ham et al suggested that intervention would be of little benefit to the patient.
Case contributed by A/Prof. Pramit Phal.