Concomitant Brain Injury and Spinal Cord Injury Management Strategies: A Narrative Review

Spinal cord injury (SCI) and traumatic brain injury (TBI) often occur together, leading to a complex set of challenges for patients and healthcare providers. This review examines the causes, prevalence, and management of combined SCI and TBI, focusing on optimizing functional recovery. Initial evaluation can be difficult due to altered mental status from medications or the focus on one apparent injury potentially overshadowing the other. This can delay accurate diagnosis and intervention. Both SCI and TBI can cause autonomic dysfunction, such as paroxysmal sympathetic hyperactivity (PSH) in TBI and autonomic dysreflexia (AD) in SCI, requiring careful management to avoid complications.

• 1
  Estimates of concurrent TBI in patients with primary traumatic SCI range from 12.5 to 74.2%, based on the diagnostic criteria utilized.
• 2
  Patients with dual diagnosis are more likely to manifest behavioral issues, exhibit psychopathology, and have more severe neuro-psychological impairment than patients with SCI alone.
• 3
  The improvement in scores at discharge relative to admission (FIM gain), and FIM efficiency (change/unit time) are likely to be lower relative to an SCI patient without TBI