Infection
The person who has experienced a brain injury may be vulnerable to infection and be unable to accurately report symptoms, particularly if the person has communication and/or cognitive difficulties.  Therefore there is a risk that infection may be unrecognised until the person becomes quite unwell. Infections may occur in the following circumstances after Acquired Brain Injury:

  • If the person has problems swallowing safely (i.e. arising from dysphagia and/or disorganised and impulsive eating behaviour) there is a risk of aspiration pneumonia.
  • If the person has bladder dysfunction, there is an increased risk of urinary tract infections. Indwelling catheters result in a significantly increased risk of urinary tract infection.
  • If the person is wheelchair dependent or bedbound, pressure areas are at increased risk of skin breakdown which may be associated with infection.

Where the person already has cognitive and/or communicative problems following brain injury, any infection may result in a deterioration of cognitive and communicative functioning.   Sepsis may present as increased confusion.  When the person develops an infection, they may alternatively present in a state of delirium (i.e. acute onset of severe confusion associated with changes in mental state).  Delirium may present as fluctuating levels of consciousness associated with loss of the person’s normal day-night sleep pattern (i.e. they may be drowsy during the day and wakeful at night). Confusion with marked inattention and distractibility, hallucinations and fleeting paranoid delusions may also be observed.

Management is aimed at treating the underlying infection and recognising any other contributory factors.  Low dose Haloperidol may be helpful in some cases and shorten the duration of delirium (if there are no contraindications).

Endocrine Dysfunction
Dysfunction of the pituitary gland sometimes occurs after brain injury and can be associated with general deterioration, including in cognition.  Some patients who have had brain injuries may also have risk factors for diabetes mellitus (obesity, poor diet and limited physical activity, family history, antipsychotic medication).  Better glycaemic control in those with diabetes may improve mood and cognition.