What are the common complications of traumatic brain injury that I should monitor for in my patients?

Common complications of traumatic brain injury (TBI) to monitor in patients include:

• Neurological deterioration: Watch for a decrease in Glasgow Coma Scale (GCS) score, progressive focal neurological signs, seizures without full recovery, and unexplained or persistent confusion lasting more than 4 hours, as these may indicate worsening brain injury requiring urgent neurosurgical input ¹.
• Post-concussion syndrome: Symptoms such as headache, dizziness, nausea, visual disturbances, sensitivity to noise and light, balance and coordination difficulties, cognitive impairments (including memory problems, brain fog, and executive dysfunction), and speech problems can occur even after mild head injury ¹.
• Hypopituitarism: Pituitary dysfunction can develop immediately or months after injury, presenting with symptoms like fatigue, weakness, hypotension, hyponatraemia, cognitive and mood changes, sexual dysfunction, and polyuria. Persistent low sodium or blood pressure in admitted patients should prompt consideration of this complication ¹.
• Skull fractures and cerebrospinal fluid leaks: Penetrating injuries or fractures with cerebrospinal fluid leakage require close monitoring and specialist referral ¹.

Regular neurological observations including GCS, pupil size/reactivity, limb movements, respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation should be documented frequently during hospital observation to detect early signs of complications ¹.