All of the following are ominous signs in a case of severe head injury, EXCEPT:
Anisocoria, decoicate posturing, and decerebrate posturing, all are mentioned as the ominous signs of severe head injury so development of diabetes insipidus is the answer of choice by exclusion here. Normally are equal in size, round and briskly reactive to light. Brain injury and pressure on the nerves leading to pupils can produce change in pupil size, shape and reacting to light and movement. These changes can be correlated with the severity and type of brain injury. A sudden enlargement (Dilation) of one pupil (anisocoria) is an ominous sighn that require immediate intervention. This typically signals increased pressure on one side of the brain, causing the brain to shift downwards in the skull cavity (uncal or tonsillar herniation). "While decoicate posturing is still an ominous sign of severe brain damage, decerebrate posturing is usually indicative of more severe damage as the rubrospinal tract and hence, the red nucleus, is also involved indicating lesion lower in the brainstem". Signs of brain injury: Loss of the normal autoregulation of blood pressure and pulse, called the cushing's reflex is a hallmark of severe brain injury or imminent crisis. This generally results in a sudden rise in blood pressure and a slowing of the pulse. A person with a moderate or severe TBI may have a headache that does not go away, repeated vomiting or nausea, convulsions, an inability to awaken, dilation of one or more pupils, slurred speech, aphasia (word- finding difficulties), dysahria (muscle weakness that causes disordered speech), weakness or numbness in the limbs, loss of coordination, confusion,restlessness, or agitation. When the pressure within the skull (intracranial pressure, abbreted ICP) rises too high, it can be deadly. Sign of Increased ICP include decreasing level of consciousness, paralysis or weakness on one side of the body, and a blown pupil, one that fail to constrict in response to light or is slow to do so. Cushing's triad, a slow hea rate with high blood pressure and respiratory depression is a classic manifestation of significantly raised ICP. Anisocoria, unequal pupil size is another sign of serious TBI. Abnormal posturing, a characteristic positioning of the limbs caused by severe diffuse injury or high ICP, is an ominous. Ref: Reddy 27/e, Page 213-25 ; Parikh 6/e, Page 4.92-110 ; Harrison 17/e, Page 2218
Anisocoria
Decoicate posturing
Decerebrate posturing
Development of diabetes insipidus