Unrecognized peripheral nerve lesions in a traumatic brain injury patient

Patients with traumatic brain injury constitute a diagnostic challenge since peripheral nerve injuries may be overlooked due to cognitive dysfunction and priority given to life-sustaining measures. Electromyography may be helpful in the differential diagnosis of weakness and atrophy. Problems specific for the traumatic brain injury patients, namely heterotopic ossification, hypertrophic callus formation and myositis ossificans should be considered by the physician. We report a 15-year-old patient involved in a pedestrian motor vehicle accident with traumatic brain injury. He had weakness and atrophy of the left upper extremity. Electromyographic examination revealed axillary nerve injury and carpal tunnel syndrome. Differential diagnosis of atrophy and weakness in traumatic brain injury patients is discussed.