Question:
In a patient with head injury, damage in the brain is aggravated by:
In a patient with head injury, damage in the brain is aggravated by:
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High glucose feeds anaerobic acidosis in injured brain.
Updated On: Jun 24, 2026
- Hyperglycemia
- Hypothermia
- Hypocapnia
- Raised serum osmolality
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The Correct Option is A
Solution and Explanation
Step 1: Frame the question. After head injury, secondary brain injury is driven by factors that worsen ischemia and metabolic stress in already vulnerable tissue. We need the factor that aggravates damage.
Step 2: Why hyperglycemia harms. High blood glucose in injured or ischemic brain fuels anaerobic glycolysis, producing more lactate and intracellular acidosis. This worsens neuronal injury and is linked to poorer outcomes after traumatic brain injury. So hyperglycemia clearly aggravates damage.
Step 3: Why hypothermia does not aggravate. Lowering temperature reduces cerebral metabolic rate and oxygen demand, which is protective rather than harmful, so it does not aggravate the injury.
Step 4: Consider hypocapnia. Low carbon dioxide causes cerebral vasoconstriction. Brief controlled hyperventilation can lower a dangerously high intracranial pressure, but excessive or prolonged hypocapnia reduces cerebral blood flow and can cause ischemia. This is why the original key noted A is greater than C: hyperglycemia is the clearest single aggravating factor, while excessive hypocapnia is only conditionally harmful.
Step 5: Serum osmolality. Raising serum osmolality with agents like mannitol or hypertonic saline is actually used to reduce cerebral edema, so it is therapeutic, not harmful.
Conclusion: The single best answer is Hyperglycemia, option A.
Step 2: Why hyperglycemia harms. High blood glucose in injured or ischemic brain fuels anaerobic glycolysis, producing more lactate and intracellular acidosis. This worsens neuronal injury and is linked to poorer outcomes after traumatic brain injury. So hyperglycemia clearly aggravates damage.
Step 3: Why hypothermia does not aggravate. Lowering temperature reduces cerebral metabolic rate and oxygen demand, which is protective rather than harmful, so it does not aggravate the injury.
Step 4: Consider hypocapnia. Low carbon dioxide causes cerebral vasoconstriction. Brief controlled hyperventilation can lower a dangerously high intracranial pressure, but excessive or prolonged hypocapnia reduces cerebral blood flow and can cause ischemia. This is why the original key noted A is greater than C: hyperglycemia is the clearest single aggravating factor, while excessive hypocapnia is only conditionally harmful.
Step 5: Serum osmolality. Raising serum osmolality with agents like mannitol or hypertonic saline is actually used to reduce cerebral edema, so it is therapeutic, not harmful.
Conclusion: The single best answer is Hyperglycemia, option A.
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