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Keywords:

  • adolescent;
  • brain injury;
  • cognitive reserve;
  • toxic-metabolic encephalopathy

Abstract

We report on an adolescent with prior brain injury who responded to abrupt drug changes and an electrolyte imbalance with a significant alteration in the level of consciousness. In children with prior brain injury, paediatricians should consider the concept of a ‘fragile brain’ with limited ‘cognitive reserve’ and increased susceptibility to relatively minor toxic-metabolic insults. Psychoactive and central nervous system drugs should be managed with prudence in these patients.