Cases Of Head Injury Research Articles

Influence of two anesthetic techniques on blood sugar level in head injury patients: A comparative study.

Background:Head injury presents a major worldwide social, economic, and health problem. Hyperglycemia is a significant indicator of the severity of injury and predictor of outcome, which can easily be prevented. There has been a long-standing controversy regarding the use of inhalational or intravenous (i.v.) anesthetic agents for surgery of head injury cases and impact of these agents on blood sugar level.Aims and Objectives:The aim of this study is to find out anesthetic drugs and technique having minimal or no effect on the blood sugar, and Glasgow Coma Scale (GCS) of patients with a head injury by comparing two types of anesthetic techniques in surgery of head injury patients.Materials and Methods:This was a prospective, randomized, and comparative study, conducted on 60 adult head injury patients. The patients were divided into two groups of 30 each. Group I patients received induction with sevoflurane and then had O2 + air + sevoflurane for maintenance with controlled ventilation. Group II patients received induction with i.v. propofol and then had O2 + air + propofol for maintenance with controlled ventilation. Injection fentanyl was used in both the groups at the time of induction and in intermittent boluses in maintenance. In observation, blood sugar level and mean arterial pressure were assessed at different time periods perioperatively in both groups while GCS was analyzed pre- and post-operatively.Statistical Analysis:Statistical analysis was performed by Microsoft Excel 2010 using t-test for comparison between the two groups and Z-test for comparison of proportions.Results and Conclusion:Blood sugar level was found significantly higher in patients of sevoflurane group at 30 min after induction, at the end of surgery, and 1 h after the end of anesthesia than propofol group patients. This increase of blood sugar level did not have any significant alteration in the GCS profile of the patients in sevoflurane group as compared to propofol group patients. Nausea and vomiting were found more in sevoflurane group while hypotension and bradycardia were found more with propofol group.

Head Injury Pattern in Fatal Road Traffic Accidents

This study was conducted in mortuary of the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi where 100 fatal Road Traffic Injury cases over a period of three years from 2012–2015. Pattern of distribution of head injury cases in fatal road traffic accidents were analyzed in detail during post mortem. In skeletal fractures overall fractures of whole calvaria + facial skeleton were the commonest, followed by temporo-parietal fractures. Subdural hemorrhage was the most common affliction of meninges.

Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study.

The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29% (n = 83) were males and 11.70% (n = 11) were females. Commonest mode of injury was road traffic accident in 56.38% (n = 53) followed by fall from height in 29.78% (n = 28). In our study, 25.53% patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n = 24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08% (n = 17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58% patients had good GOS, 19% had moderate disability, and 9% remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging.

Urgency for surgical evacuation of post traumatic Intracranial acute epidural hematoma

Introduction: Intracranial epidural haematoma, (EDH) is a collection of blood between the skull and dura mater due to head injury. It is considered to be the most serious complication of head injury requiring immediate diagnosis and surgical intervention. Background: The aim of our study was to present the outcome of consecutive patients with Acute EDH managed surgically & to prove the high risk of death or permanent brain damage without prompt surgical intervention. Method: In this study we retrospectively examined all consecutive head injury cases managed between September 2014 & September 2015 and diagnosed with acute traumatic epidural hematoma in isolation or in combination with intra cranial lesions. Age, sex, mechanism of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, time of surgery and clinical outcomes were evaluated. Results: Out of 31 cases 87%, (n=27) were males and 13 %,( n=4) were females. The mean age was 17.75 years. 74% (n=23) patients under the age of 25years. The most common mode of injury was road traffic accident 48%, (n=15) followed by fall 42%, (n=13). The mortality rate was 6% (n=2). The time interval between trauma & operation of both patients who died were more than 8 hours. Conclusions: An acute epidural hematoma is an emergency condition, the diagnosis of the EDH must be promptly made by CT scan and the patient should be immediately transferred into a neurosurgical centre, Early surgical intervention is associated with the best outcome.

Bilateral Cerebellar Haemorrhage after Lumbar Drain Placement in a Case of Primary Intraventricular Bleed- Complication Revisited

Background and Importance: Lumbar drain placement and diversion of cerebrospinal fluid is a therapeutic procedure, often done bedside to accentuate wound healing in case of dural transgression following cranial or spinal procedures. Indications include cases of open head injuries with Cerebrospinal fluid (CSF) leak and for re-establishment of CSF flow in primary intraventricular bleed with prolonged periods of External ventricular drain (EVD) placement. Complications include central herniation as a result of over drainage of spinal fluid, low-pressure headache and, in some cases profound dyselectrolytemia and nausea and vomiting. Clinical Presentation: We illustrate a complication, which presented to us, in a 42-year old gentleman with primary intraventricular bleed with EVD in situ. Lumbar drain placement was planned to re-establish CSF flow and for EVD removal, however, once spinal fluid was drained patient deteriorated neurologically. He developed a tight posterior fossa secondary to tonsillar herniation with vermian foliar haemorrhage and had to undergo emergency surgical decompression as a salvage procedure. Conclusions: Herniation following CSF diversion is a known complication, however, they are less often seen after a lumbar drain placement. Early clinical suspicion and posterior fossa decompression can prevent, the otherwise, lethal outcome in such patients. Here we discuss the complications that ensued and the management thereafter in this clinical vignette.

Clinical Study on Cerebellar Contusion:A Report on 9 Cases and Literature Review

We report 9 cases of cerebellar contusion from April 2011 to September 2014 at our department. Frequency, clinicoradiological findings, mechanism of injury, treatments, and outcomes were retrospectively analyzed. Of 239 head injury cases admitted to our department during the same period, 9(3.8%)were diagnosed as cerebellar contusion. Among these 9 cases, 7 were men, and 2 were women. The patient age ranged from 12 to 83 years with a mean age of 64.7 years. The mechanism of injury was traffic accident in one patient, and fall in 8. All cases were associated with direct head trauma to the occiput, and radiographic studies showed occipital bone fracture in 8 cases. Six cases were managed conservatively. Three cases underwent suboccipital craniectomies and clot evacuations. Glasgow Outcome Scale(GOS)score at discharge were Good Recovery(GR)in 2, Moderate Disability(MD)in 2, Severe Disability(SD)in 3, Vegetative State(VS)in 1, and Dead(D)in 1. GOS scores in surgically treated cases were GR in 1, SD in 1, and VS in 1. Supratentorial severe traumatic lesions were concomitant with poor prognosis. Coup injury was a significant cause of cerebellar contusion. External decompression and clot evacuation were useful in patients who suffered severe cerebellar contusion;however, concomitant supratentorial lesions influenced the prognosis.

Two different immunostaining patterns of beta-amyloid precursor protein (APP) may distinguish traumatic from nontraumatic axonal injury.

Immunostaining for beta-amyloid precursor protein (APP) is recognized as an effective tool for detecting traumatic axonal injury, but it also detects axonal injury due to ischemic or other metabolic causes. Previously, we reported two different patterns of APP staining: labeled axons oriented along with white matter bundles (pattern 1) and labeled axons scattered irregularly (pattern 2) (Hayashi et al. (Leg Med (Tokyo) 11:S171-173, 2009). In this study, we investigated whether these two patterns are consistent with patterns of trauma and hypoxic brain damage, respectively. Sections of the corpus callosum from 44 cases of blunt head injury and equivalent control tissue were immunostained for APP. APP was detected in injured axons such as axonal bulbs and varicose axons in 24 of the 44 cases of head injuries that also survived for three or more hours after injury. In 21 of the 24 APP-positive cases, pattern 1 alone was observed in 14 cases, pattern 2 alone was not observed in any cases, and both patterns 1 and 2 were detected in 7 cases. APP-labeled injured axons were detected in 3 of the 44 control cases, all of which were pattern 2. These results suggest that pattern 1 indicates traumatic axonal injury, while pattern 2 results from hypoxic insult. These patterns may be useful to differentiate between traumatic and nontraumatic axonal injuries.

Head injury in infant with Collet-Sicard syndrome: A case report

Head injury in pediatric age groups causes lesser mass and structural lesions in comparison to adults, because the pediatric brain is more compressible and calvarium more pliable. Occipital condyle fracture with multiple cranial nerve involvement in pediatric age is a rare phenomenon. We report a case of head injury in 1-year-old female child who presented with sixth, seventh and lower cranial nerve paresis with an occipital condylar fracture. Tere have been no previous reports of such a presentation in this age group. The mechanism, management and outcome of such cases are discussed in this respect.

Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study.

IntroductionTraumatic brain injury (TBI) is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs). We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability.MethodsWe analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430) distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico). Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR) from Poisson regressions were used to identify associated risk factors.ResultsThe standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29–1.82), younger (PR: 0.95, 95% CI: 0.92–0.99), with lower education (PR 0.91, 95% CI: 0.86–0.96), and having fewer assets (PR 0.92, 95% CI: 0.88–0.96), was associated with a higher prevalence of TBI when pooling estimates across sites.DiscussionOur analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.

Optical clearing of the dura mater using glycerol: a reversible process to aid the post-mortem investigation of infant head injury.

In cases of suspected abusive head trauma, a thorough and systematic study of the cranium and its contents is essential, preferably using the best available methods for observing the brain and its coverings. Building upon recent developments in skull bone removal techniques in infant autopsies, we have assessed the use of two optical clearing agents (OCAs), glycerol and mannitol, on pediatric dura mater in an attempt to increase the transparency of this tissue and thereby enhance the post-mortem assessment of infant head injuries, particularly subdural hematomas. Extracorporeal testing revealed glycerol to be the more effective OCA. Therefore, in situ investigations were commenced using glycerol during 33 pediatric post-mortem examinations. An increase in the transparency of the dura was observed in 32 of the 33 cases, within 1 min of application of the OCA. In a 2 year old with cerebral palsy, only partial optical clearance of the dura was seen, most likely due to a significantly atrophic brain, prominent gelatinous leptomeninges, and abnormally thickened dura. This technique allowed for detection of minimal amounts of subdural bleeding over the convexities, before dissection of the dura, avoiding post-mortem blood spillage from artifactually disrupted bridging veins. Optical clearing of the dura aided in the evaluation of patterns of subdural hemorrhage in three cases of non-accidental head injury, three cases of peri-natal head injury and one case of overlaying, apparently resulting in minor crush injury to the head. We have demonstrated that glycerol is an effective and easy-to-use OCA to effect the readily reversible optical clearing of human infant calvarial dura at autopsy.

Biomechanical analysis of biphasic distribution of skull injury in falls from height

Fall from height is one of the most common ways of suicide in Korea. Skull fractures are typically accompanied with these cases, but several autopsy cases show absence of skull fracture even with serious body injuries including sternal and vertebral fracture. The mechanism of this pattern of injury can be explained by impact of facial part on chest or abdomen when the back of the body touches the ground first. We tried to figure out the relevance of this pattern of injury to the height of fall using a computer simulation tool (MADYMO 7.5). For this experiment, a condition of initial pose was limited to leaning forward. The simulation showed that when the body rotated forward, the body parts which got injured by the ground depended on the height of fall. For relatively lower height, head got injured, but as the height was set higher, the point of first impact area changed to the back, hip and then legs. When the body struck first around hip area on supine position, the impact made forceful flexion of lumbar, thoracic and cervical vertebrae, leading to folding the body in two, which resulted in collision between the part of face and the anterior part of body. Through the current investigation, it was explained that the biphasic distribution of the number of head injury cases versus the height distribution was attributed to the forward rotation of the body during the fall.

Study on head injuries through data from the National Injury Surveillance System of China, 2013

To understand the epidemiological characteristics of head injuries through data from the Chinese National Injury Surveillance System (NISS). Descriptive analysis was applied to display the overall trend of head injuries in 2013 in NISS and to depict general information, events and clinical characteristics of head injuries with SPSS 19.0 software. In 2013, 195 189 cases of head injuries were collected, males were twice higher than females, with 25.19% of them under 30-44 years of age. The three leading causes responsible for head injuries were falls (42.17%), blunt force injuries (27.46%) and road traffic injury (23.33%). Main locations causing head injuries were in road/street (31.41%), at home (25.02%) and public places (17.17%). Recreation activates (54.22%), driving (19.73%), paid work (12.95%) were the three major activities when injuries took place. Majority of the cases belonged to unintentional (86.79%) with bruise injuries (65.18%). Those mild injuries (78.87%) were treated and discharged (82.02%). In 2013, head injuries were seen more in males than in females, mostly involved in labor force population on head injuries. The leading causes for head injuries were falls, blunt injuries and road traffic.

Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases.

Background:Significant dural sinus injury occurs in 1.5- 5% of all head injuries and injury to superior sagittal sinus accounts for 70-80% of these. Its management is also a challenging issue to every neurosurgeon.Materials and Methods:In a period of one year (Aug 2011 to july2012) out of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have superior sagittal sinus injury. Three dimensional reconstruction of skull bone during CT scan helped us to diagnose possible dural sinus injury pre-operatively.Results:SSS injury was due to direct impact of fracture segment (5 cases), extension of fracture line over sinus area (4 cases) or due to coronal suture diastases (6 cases). Injury to anterior third of sagittal sinus occurred in 12 cases (80%) and injury to middle third occurred in 3 cases (20%). Small tear over superior sagittal sinus was found in 7 cases (46.66%) and was managed with Gelfoam® compression only and in two cases (13.33%) were large tear, which was managed with sinoraphy. In four cases (36.34%) hitch stitches over Gelfoam® to adjacent bone given and in rest two cases (13.33%) a strip of bone was left over the sinus area and bilateral hitch stitches were applied.Conclusion:Injury to SSS in traumatic head injury patient though rarely encountered during surgery, the management is challenging to every neurosurgeon. Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.

Pattern of Head Injuries in Fatal Road Traffic Accidents-An Autopsy based Retrospective Study

This study pertains to observe the Pattern of fatal head injuries in road traffic accident. Post-mortem reports and clinical records of victim of RTA autopsied during the period of November 2013 to October 2014 at Department of Forensic Medicine and Toxicology, NDMC and Hindu Rao Hospital, New Delhi, were analyzed retrospectively. Out of 205 medico-legal autopsies conducted during the study period, RTA contributed to 105 cases of which head injuries comprised of 70 cases. Commonest age group was between 21 to 40 years Involving 40 (35.13%) cases. Motorcyclists were the major group of victims sustained head injuries. Skull fractures were present in 56 (80%) cases of head injuries; most common bone fractured was Temporal bone 38 (67.82%). The commonest type of intracranial hemorrhage was found to be subdural hemorrhage 56 (80%) followed by SAH and EDH.

Computed Tomographic Scan Findings in Head Injury from a Tertiary Health Facility in South-East Nigeria

Background: Computed tomographic (CT) scan is the ultimate neuro-imaging standard for full evaluation of head injured patients. It guarantees a definitive diagnosis and guides specific treatment. Objective: This study is aimed at examining the CT scan findings in head injury patients managed in a teaching hospital in South-East Nigeria and correlating these with similar studies reported from other centers. Patients & Methods: It is a 3-year retrospective study of the CT scans of head injury patients that presented in our Unit from 1st April 2007 to 31st March 2010. Data was sourced from the Department of Medical records, Radiologists’ reports and Neurosurgery unit records. Only cases of head injury that had CT scanning were included in this study. Data was collated and analyzed with SPSS 13.0. Results: There were 737 cases of head injury within the study period, representing 25.5% of all neurosurgical patients managed under our service in that period. Only 26.6% of these 737 patients did cranio-cerebral computed tomography. Nine of these patients constituting 4.6% had normal CT results. The commonest abnormal findings included: intracranial hemorrhage/hematoma (n-92, 21.3%), cerebral edema (n-85, 19.7%), skull fracture (n-82, 19%), and cerebral contusion (n-76, 17.6%). Conclusion: Intracranial hemorrhage is the most common craniocerebral computed tomographic finding in head injury cases seen in our centre. Computed tomographic scan remains invaluable in the assessment and treatment of some patients with head injuries, considering the high rate of abnormal findings.

Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review

Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.

Экономический ущерб от черепномозговых травм у детей

Background : Currently, analyzing the economic losses caused by health problems in population is of particular importance since it stipulates calculations of the volumes invested in healthcare systems in order to improve population’s health. Objective: The aim of our study was to find out economic losses caused by traumatic brain injury (TBI) in children. Methods: The given work has utilized governmental statistical reports for Russia, for federal regions as well as for individual subjects. Direct medical expenses (medical services) and indirect expenses (losses due to a temporary disability of parents having a sick child) were calculated both in general and per patient. Results : Among all the direct medical costs of treatment of children with TBI inpatient care costs account for 85%. In the Central and Volga Federal District accounted for half of nationwide spending in general, brain injury and to provide certain kinds of healthcare. The structure of Russian costs as a result of the incidence of TBI children Moscow accounts for 20%. In Moscow, the cost of treating cases of traumatic brain injury in children is 3.2 times higher than the average for Russia. The resulting calculations of the value of health care costs attributable to a case of child head injury, behind the cost of treatment of the case of a child with head trauma, calculated according to the standards of Russia and the territories. This difference in the whole RF is 23%. Conclusion : The obtained findings have shown that in 2010 in Russia the magnitude of losses caused by TBI incidence in children amounted to 3 billion roubles or 0.008% of the gross product 1.2 billion roubles of which were direct expenses. However, this figure is considerably lower of the real amount; it becomes evident after the analysis of direct medical expenses per one case of pediatric TBI. Our calculations have shown that in Russia and in its regions the amount of expenses per one TBI patient is a quarter less of the standard sum per one TBI case what is calculated according to factual parameters. The detected incomplete sum per one case of pediatric TBI, on one hand, may be explained by a high level of hospitalization of children with minor head injury. On the other hand, it may be a result of insufficient healthcare financing in regions as well as it may be explained by unaccounted expenses for medical care and drug coverage, especially in children with severe traumatic brain injury.

Co-relation of CT scan findings with Glasgow coma scale scores in pediatric head injury

Background:Head injury in pediatric age is a major cause of mortality and disability. Clinical selection of cases prior to ordering CT scan would be desirable to avoid unnecessary radiation exposure and risk of malignancy.Methods: An observational study of 50 pediatric cases of head injury that underwent CT scan as part of routine diagnostic work up. Correlation of CT scan findings with GCS scores and clinical profile done.Results:Contusion was the most frequent finding in cases with positive CT scan findings and majority (94%) of patients could be managed conservatively. Among the mild head injury cases only 1 (3.8%) had positive CT scan findings whereas 16 (80%) with moderate head injury and almost all (100%) subjects with severe head injury had positive CT scan findings.Conclusions:Careful clinical selection based on GCS score before ordering CT scan can help reduce radiation exposure among pediatric patients and pressure on limited resources. Studies with larger sample size would be warranted.

Study of Pattern of Traumatic Brain Injury in a Series of 50 Cases of Head Injuries

Traumatic brain injuries are posing high burden of mortality and morbidity in the world with particular threat to developing nation like India, which is heading towards ultra-modernization at rapid pace. The major load of such injuries lies on road Road Traffic accidents, industrial Accidents, Domestic accidents, fall from height and physical assaults. METHODology The present study was carried out in the Mortuary, of Bowring and Lady Curzon Hospital, Bangalore attached to the Department of Forensic Medicine, Bangalore Medical College, Bangalore, over a period of two year from January 2003 to January 2005. A total of 57 cases of deaths due to TBI have been studied. The study was a cross-sectional study. RESULTS RTA is leading cause of traumatic brain injuries among all with 71.93% followed by fall 22.81%. All the causes showed male predominance with males involved being 92.68% and most vulnerable age group was those in 3rd, 4th and 5th decade of life. Language: en

A Study on Trends and Pattern of Head Injuries, Due to Road Traffic Accidents Involving Two Wheelers

The incidence of head injuries is growing with greater mechanization in industry an increase in high velocity mode of transport. The present study is conducted on 187 cases of fatal road traffic accidents of all age groups. All the cases of head and neighboring injuries admitted in respective health centers from January, 2013 to January, 2014, for treatment are included in the study. The pattern and distribution of head injuries due to Road Traffic Accidents (RTA) with/without helmet and other associated life saving measures are analyzed. Most of the cases of head injury belong to younger age group (21–40) years comprising of (70%) with male and (30%) with female of the cases related to road traffic accidents. Scalp injury in 100 cases whereas 60 cases are of the skull fracture and extradural haemorrhage 15% is most common intracranial injury followed by subdural haemorrhage (5%).