Cases Of Head Injury Research Articles

Save kids, not all children with minor head injury need CT head, QIP in Hamad General Hospital Emergency Department, Qatar

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationally acceptable guidelines of Head CT scanning for pediatric minor head trauma at Hamad General Hospital Emergency Department (ED). Intervention: We conducted staff education through weekly program of Continuing Medical Education for emergency physicians, prominent display and availability of handouts of the International clinical decision rules (NICE guidelines, PECARN) in all clinical areas within the ED, encourage proper documentation for all head injury cases to meet JCI standards of documentation, and formulate a revised pediatric head injury guideline based on the international clinical decision rules. Methods and results: The audit in August 2014 showed that 62 CT head were done, 45% of them were deemed unnecessary when measured against NICE guidelines. Also there was deficient documentation in 36% of cases due to the unavailability and difficulty accessing the guidelines. We supplied all areas in the ED with handouts of the guidelines, and conducted shop floor education for ED physicians. Regular sessions were conducted during educational activities and emergency seminars. The re-audit in January 2015 showed decreasing rate of CT scans at the rate of 22% achieving a reduction by 33% and improvement in the documentation by 31%. The overall reduction of and decreasing the percentage of unindicated CT head by around 30%. Conclusion and recommendation: Managing minor head injury in pediatric age group becomes more safe by increasing the physician awareness about the evidence based updated guidelines.

RARE CASE OF TRAUMATIC PENETRATING HEAD INJURY CAUSED BY POWDER-ACTUATED TOOL

The article describes a case of lethal penetrating head injury by a powder-actuated tool.

Bifrontal Extradural Hematoma (EDH) Causing Isolated Right 3rd Nerve Palsy with Spontaneous Partial Recovery

All neurosurgeons are aware of traumatic intracranial hematomas presenting with oculomotor nerve palsy which requires immediate surgical intervention. Isolated third nerve palsy with no other neurological signs due to head injury is a rare occurrence. We report a case of head injury with bifrontal extradural hematoma presenting as isolated right sided third nerve palsy which partially improved with nonsurgical management. We also discuss the possible causes of such involvement.

Traumatic Brain Injuries: Experience of an Industrial Hospital in Eastern India

Background: Traumatic Brain Injury (TBI) is one of the leading causes for morbidity, mortality and economic loss. Aim: To study the etiology, epidemiological aspect and outcome of Traumatic Brain Injuries admitted at Tata Main Hospital. Material and Methods: Retrospective case series study undertaken for a period of 2 years from January 2014 to December 2015.2855 patients presenting to our Emergency Department with head injury were included in the study. Patients underwent detailed clinical and radiological evaluation as per trauma protocol. Results: The most commonly affected age group was 21 to 30 years (25,6%)%) with male to female ratio of 2.3:1. Injuries were predominantly caused by road traffic accident (69.4%), followed by fall from height (15%) and assault (5.1%). The most common CT scan finding was brain contusion (14%); others included acute subdural hematoma (9%), extra-dural hematoma (6%) and depressed skull fracture (4%) and traumatic sub-arachnoid hemorrhage (2%).Out of 400 severe head injuries 227 ( 57% ) expired. Out of 685 casas with moderate Head Injury 301 (44% ) cases showed complete recovery.100% recovery was seen in Mid Head Injury cases. Conclusion: Road Traffic Accidents are a major cause of severe traumatic brain injury. About 66% cases reported to Emergency after 2 hours suggestive of an imperetive need of timely referral to hospitals so as to minimize the consequences of secondary brain injury. Only 5.5% cases required surgical intervention signifying the need for proper treatment measures.

Utilidad de las reglas de decisión clínica PECARN como predictor de lesión intracraneana en el trauma cráneo encefálico catalogado como leve en la población pediátrica de Tunja, Boyacá

ObjectiveIdentify the usefulness of PECARN decision guidelines as a predictor of traumatic brain injury in mild head injury in the paediatric population of Tunja, Boyacá. Methods and resultsA retrospective 5 years observational, descriptive study was performed, using the medical records of 220 paediatric patients. The population was divided into groups of 0-24 months and 2-18 years. The PECARN clinical decision criteria were applied and its result was compared with the official interpretation of computed tomography of the brain. Parametric tests were performed to evaluate the performance of PECARN as a predictor of intracranial injury. There was a positive predictive association of PECARN, with a P=001, in the group of patients that were 2 years or older. However, in the group younger than 2 years old no relation was found with a P=.5. An increased of MHI was found in the male population and, the tendency to the increase cases of mild head injury as the patients were older. ConclusionsIn the population of 2 years or older, 28 brain computed tomographies were performed that could have been avoided according to the application of clinical decision rules PECARN, thus decreasing the radiation levels of these patients. A prospective multicentre study involving validation of PECARN is needed in the Republic of Colombia.

Tumor necrosis factor-α antagonist suppresses local inflammatory reaction and facilitates olfactory nerve recovery following injury.

Olfactory dysfunction is a common finding in head trauma due to injury to the olfactory nerve. We previously reported that anti-inflammatory treatment with steroids improves recovery outcome in olfactory nerve injury models. Clinically, however, steroid administration is not recommended in the acute phase of head injury cases because of concerns regarding its side effects. Tumor necrosis factor (TNF-α) is known to play a key role in inflammatory response to injury. The present study examines if the inhibition of TNF-α can facilitate functional recovery in the olfactory system following injury. Olfactory nerve transection (NTx) was performed in olfactory marker protein (OMP-tau-lacZ) mice to establish injury models. We measured TNF-α gene expression in the olfactory bulb using semi-quantitative and real time polymerase chain reaction (PCR) assays and found that they increase within hours after NTx injury. A TNF-α antagonist (etanercept) was intraperitoneally injected immediately after the NTx and histological assessment of recovery within the olfactory bulb was performed at 5-70 days. X-gal staining labeled OMP in the degenerating and regenerating olfactory nerve fibers, and immunohistochemical staining detected the presence of reactive astrocytes and macrophages/microglia. Etanercept-injected mice showed significantly smaller areas of injury-associated tissue, fewer astrocytes and macrophages/microglia, and an increase in regenerating nerve fibers. Olfactory function assessments using both an olfactory avoidance behavioral test and evoked potential recordings showed improved functional recovery in etanercept-injected animals. These findings suggest that inhibition of TNF-α could provide a new therapeutic strategy for the treatment of olfactory dysfunction following head injuries.

Quantifying the biotribological properties of forehead skin to enhance head impact simulations

Head injury severity is dependent on the loading and accelerations experienced during, and immediately after, impact. In England and Wales alone, for example, 700,000 head injury cases are reported annually within Emergency Departments; however, there remains a lack of data that quantifies the fundamental interaction of the head with an impacting surface. The consequence of impact depends upon a precise understanding of the head–surface interaction; hence, there is a need to appreciate the magnitude of, and variation in, frictional coefficient between the head and a range of possible surfaces. This study develops and validates a novel protocol for quantifying friction between the forehead skin and some potential surfaces. Thirteen participants were recruited and four materials tested, with the lowest (0.11) and highest (1.64) dynamic frictional coefficients measured between skin, and expanded polystyrene and laminate flooring, respectively. Preliminary computational simulation identified that a modest variation in head–surface frictional coefficient (0.6 & 0.7) increases rotational accelerations by 23–33%. Hence, this study highlights the significance of the head–surface interaction, whilst providing some data that will assist investigators evaluating head impacts within both a domestic and sporting environment.

Household Cyanoacrylate is an Efficient and Safe Adhesive for Urgent Repair of Cerebrospinal Leaks

Background: Both transcranial and spinal cerebrospinal fluid (CSF) leaks are serious and potentially fatal conditions. Reparative surgery fails in 6% to 25% of cases. The so-called “super glue” cyanoacrylate is an acrylic resin that rapidly polymerizes in the presence of water, specifically hydroxide ions. The reaction proceeds rapidly and a strong bond is formed within seconds. Cyanoacrylate glues have been reported for their possible usefulness in the treatment of CSF leaks. Methods: In this report, the records of 1 female and 2 male patients aged between 43 and 68 years with low-pressure CSF leaks were retrospectively reviewed. The causes of fistulas were head trauma in 1 case and iatrogenicity during surgery for lumbar disc herniation in 2 cases. Results: In the 2 patients who underwent spinal surgery, primary repair was unsuccessful. The leaks were therefore sealed with cyanoacrylate glue packed between a cellulose-based hemostat and a fat plug. In the head injury case, the leak was treated with a periosteal graft attached to the injured dura with sutures. A cellulose-based hemostat followed by cynoacrylate glue was then applied. The patients have been followed up for between 3 and 6 years with no CSF leakage, infection, or neurological problems. Conclusion: Cyanoacrylate adhesive seems to be an efficient and safe alternative for the prevention of low-pressure CSF leaks.

Interleukin (IL)-8 immunoreactivity of injured axons and surrounding oligodendrocytes in traumatic head injury

Interleukin (IL)-8 has been suggested to be a positive regulator of myelination in the central nervous system, in addition to its principal role as a chemokine for neutrophils. Immunostaining for beta-amyloid precursor protein (AβPP) is an effective tool for detecting traumatic axonal injury, although AβPP immunoreactivity can also indicate axonal injury due to hypoxic causes. In this study, we examined IL-8 and AβPP immunoreactivity in sections of corpus callosum obtained from deceased patients with blunt head injury and from equivalent control tissue. AβPP immunoreactivity was detected in injured axons, such as axonal bulbs and varicose axons, in 24 of 44 head injury cases. These AβPP immunoreactive cases had survived for more than 3h. The AβPP immunostaining pattern can be classified into two types: traumatic (Pattern 1) and non-traumatic (Pattern 2) axonal injuries, which we described previously [Hayashi et al. Int. J. Legal Med. 129 (2015) 1085–1090]. Three of 44 control cases also showed AβPP immunoreactive injured axons as Pattern 2. In contrast, IL-8 immunoreactivity was detected in 7 AβPP immunoreactive and in 2 non-AβPP immunoreactive head injury cases, but was not detected in any of the 44 control cases, including the 3 AβPP immunoreactive control cases. The IL-8 immunoreactive cases had survived from 3 to 24 days, whereas those cases who survived less than 3 days (n=29) and who survived 90 days (n=1) were not IL-8 immunoreactive. Moreover, IL-8 was detected as Pattern 1 axons only. In addition, double immunofluorescence analysis showed that IL-8 is expressed by oligodendrocytes surrounding injured axons. In conclusion, our results suggest that immunohistochemical detection of IL-8 may be useful as a complementary diagnostic marker of traumatic axonal injury.

Key in Brain: An Interesting Case of Civilian Penetrating Head Injury

Civilian penetrating head injuries are not common, and the occurrence of such injuries in the pediatric population is rare. Pediatric penetrating head injuries are low-velocity injuries, resulting from household objects. Presentation entirely depends on the area of the brain involved. There are several management dilemmas related to the nature, size, shape, and location of the object, but always warrants removal of the foreign body into the operation theater. The outcome depends on the presenting neurological status of the patient, which reflects underlying parenchymal injury. We are reporting an interesting case of civilian penetrating head injury in a 5-year-old female child with a key in the brain. Computed tomographic scan of the brain revealed a household key penetrated through the right temporal bone. The patient underwent a surgical procedure for the removal of the key. She recovered well without any neurological deficit.

Craniofacial injuries in professional cricket: no more a red herring.

The issue of head injury in a noncontact sport like cricket is a matter of great debate and it carries more questions than answers. Recent incidents of fatal head injuries in individuals wearing a helmet have caused some to question the protective value of the helmet. The authors discuss the pattern, type of injury, incidents, and location of cranio-facio-ocular injuries in professional cricket to date. They evaluate the history of usage of the helmet in cricket, changes in design, and the protective value, and they compare the efficacy of various sports' helmets with injury profiles similar to those in cricket. The drop test and air cannon test are compared for impact energy attenuation performance of cricket helmets. A total of 36 cases of head injuries were identified, of which 5 (14%) were fatal and 9 (22%) were career-terminating events. Batsmen are the most vulnerable to injury, bearing 86% of the burden, followed by wicketkeepers (8%) and fielders (5.5%). In 53% of cases, the ball directly hit the head, while in 19.5% of cases the ball entered the gap between the peak and the faceguard. Ocular injuries to 3 wicketkeepers proved to be career-terminating injuries. The air cannon test is a better test for evaluating cricket helmets than the drop test. Craniofacial injuries are more common than popularly believed. There is an urgent need to improve the efficacy and compliance of protective restraints in cricket. A strict injury surveillance system with universal acceptance is needed to identify the burden of injuries and modes for their prevention.

Characteristics of head injuries-data from the Jiangsu Injury Surveillance System, 2006-2014

To understand the epidemiological characteristics of head injuries through data gathered from the Jiangsu Injury Surveillance System. Data on head injury that occurred during 2006-2014 were collected from the Jiangsu injury surveillance system and analyzed by SPSS 19.0 software. From 2006 to 2014, data on 133 172 cases of head injuries were collected which accounting for 26.2% (133 172/509 175) of all the injury cases. Among them, males were 2.18 times higher than the females. The top five leading causes of head injuries were falls 24.6% (32 796/133 172), blunt force injuries 24.4% (32 446/133 172), motor car accident injuries 20.3% (26 993/133 172), knife or sharp force injuries 10.7% (14 183/133 172) and non-motor car accident injuries 6.7% (8 919/133 172). Main locations that head injuries occured would involve roads/streets 32.5% (43 262/133 172), working places 22.2% (29 526/133 172), at home 20.5% (27 925/133 172) and public residences 10.8% (14 367/133 172). Recreation activates 37.9% (50 479/133 172), driving 26.1% (34 749/133 172), paid jobs 24.8% (33 034/133 172) were the three major activities related to head injuries. Severity of injuries would depend on the situations on site. As for minor injuries, bruise accounted for 63.5% (67 929/106 912). Brain trauma 21.5% (5 119/23 803) and fracture 14.9% (3 554/23 803) appeared an increasing trend. Severe injuries would include brain trauma 74.6% (1 833/2 457). 78.8% (104 940/133 172) of the patients with head injuries would go home after receiving treatment the hospital, with fetality only as 0.1% (134/133 172). Data from the Jiangsu surveillance program showed that Head injury appeared the highest proportion among all the body injuries that called for special attention.

Large bone-flap decompressive craniotomy for treatment of serious craniocerebral injury associated with cerebral infarction

ObjectiveTo elucidate the therapeutic effect of subtemporal decompressive craniotomy with large flap resection on serious craniocerebral injury associated with cerebral infarction. MethodsForty-eight cases of serious head injury accompanied by cerebral infarction were classified into two groups with each having 24 cases: treatment group, in which large bone-flap decompressive craniotomy was performed; control group, in which routine craniotomy and hematoma evacuation were adopted. The status of cerebral infarction pre- and post-operation, as well as the curative effect 3 months after operation were comparatively analysed between the two groups. ResultsThere was no significant difference regarding the status of cerebral infarction on the first day after operation; while one week after operation, the size of cerebral infarction was significantly smaller in treatment group than control one (P<0.05). Postoperative 3 months, the mortality rate was 20.8% in treatment group, being evidently superior to that of control group (33.3%, P<0.05). The moderate disability (good and fair) rate was 41.7% in treatment group, significantly higher than that in control group (25.0%, P<0.05). ConclusionLarge bone-flap decompressive cran-iotomy is confirmed effective and hence it offers us a preferable alternative of treatment by which to reduce disability and fatality rates for patients with serious head injury accompanied by cerebral infarction.

A case of uncorrected adult tetralogy of Fallot for emergency decompressive craniotomy: An anesthetic challenge!!

Cyanotic heart disease (CHD) includes those anatomical heart defects that produce a limitation in pulmonary blood flow or result in mixing of oxygenated and deoxygenated blood. Both conditions lead to decreased blood oxygen content and cyanosis. The most frequent defects seen in the outpatient adult congenital setting include tetralogy of Fallot (TOF). The cardiovascular anatomy and physiology of adult CHD is complex and requires specific knowledge of the defect and its anesthetic implications. Hence, they should receive care with multidisciplinary collaboration among anesthesiologists, cardiologists, surgeons, and intensivists. We hereby report the anesthetic management of such a case of head injury in an adult uncorrected TOF with a good outcome.

Study of Pattern of Skull Fractures in Head Injury Cases among Road Traffic Accident Victims

The present retrospective study has been conducted for the period of 3 years i.e. 2010, 2011 and 2012 based on autopsy records of the road traffic accident cases. Randomly picked 100 male cases and 100 female cases autopsied at mortuary of the District hospital, Raichur, Karnataka have been considered for the study and analyzed retrospectively. Predominant age group were found to be 21–30 years (30%) followed by age group 41–50 years (20%) and 11–20 years (15%) showing that youngsters were more involved in deaths due to road traffic accidents. Out of 200 cases studied, 168 cases were linear fractures and comminuted fractures were seen in only four cases. In 50% of the cases the road traffic accident case was unknown and two wheelers were involved in 25% of the cases and in only 5% of the cases four wheelers were involved. The cause of death in all these cases was due to head injury associated with skull fractures or Brain injury or Intracranial haemorrhages.

Impact of Coagulation Profile on Outcome of Head Injury.

Worldwide, head injury is recognized as a major public health problem. Head injury patients often develop consumptive coagulopathy in the absence of other trauma or haemorrhages. The release of tissue factor from the damaged brain is postulated as the cause of coagulopathy. To know the impact of coagulation profile derangements and their effect on the outcome of head injury patients. Fifty patients in the age group of 20-70 years admitted with isolated head injury were taken. Samples of complete haemogram (CBC), prothrombin time (PTI), partial thromboplastin time (PTK), D-Dimers and fibrinogen were taken within 24 hour of admission. Coagulopathy was defined as platelet counts < 100,000 cells/mm(2) and PTI >15 seconds or a DIC score more than 4. The outcome in each group was measured according to Glasgow outcome score. Coagulation abnormalities were analysed. In case of severe head injury, p-values in patients who died with regard to DIC score, Prothrombin time and APTT were found to be significant (p< 0.05). For D-Dimers, fibrinogen and platelets counts the p-value was not significant. In case of moderate head injury, p-values in patients who died with regard to DIC score, platelet count, Prothrombin time, D-Dimer and APTT were found to be significant (0.05). For fibrinogen level it was insignificant. The mean DIC score and mean GOS in the severe head injury patients was significant (p<0.001). Patients with isolated head injury are at risk of development of coagulation abnormalities, which is associated with poor outcome. Based on our results we also emphasize the importance of early diagnosis of coagulation abnormalities in isolated head injury patients.

Patterns of Cranio-cerebral Injuries in Fatal Head Trauma

The objective of this study was to find out pattern of cranio-cerebral injuries in medico-legal cases of fatal head trauma with regards to age, sex, survival period, causes and complications leading to death of the victim. Materials were collected from 48 medico-legal cases of fatal head injury which were brought for autopsy at the mortuary of PCMS & RC, Bhopal from 01 Jan 2011 to 31Dec 2011. It was found that most commonly involved age group was 21–40 with male outnumbering the female in a ratio of 4.9 to 1. Vehicular accident was the leading cause for fatalities in 91.66% cases. 18.75% died on the spot while 45.83% of the remaining survived for 0–12 hrs. Fractures of the skull had occurred in around 81.25% of the cases. Among whole of skull cap temporal bone was most prone to fracture (22.91%) while linear/fissured fracture was the commonest type (35.41%). SDH was noted in 31.25% of cases. 18.75% deaths had occurred on the spot while 45.83% of the remaining had survived for 0–12 hrs. Traumatic cranio-cerebral injury was the primary cause of death in slightly more than the half of the victims (52.08%) indicating that timely intervention could have saved the lives of unfortunate hapless victims.

A case of the infant head injury that the seamless emergency system led to lifesaving

A case of the infant head injury that the seamless emergency system led to lifesaving

Traumatic Brain Injury Studies in Britain during World War II.

As a result of the wartime urgency to understand, prevent, and treat patients with traumatic brain injury (TBI) during World War II (WWII), clinicians and basic scientists in Great Britain collaborated on research projects that included accident investigations, epidemiologic studies, and development of animal and physical models. Very quickly, investigators from different disciplines shared information and ideas that not only led to new insights into the mechanisms of TBI but also provided very practical approaches for preventing or ameliorating at least some forms of TBI. Neurosurgeon Hugh Cairns (1896-1952) conducted a series of influential studies on the prevention and treatment of head injuries that led to recognition of a high rate of fatal TBI among motorcycle riders and subsequently to demonstrations of the utility of helmets in lowering head injury incidence and case fatality. Neurologists Derek Denny-Brown (1901-1981) and (William) Ritchie Russell (1903-1980) developed an animal model of TBI that demonstrated the fundamental importance of sudden acceleration (i.e., jerking) of the head in causing concussion and forced a distinction between head injury associated with sudden acceleration/deceleration and that associated with crush or compression. Physicist A.H.S. Holbourn (1907-1962) used theoretical arguments and simple physical models to illustrate the importance of shear stress in TBI. The work of these British neurological clinicians and scientists during WWII had a strong influence on subsequent clinical and experimental studies of TBI and also eventually resulted in effective (albeit controversial) public health campaigns and legislation in several countries to prevent head injuries among motorcycle riders and others through the use of protective helmets. Collectively, these studies accelerated our understanding of TBI and had subsequent important implications for both military and civilian populations. As a result of the wartime urgency to understand, prevent, and treat patients with TBI during WWII, clinicians and basic scientists collaborated on research projects that none of them would likely have pursued without these unique circumstances. Very quickly, there was a sharing of information and ideas that not only led to new insights into the mechanisms of TBI but also provided very practical approaches for preventing or ameliorating at least some forms of TBI. Investigators in Great Britain, in particular, pioneered accident investigations, performed epidemiologic studies, and developed animal and physical models that accelerated our understanding of TBI and had subsequent important implications for both military and civilian populations.

A five years retrospective study of head trauma cases showing the rarity of multiple site extradural haematoma

Extradural haematomas constitute about 3% of all head injury cases and the frequency of extradural haematoma occurring at more than one site in a particular victim is even lower. During a five year retrospective study of extradural haemorrhage cases discovered at autopsy we found that multiple site extradural haematomas constituted 13% of all extradural haematomas observed. The incidence and the pattern of extradural haematoma and its association with fracture of the skull are given emphasis in this study.