Cases Of Severe Head Injury Research Articles

Fall-related traumatic brain injury in a Nigerian pediatric population

BackgroundAccidental falls are a common cause of disability and trauma-related death in the pediatric population, accounting for a large number of pediatric emergency hospital admissions. This multicenter study assesses the clinical characteristics, management outcomes of pediatric falls-related traumatic brain injury and associated factors in Nigeria. MethodsA retrospective study of pediatric patients (age less than 18-years) with falls over a 2-year period. Data was extracted from clinical records and neurosurgical data sheets from three major centres in Nigeria, and was analyzed using descriptive statistics, Chi square test and multinomial regression with significance set at p < 0.05. Results128 children presented with fall-related TBI, with a median age of 96 months (age range of 5–216 months) and M:F was 6:1. 40.6 % had moderate head injury and 55.5 % of the falls were building related. There were 52(42.6 %) children with skull fractures. Older children more commonly fell from trees and had more cases of severe head injury (14.1 %) compared with those who fell from buildings (5.5 %). Children who fell from buildings presented early (64.1 %). The 10 % mortality was mainly in children older than 5-years. Children aged 0–5 years were three times likely to fall inside/outside a building (OR: 3.3, CI: 3.06 to 243.44). Also, those who fell from trees were 6 times more likely to have a long bone fracture (OR: 6.1, CI: 1.2 to 32.6). ConclusionsIn the Nigerian population Traumatic Brain Injury from falls is common among children, with older children falling more from trees and associated with high mortality.

Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP)

Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (&gt; 10 days) or prolonged intubation (&gt; 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.

Post-traumatic cerebral venous sinus thrombosis – Institutional study and literature review

BackgroundPost-traumatic cerebral venous sinus thrombosis (CVST) – incidence is rising during the last two decades, partly due to advanced imaging technologiesand partly due to accidents caused by high-velocity vehicles. Case seriesDuring a period from January 2020 to September 2020, we had 264 cases of head injury patients. On average, we receive 30 head injury cases per month, among which 50% would be severe head injury cases. We documented ten CVST cases among them. Diagnosis and managementIn severe head injuries with suspicion, CT brain with contrast done immediately to diagnose CVST. After 48 h of admission, worsening of GCS, increased severity of headache despite adequate management, worsening of CT findings as an increase in edema, and hemorrhagic transformation are all indications for repeat CTbrain with contrast. Management of CVST patients done with enoxaparin 40 mg twice a day/1.5 mg per kg in a day, for a duration of ten to fourteen days. Anticoagulants started only after 48 h of trauma. ConclusionEarly diagnosis of CVST in severe head injury patients and treatment started early (after 48 h of trauma) will help to prevent morbidity and mortality.

Acute subdural hemorrhage accompanied with rupture of the inferior vena cava: a case report

Introduction: One of the main causes of mortality and morbidity with physical and mental disabilities is traumatic brain injury (TBI). Apart from that, TBI also causes huge socio-economic burdens around the world. About 60% of TBI cases reported are caused by traffic accidents. Acute subdural hemorrhage (ASDH) is the main clinical finding in TBI cases. Blunt abdominal trauma associated with TBI accounts for 14% of cases. Inferior vena cava (IVC) injury is the most common vessel injured in a blunt (0.6-1%) and penetrating abdominal trauma (0.5-5%). Injury of the IVC can lead to a very high mortality rate.Case description: Male patient, 15 years old, presented to the emergency department 30 minutes after a traffic accident with decreased consciousness with the Glasgow Coma Scale score of 11. The patient’s chest was clear, abrasions were found on the left hypochondrium. Head CT scan represented acute subdural hemorrhage in the left frontotemporoparietal region was accompanied by midline shift more than 0,5cm. Hemicraniectomy decompression was performed. After decompression was done, the patient was unstable, blood pressure down to 70/50 mmHg and weak peripheral pulses with 140 beats per minute. Fluid and blood resuscitation have been performed but not responding. The patient remained hemodynamically unstable with minimal urine output. Physical examination reveals a tense abdomen. Diagnostic peritoneal lavage (DPL) was performed, blood was obtained. Exploration laparotomy was done by a midline incision, and IVC injury was found. The blood was removed, then packing on IVC with gauze, observation, and no blood comes out. The packing was opened, the patient stable, the operation was complete.Conclusion: Case of severe head injury with acute SDH, then a craniectomy was performed, in the abdomen had a ruptured inferior vena cava, an exploratory laparotomy was done. Currently, the patient has recovered well without deficits.

Steroids for delayed cerebral edema after traumatic brain injury.

Background: Brain edema is a common phenomenon after traumatic brain injury (TBI) resulting in increased intracranial pressure and subsequent neurological deterioration. Experimental studies have proven that brain edema is biphasic (cytotoxic followed by vasogenic). Till date, all studies, including the corticosteroid randomization after significant head injury (HI) trial, have used high-dose steroids in the acute period during which the edema is essentially cytotoxic in nature. No clinical data exist pertaining to delayed cerebral edema (vasogenic) and steroids.Methods: Patients who had received steroids for delayed cerebral edema after TBI were retrospectively analyzed over a 2-year period. Steroid dose, timing of steroid prescription, time to improvement of symptoms, and complications were noted.Results: There were six males and three females. Mean age was 41.1 years. There were no severe HI cases. All subjects had cerebral contusions on imaging. Dexamethasone was the preferred steroid starting with 12 mg/day and tapered in 5–7 days. The mean interval to steroid administration after trauma was 7 days. The mean duration of steroid prescription was 6.3 days. All patients had complete symptomatic improvement. The mean time to symptom resolution was 3.8 days. No patients experienced any complications pertinent to steroid usage.Conclusion: This is the first study to document efficacy of steroids for delayed cerebral edema after TBI, at least in mild/moderate head injuries. The timing of steroid usage and dose of steroids is key aspects that might determine its efficacy in TBI which was the drawbacks of the previous studies. Future prospective trials with the above factors in consideration may confirm/refute above findings.

Demographic and clinical profile of head injury in Western Uttar Pradesh-A study at SVBP hospital Meerut

Demographic and clinical profile of head injury in Western Uttar Pradesh-A study at SVBP hospital Meerut - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.024, IP Indian Journal of Neurosciences-IP Indian J Neurosci

スキーにより器質的病変をともなった重症頭部外傷30例の検討：2004/05〜2012/13の９ウィンター・シーズンの検討

スキーにより器質的病変をともなった重症頭部外傷30例の検討：2004/05〜2012/13の９ウィンター・シーズンの検討

A case of severe head injury with repeated contralateral hematomas in a young patient — Study of surgical strategy

A case of severe head injury with repeated contralateral hematomas in a young patient — Study of surgical strategy

Recent trend of severe head injury cases due to road traffic accident: Epidemiological features and outcomes in the Japan Neurotrauma Data Bank

Recent trend of severe head injury cases due to road traffic accident: Epidemiological features and outcomes in the Japan Neurotrauma Data Bank

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.

Validation of a prognostic score for early mortality in severe head injury cases.

Traumatic brain injury (TBI) represents a large health and economic burden. Because of the inability of previous randomized controlled trials (RCTs) on TBI to demonstrate the expected benefit of reducing unfavorable outcomes, the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Corticosteroid Randomisation After Significant Head Injury) studies provided new methods for performing prognostic studies of TBI. This study aimed to develop and externally validate a prognostic model for early death (within 48 hours). The secondary aim was to identify patients who were more likely to succumb to an early death to limit their inclusion in RCTs and to improve the efficiency of RCTs. The derivation cohort was recruited at 1 center, Hospital 12 de Octubre, Madrid (1990-2003, 925 patients). The validation cohort was recruited in 2004-2006 from 7 study centers (374 patients). The eligible patients had suffered closed severe TBIs. The study outcome was early death (within 48 hours post-TBI). The predictors were selected using logistic regression modeling with bootstrapping techniques, and a penalized reduction was used. A risk score was developed based on the regression coefficients of the variables included in the final model. In the validation set, the final model showed a predictive ability of 50% (Nagelkerke R(2)), with an area under the receiver operating characteristic curve of 89% and an acceptable calibration (goodness-of-fit test, p = 0.32). The final model included 7 variables, and it was used to develop a risk score with a range from 0 to 20 points. Age provided 0, 1, 2, or 3 points depending on the age group; motor score provided 0 points, 2 (untestable), or 3 (no response); pupillary reactivity, 0, 2 (1 pupil reacted), or 6 (no pupil reacted); shock, 0 (no) or 2 (yes); subarachnoid hemorrhage, 0 or 1 (severe deposit); cisternal status, 0 or 3 (compressed/absent); and epidural hematoma, 0 (yes) or 2 (no). Based on the risk of early death estimated with the model, 4 risk of early death groups were established: low risk, sum score 0-3 (< 1% predicted mortality); moderate risk, sum score 4-8 (predicted mortality between 1% and 10%); high risk, sum score 9-12 (probability of early death between 10% and 50%); and very high risk, sum score 13-20 (early mortality probability > 50%). This score could be used for selecting patients for clinical studies. For example, if patients with very high risk scores were excluded from our study sample, the patients included (eligibility score < 13) would represent 80% of the original sample and only 23% of the patients who died early. The combination of Glasgow Coma Scale score, CT scanning results, and secondary insult data into a prognostic score improved the prediction of early death and the classification of TBI patients.

Is Decompressive Craniectomy is an effective method in treatment of brain swelling in traumatic brain injury

Background: Decompressive craniectomy is considered a line of treatment strategy that indicated after failure of conservative management. Aim of work :to detect the effectiveness of decompressive Craniotomy as treatment of brain swelling in traumatic brain injury Methods: A cross-sectional study was employed including 20 patients of severe closed head injury in age between 18 and 48 years old operated with decompressive craniectomy and duraplasty. All patients had Glasgow coma score 4 to 8. We follow up the cases at least 6 months following Glasgow outcome scale score. Results: The poor outcome were reported with score 1, 2 and 3 (death, vegetative and severe disability in 35% of cases, while good prognosis are reported in score 4 and 5 (moderate, mild or no disability). The outcome is better with younger patient, high Glasgow coma score, low intracranial pressure and presence of papillary reflex. Conclusion: .Decmpressive craniotomy and duraplasty is a safe procedure that correct the intercranial, so improving the outcome. It is recommended for cases of severe head injury with cerebral swelling in CT scan and medically refractory intracranial hypertension with clinical deterioration neurologically. Conflict of interest: The authors declare that they have no conflict of interest. Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Fatal Rhabdomyolysis in a Patient with Head Injury

Rhabdomyolysis is a rare but potentially life-threatening disorder caused by the release of injured skeletal muscle components into the circulation. The authors report a case of severe head injury, in which a hyperosmolar state and continuous seizure complicated by severe rhabdomyolysis and acute renal failure evolved during the course of treatment resulted in a fatal outcome despite intensive supportive treatment. Our bitter experience suggests that rhabdomyolysis should be born in mind in patients with severe head injury who may develop hyperosmolar state and continuous seizure.

Zolpidem（マイスリー&lt;SUP&gt;&amp;reg;&lt;/SUP&gt;）を過量服用した母体から生まれた新生児仮死の1例

Zolpidem（マイスリー®）の過量服用による急性薬物中毒の母体から出生した児が急性薬物中毒よる無呼吸状態であった1例を経験したので報告する。症例は35歳の女性。公園内で意識障害の状態で倒れていたところを発見される。周囲に薬包が散乱していたため，急性薬物中毒疑いにて当院へ搬送された。来院時意識レベルJCS200。腹部膨満を認め，腹部エコーにて子宮内に心拍を伴う胎児を認めた。その時点で妊娠37週であること，出産の徴候が認められたためパニックとなり行方不明となっていたことが発覚した。産婦人科診察にて分娩の進行が確認されたが，意識障害が遷延していたため，緊急帝王切開を施行することとなった。出産児は男児，体重2,572gでapgar scoreは1分後4点，5分後4点であった。児は自発呼吸を認めず気管挿管下の人工呼吸管理を要した。日齢1には自発呼吸認めたため抜管，その後は薬物離脱症状や合併症を認めることなく日齢22に退院となった。母親（本人）は入院2日目に意識レベルが回復し，とくに合併症なく経過した。精神科診察にてうつの診断となり，自殺企図を伴ううつの治療目的に転院となった。後日，分娩当日の母・児の血液よりZolpidemが異常高値で検出され，母児の意識障害の原因としてZolpidem中毒の診断が確定した。うつによる薬物過量服用はよくみられるが，妊婦が薬物を過量服用し，そのまま分娩を迎える例は稀である。Zolpidemは妊婦に比較的安全とされているが，本報告のように過量服用の場合には胎児に影響がでることがある。そして母体で中毒症状が出現している場合は，児ではそれ以上の中毒症状がでる場合があると想定するべきであり，妊婦の薬物過量服用の場合は常に胎児への影響について考えるべきである。また妊娠可能な年齢の女性の意識障害で詳細不明な場合，常に妊娠の合併について考えるべきである。

Can glasgow score at discharge represent final outcome in severe head injury?

Background:Patients with head injury continue to improve over time and a minimum follow-up of six months is considered necessary to evaluate outcome. However, this may be difficult to assess due to lack of follow-up. It is also well known that operated patients who return for cranioplasty usually have the best outcome.Aims and Objectives:To assess the outcome following severe head injury using cranioplasty as a surrogate marker for good outcome.Materials and Methods:This was a retrospective study carried out from January 2009 to December 2010. All patients with severe head injury who underwent decompressive craniectomy (DC) in the study period were included. Patients who came back for cranioplasty in the same period were also included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score (GCS) on admission and Glasgow Outcome Score (GOS) at discharge were assessed.Observations and Results:Of the 273 patients, 84.25% (n=230) were males and 15.75% (n= 43) were females. The mean age was 34.3 years (range 2-81 years, SD 16.817). The mean GCS on admission was 5.615 (range 3-8, SD 1.438). The in-hospital mortality was 54% (n=149). Good outcome (GOS of 4 or 5) at discharge was attained in 22% (n=60) patients. Sixty five patients returned for cranioplasty (with a GOS of 4 or 5) during the study period. There was no statistical difference in the number of patients discharged with good outcome and those coming back for cranioplasty in the study period (P>0.5). Patients who came back for cranioplasty were younger in age (mean age 28.815 years SD 13.396) with better admission GCS prior to DC (mean GCS 6.32 SD1.39).Conclusions:In operated severe head injury patients significant number of patients (24% in our study) have excellent outcome. However, insignificant number of patients had further improvement to GOS 4 or 5 (good outcome) from the time of initial discharge. This suggests that due to lack of intensive rehabilitative facilities, GOS at discharge may be representative of final outcome in the vast majority of cases of severe head injury in developing countries like India

重症頭部外傷の経過中に外傷性脳動脈瘤破裂を合併し2度の脳低温療法を施行し社会復帰した1例

【はじめに】重症頭部外傷の合併症として外傷性脳動脈瘤が知られており，その致死率は高い。今回，両側急性硬膜下および硬膜外血腫に対する両側減圧開頭血腫除去術後に外傷性末梢性前大脳動脈瘤破裂を認めた症例に対して動脈瘤コイル塞栓術および2度の脳低体温療法により良好な結果を得た一例を経験したので報告する。【症例】33歳の女性。交通外傷で来院時GCS 6，左側瞳孔が散大し，初回CTにて，脳挫傷，硬膜外血腫および硬膜下血腫を認め，左側減圧開頭血腫除去術を行った。術直後に右側の瞳孔散大を認め，続いて右側減圧開頭術を施行し，34℃の脳低温療法を行った。その後，意識レベルは徐々に改善傾向に向かったが，第17病日にけいれん発作を生じ，CT上大脳鎌にそって急性硬膜下血腫を認めたため，3D-CTAを施行したところ，末梢性前大脳動脈瘤を認めた。脳腫脹が著明なため，開頭術困難と判断し，コイル塞栓術を選択した。術中より再度34℃の脳低温療法を導入し，頭蓋内圧（ICP）を厳重に管理した。第64病日，歩行および自力食事摂取も可能となり，両側頭蓋形成術施行し，社会復帰，独歩外来通院中である。【まとめ】急性脳腫脹を伴いICPコントロールに苦慮する中で発症した外傷性脳動脈瘤破裂は，治療に難渋することが多い。本症例は，開頭術が困難な中，コイル塞栓術を選択し脳低温療法を行い，良好な結果を得た。脳腫脹を伴う重症頭部外傷での外傷性脳動脈瘤破裂の症例においては，開頭術，血管内治療，神経集中治療などの集学的治療を考慮する必要がある。

The clinical analysis of two different surgical treatment on severe head injury with brain swelling

Objective To study the different effects of standard large trauma craniotomy and frontotemporal craniectomy and decompression treatment to cure severe head injury with brain swelling.Methods Retrospective analysis of 56 cases of severe head injury with brain swelling in patients with operation data,They were divided into two groups according to the different operation methods,and compared the incidence of postoperative complications,and short-term effect,long-term effect and so on.Results The difference was significant in two groups of patients of incidence of early complications and postoperative GOS score a week(P＜0.05).There was a significant difference in close effect and late complication rate (P＜0.05 ).There was no significant differences in late effect (P＞0.05).Conclusion Frontotemporal craniotomy and decompression surgery have features such as a little injury,decompression full,low complication rate,and can improve the short-term efficacy of severe head injury with brain swelling in patients,and promote the patients' recovery. Key words: Standard large trauma craniotomy; Decompression.surgery; Traumatic brain injury; Brain swelling

Intraoperative contralateral extradural hematoma developing during evacuation of a traumatic contusion

We present a case of severe head injury who developed contralateral extradural hematoma during evacuation of contused brain. The lesion was suspected due to sudden brain swelling at the site of surgery and was confirmed by computed tomography and was evacuated in emergency.

Clinical investigation for severe head injury cases with organic lesions due to skiing

Clinical investigation for severe head injury cases with organic lesions due to skiing

Intracranial migration of Foley catheter—an unusual complication

Profuse nasal bleeding in cases of severe head injury is mostly associated with facial and skull base fractures and various methods have been tried to control such bleeding. Anterior nasal packing, producing a tamponade effect with a Foley catheter and other inflatable balloon devices are time proven methods. We describe a case of severe head injury with such fractures where a Foley catheter tamponade was attempted to control the severe nasal bleeding and the CT brain scan revealed inadvertent malposition of the catheter into the cranial cavity. This rare entity is described to highlight the potential danger associated with a proven method of controlling severe nasal bleeding and suggestions are outlined as to how to avoid such a mishap, along with a brief review of the literature.