Complication Of Head Injury Research Articles

The Impact of Time till Surgery on Post-Operative Outcome of Traumatic Extradural Hematoma

Objective: Traumatic extradural hematoma (EDH) is a common complication of head injuries, predominantly affecting the working-age male population due to increased outdoor activity. This study aimed to assess the impact of timing in surgical intervention and identify factors influencing outcomes. Materials and Methods: Seventy-eight consecutive patients diagnosed with traumatic EDH at Lady Reading Hospital, Peshawar, were included. Patients were categorized into two groups based on the timing of presentation: within 6 hours (early) and after 6 hours (late). Craniotomy and hematoma evacuation were performed, and outcomes were assessed at discharge. Results: In our study mean and SDs for age were 21.83±31.57. Most of the patients i.e., 54(69.2%) were from the 2nd and 3rd decade of life. The mean hematoma volume was 37.17 ml. The majority of the patients were males 65(83.3%) and RTA 32(42.02%) was the most common cause followed by falls and physical assault respectively. The outcome of early operated (within 6 hours) patients was favorable in 44(95.65%) while 2 (4.34%) did not improve (GOS 2,3). Favorable outcomes (GOS 4,5) in delayed presented patients who operated after 6 hours were 23 (71.87%). 5(15.6%) were not improved (GOS 2,3) and 4(12.5%) died (GOS 1). Conclusion: Outcomes of patients who operated early are more favorable than those who were operated late. Delayed presentation and intervention increase the mortality and morbidity of patients having traumatic extradural hematoma.

Growing skull fracture of the orbital roof: case report and literature review

Growing skull fracture (GSF) of the orbital roof is a rare complication of head injury in infancy and early childhood. Analysis of the Medline database between 1983 and 2023 identified 17 articles describing 63 children after surgical treatment of GSF of the orbital roof. We present a 2-year-old child with moderate traumatic brain injury (TBI) complicated by GSF of the orbital roof. Neuroimaging and literature data are described. Severe ophthalmological symptoms in acute period of TBI subsequently partially regressed with persistent swelling of the upper eyelid and hypophthalmos. CT and MRI revealed a linear fracture of the frontal bone extending to superior orbital wall and intraorbital collection of cerebrospinal fluid (pseudomeningocele) mixed with blood. MR signs of GSF of the orbital roof with pseudomeningocele shrinkage were found in 5 weeks after injury. After 6 months, CT and MRI revealed signs of more severe GSF. Surgical treatment implied craniotomy, excision of scars, arachnoid membrane and abnormal brain matter, resection of deformed fracture edges, dura mater sealing and orbital roof reconstruction with bone autograft. Ophthalmological symptoms regressed after 6 months. The follow-up period was 6 years. There were no signs of fracture recurrence. In this case, acute intraorbital pseudomeningocele led to GSF of the orbital roof in 5 weeks after injury. Incomplete regression of ophthalmological symptoms, their aggravation or delayed appearance in children with orbital roof fracture requires a thorough examination including high-resolution CT and MRI, and orbital roof GSF should be considered in the differential diagnosis.

Reduced Sensitivity to Background Reward Underlies Apathy After Traumatic Brain Injury: Insights From an Ecological Foraging Framework.

Altered reward processing is increasingly recognised as a crucial mechanism underpinning apathy in many brain disorders. However despite its clinical relevance, little is known about the mechanisms of apathy following moderate-to-severe traumatic brain injury (TBI). In real-life situations, reward representations encompass both foreground (gains from current activity) and background (potential gains from the broader environment) elements. This latter variable provides a crucial set-point for switching behaviour in many naturalistic settings. We hypothesised apathy post-TBI would be associated with disrupted background reward sensitivity. We administered a computer-based foraging task to 45 people with moderate-to-severe TBI (20 with apathy, 39 males) and 37 matched controls. Participants decided when to leave locations (patches) where foreground reward rates depleted at differing rates, to pursue greater rewards from other patches in the environment, which had either a high or low background reward rate. Primary analysis was performed using linear mixed effects models, with patch leaving time the dependent variable. Findings showed a significant interaction between apathy and background reward sensitivity, driven by apathetic TBI participants not altering patch-leaving decisions as environmental reward rate changed. In contrast, although TBI was associated with reduced sensitivity to changing foreground rewards, this did not vary as a function of apathy. These results provide the first evidence directly linking disrupted background reward processing to apathy in any brain disorder. They identify a novel mechanism for apathy following moderate-to-severe TBI, and point towards novel interventions to improve this debilitating complication of head injury.

PHENYTOIN AS A PROPHYLAXIS OF POST-TRAUMATIC SEIZURES IN HEAD TRAUMA PATIENTS AT JAKARTA ISLAMIC HOSPITAL CEMPAKA PUTIH IN 2020-2022

Introduction: Post-traumatic seizures can occur as a complication of head injury, whether it is immediately after the head injury to months or years after. Phenytoin is an anti-epileptic drug that has been used widely as a prophylaxis for posttraumatic seizures. Method: The study was conducted retrospectively using medical records of head trauma patients in hospitals in 2020-2022 on 54 samples treated up to seven days post-trauma. Samples were obtained which were then analyzed by medical records, looking at the patient's identity, patient diagnosis, seizure symptoms, and history of anti-seizure drugs. Result: Patients given phenytoin prophylaxis [22 (40.7%)] who did not have seizures [18 (33.3%)] were more than patients who had seizures [4 (7.4%)]. Similar results occurred in patients without phenytoin prophylaxis [32 (59.3%)], more patients with no seizures [30 (55.6%)] than those with seizures [2 (3.7%)]. Conclusion: The usage of phenytoin is still not routinely given to post-traumatic head patients at RSIJ Cempaka Putih. The administration is carried out on a case-by-case basis assessment must be carried out in determining the use of phenytoin as a seizure prophylactic so that the benefits outweigh the side effects. For further research, it is recommended to conduct an EEG examination on head trauma patients to determine the diagnosis of post-traumatic seizures/epilepsy and conduct further seizure evaluation. Keywords: Post-trauma seizure; Phenytoin; Prophylaxis; Head Trauma; Jakarta Islamic Cempaka Putih Hospital

Incidence of surgically treated post-traumatic hydrocephalus 6 months following head injury in patients undergoing acute head computed tomography

BackgroundPost-traumatic hydrocephalus (PTH) is a well-known complication of head injury. The percentage of patients experiencing PTH in trauma cohorts (0.7–51.4%) varies greatly in the prior literature depending on the study population and applied diagnostic criteria. The objective was to determine the incidence of surgically treated PTH in a consecutive series of patients undergoing acute head computed tomography (CT) following injury.MethodsAll patients (N = 2908) with head injuries who underwent head CT and were treated at the Tampere University Hospital’s Emergency Department (August 2010–July 2012) were retrospectively evaluated from patient medical records. This study focused on adults (18 years or older) who were residents of the Pirkanmaa region at the time of injury and were clinically evaluated and scanned with head CT at the Tampere University Hospital’s emergency department within 48 h after injury (n = 1941). A thorough review of records for neurological signs and symptoms of hydrocephalus was conducted for all patients having a radiological suspicion of hydrocephalus. The diagnosis of PTH was based on clinical and radiological signs of the condition within 6 months following injury. The main outcome was surgical treatment for PTH. Clinical evidence of shunt responsiveness was required to confirm the diagnosis of PTH.ResultsThe incidence of surgically treated PTH was 0.15% (n = 3). Incidence was 0.08% among patients with mild traumatic brain injury (TBI) and 1.1% among those with moderate to severe TBI. All the patients who developed PTH underwent neurosurgery during the initial hospitalization due to the head injury. The incidence of PTH among patients who underwent neurosurgery for acute traumatic intracranial lesions was 2.7%.ConclusionThe overall incidence of surgically treated PTH was extremely low (0.15%) in our cohort. Analyses of risk factors and the evaluation of temporal profiles could not be undertaken due to the extremely small number of cases.

Intracranial Hemorrhage Prediction for Traumatic Brain Injury Using Glasgow Comma Scale: Encountering the Absence of CT Scan

Background: Intracranial hemorrhage is a complication of head injury. The initial assessment of the consciousness using Glasgow Coma Scale (GCS) shows severity level of head injury since arriving to the hospital. The GCS score is also known to have association with the presence of intracranial bleeding caused by head injury. This finding helps doctor lived in rural area with no facility of computed tomography (CT) scan to predict the intracranial haemorrhage by assessing the level of consciousness correctly using GCS score. Methods: This study is an observational analytic study using a cross-sectional design. The research was conducted in Dr. Moewardi Hospital for 6 months starting from July to October 2020. The population was all patients with head injury and were then examined by CT scan of head. The 61 subjects were established through the inclusion and the exclusion criteria. Results: There were 61 patients in this study. The reliability test of CT-Scan instrument used Kappa-Cohen test which showed the K value of 0.875 with p < 0.001. The finding of moderate-severe head injury (GCS score 3-12) was associated with the increased risk of intracranial bleeding in head CT scan by 20.70 (5.58-76.77) times significantly higher (p < 0.001). Conclusion: There is significant relationship between the patient's level of consciousness represented by Glasgow Coma Scale (GCS) and the intracranial bleeding based on the head CT scan in the patients with head injuries

Traumatic intracranial aneurysms associated with traffic accidents and endovascular management options

Traumatic intracranial pseudoaneurysms are rare complications of head injuries following traffic accidents, occurring in less than 1% of all cerebral aneurysms. Most cases are associated with fracture of the skull. Rupture of these traumatic aneurysms occur in up to 50% of all cases and are typically delayed from days to weeks following the initiating trauma. Traumatic pseudoaneurysms are often called a pulsating hematoma, which occurs when the arterial wall is ruptured by trauma and bleeding is confined only by the adventitia or surrounding tissues. Unlike the structure of a true aneurysm, that has all anatomical layers, the wall of a traumatic intracranial pseudoaneurysm is composed mainly of blood clot and a small amount of fibrous tissue. Difficult diagnosis, delayed presentation and poor outcomes contribute to overall prognosis of these traumatic intracranial aneurysms.
 We investigated the patients with traumatic intracranial aneurysms developed after traffic accidents and treated with endovascular embolization in our Institution, with a review of literature and discussion of management options.
 As traumatic intracranial aneurysms may present both diagnostic challenges and surgical difficulties, especially after polytrauma cases, rarely being appropriate for conservative treatment, early and precise diagnosis with cerebral angiography and prompt treatment are essential for good prognosis. Due to its nature to be fragile and prone to rupture, careful and precise endovascular embolization is thus a method of choice for treatment of these pseudoaneurysms.

MANAGEMENT OF MULTIPLE MAXILLOFACIAL FRACTURE WITH MILD HEAD INJURY

Introduction: Maxillofacial fracture is an injury that is often followed by head injury. Maxillofacial fractures vary in their severity, some involves either a single bone or several complex bones, depending on the force degree of impact on the face region. A comprehensive management can prevent more severe complications of head injury. This case report describes the management of multiple maxillofacial fractures with head injury. Case report: A 26-year-old female patient came to the Emergency Department of RSUP Dr. Hasan Sadikin Bandung with complaints of fractures in the facial bones and headaches due to an accident. Physical examination revealed facial asymmetry, edema, and hematomas in the bilateral periorbita, right and left mandible, and mental region. The patient had performed a CT scan of the head before and it appeared that there was a soft tissue swelling in the left temporal region, as well as bone discontinuities in the left zygoma and left mandibular angle with sulcus and gyrus, sylvian fissure, uncompressed ventricles and cisterns and no midline shift. The patient underwent definitive treatment with open reduction intermaxillary fixation (ORIF) for multiple maxillofacial fractures and conservative treatment for her head injury. Conclusion: The success of maxillofacial fracture treatment with head injury is strongly determined by accuracy in the initial assessment and comprehensive treatment involving multidisciplinary. Head injuries need priority treatment followed by treatment of maxillofacial fractures. Keywords: Multiple maxillofacial fractures, Head injury, Open reduction (ORIF), Close reduction

CORRELATION OF COMPUTED TOMOGRAPHY AND INTRAOPERATIVE FINDINGS WITH CLINICAL SYMPTOMS IN HEAD TRAUMA PATIENTS

Hematoma in different parts of the brain is one of the most important complications of head injury and is associated with high mortality and morbidity rate. The aim of this study was evaluation of the relationship between Computed Tomography (CT) and intraoperative findings with clinical symptoms in head trauma patients. In this study 95 patients with cerebral hemorrhage due to head trauma, referred to Taleghani Hospital in Kermanshah were studied. After an initial clinical examination, the level of consciousness determined according to the Glasgow Coma Scale (GCS) was recorded. All patients underwent brain CT scan and findings were recorded, including size and location of the hematoma. Patients in all treatment such as surgical procedures under the supervision, and the information on their status was recorded until discharge or death. It was found that most patients (38%) were between 40-20 years: 73% of patients were male, while 27% were female. The outcome of 35 patients (35.4%) were normal, 12 patients (12.3%) had moderate disability, 9 patients (9.2%) had severe disability, 11 patients (10.8%) vegetative state and 31 patients (32.3%) died. There was a significant association between location of the hematoma and hematoma in CT scan and outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). We also found a significant association between size of the hematoma and midline shift in CT scan with outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). The prognosis of patients with traumatic brain injury depends on location of the hematoma; volume of hematoma, midline shift in CT scan and length of trauma to surgery more than 4 hours.

Incidence, ethology and location of extradural hematoma in surgically managed patients

One of the major public health issues worldwide is traumatic brain injury. EDH is most commonly located in the temporoparietal region. Proper and timely management of these patients improves the outcome. To interpret theincidence, etiology and location of EDH in surgically managed patients.Surgically operated EDH patients were epidemiologically analysed as per the age, gender, mechanism of injury, GCS at admission, site of hematoma and associated intracranial injuries.: Epidemiological analysis of thirty operated EDH patients was done.: Statistical evaluation was done .EDH was more common (76.67%) among males than females (23.33%). Mostly patients (50%) were in the age group of 21-41 years. Road traffic accident was the most common (50%) mode of trauma leading to EDH occurrence. Temporoparietal EDH was the most common (36.66%) location on CT scan. Most common (70%) associated intracranial injury observed was the skull fractures.: EDH is a serious complication of head injury. Early diagnosis and proper management is required. EDH is more common in men. Careful interpretation of CT scan head is important to get information about the location EDH and other associated injuries before proceeding for surgical evacuation.

Solitary Sign of Third Nerve Palsy in a Conscious Patient With Epidural Hemorrhage

Epidural hematoma is a life-threatening complication of head injury, which often occurs as a result of blunt trauma to the skull. Unregulated hematoma expansion in any setting results in elevated intracranial pressure and may contribute to the compression of the oculomotor nerve among several other adversities culminating in various long-lasting complications in the future. In this case report, we present the findings of a rare, insightful case of a 47-year-old Southeast Asian male with no established prior medical history apart from being a victim of blunt trauma attributable to a fall four days before presenting to the emergency department with abrupt onset of diplopia and drooping of the left eyelid. The initial physical examination helped to establish a diagnosis of third nerve palsy. A non-contrast CT of the head was conducted, and its findings revealed the presence of a right temporal-parietal-occipital epidural hemorrhage, with no mass impact on the cerebral hemisphere. The patient later underwent a successful left temporoparietal craniotomy, during which 100-125 ml of blood was drained out. Post-surgery, a near-full reduction of ptosis was recorded at the end of the first week. This case report summarizes this ingenious depiction of a partial third nerve palsy presenting as the sole sign of the epidural hemorrhage in a cognizant patient.

Depressed Skull Fracture over Cranial Venous Sinuses

Abstract Background Depressed skull fracture overlying venous sinuses deserves a special attention among skull fractures. It puts high demand on every neurosurgeon, as the management of this kind of trauma carry high risk of mortality. It is considered as one of the most dangerous complications of head injuries. Either it is due to fatal venous bleeding, or disturbing the intracranial pressure via thrombosis or stenosis. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Moreover, it should always be treated with high cautions. Aim of the Work This study aims at reviewing available scientific data based on clinical trials about the proper management approaches for the treatment of depressed skull fractures overlying major cranial venous sinuses. Either through surgery or medical and conservative management. Patients and Methods The study review yielded 22 relevant papers, with a total number of 85 patients. These patients presented to different institutes, at the period between 1996 and 2017. Diagnosed with depressed skull fracture overlying major venous sinuses. The cases divided according to the way of management as follow: 72% of patients treated with surgical approaches. While 28% of patients treated with conservative care. Results In total surgical intervention showed to be successful in 53 patients, out of 85 patients included in the study, without any intraoperative complication of bleeding. While 6 patients passed away during the surgical interventions. On the other hand, 18 patients who treated conservatively did not need any further intervention. While 2 studies reported the need of medication following surgery. Furthermore, 6 studies reported failure of conservative management, and needed urgent surgical elevation of the depressed fragment that compressing the sinus. Based on the results, the mortality rate over all was 7%; death was mainly due to inability to control the profusely bleeding from the injured sinuses. With a success rate over the surgical cases in 87%. While it was 75% over the conservative cases. However, this pooled data need further statistical analysis to obtain guiding evidence for current practice. Conclusions Clinical decision making must be tailored to each patient independently. In the presence of clinical and radiographic evidence of sinus occlusion surgery is preferred. In such instances where there is a clear need for surgery, adequate precautions should be taken, and an expertise in neurotrauma should always be available. Delayed intracranial hypertension is a possible complication and should always be considered in all patients.

Effect of Designed Practice Guidelines on Nurses’ Performance and Outcome of Children with Head Injuries

Contexts Acute head injury resulting from a trauma to the head, leading to brain injury or bleeding within the brain, it can cause edema and hypoxia. Head injury is the leading cause of death in the first four decades of life. Effective nursing management strategies for children with severe traumatic brain injury are still a remarkable issue and a difficult task for neurologists, neurosurgeons, and nurses.
 Aim: To evaluate the effect of designed practice guidelines on nurses' performance regarding the care of children with head injuries.
 Methods: A quasi-experimental research design utilized to conduct the current study on pediatric neurosurgery departments of Benha University Hospital and Benha Teaching Hospital. A purposive sample of 72 children with head injuries and a convenient sample of all available nurses. They were 62 nurses who are working on the previously mentioned study settings. Four tools used to collect data in this study. A structured interviewing questionnaire sheet developed to assess the studied nursing personal characteristic of the studied nurses and nurses' knowledge regarding head injuries. Child medical data record developed to assess children's personal and head injuries characteristics for children. Glasgow coma scale adopted to assess the child conscious level. Observational checklists to assess the actual nurses' practices regarding the care of children with head injuries.
 Results: There was a statistically significant improvement in nurses' knowledge and practice regarding the care of children with head injuries before and after the implementation of designed practice guidelines (p˂0.001). There was a statistically significant improvement regarding the occurrence of convulsion after the implementation of the program.
 Conclusion: The study concluded that the implementation of designed practice guidelines for nurses improves their knowledge and practice as well as reduced occurrence of frequency, duration, and timing of convulsion, which support the current research hypotheses. The study emphasizing the importance of implementing of designed practice guidelines for nurses caring of children with a head injury to reduce the occurrence of head injury complications, which is an effective and safe non-invasive intervention in neurosurgery and emergency departments as a standard of care for all head-injured children.

Growing skull fracture with leptomeningeal cyst associated with superior sagittal sinus thrombosis

Growing skull fracture is a rare complication of head injury usually occurs during the first 3 years of life. It may be associated with cerebral herniation, subdural hygroma, and subgaleal cerebrospinal fluid collection (leptomeningeal cyst). Posttraumatic cerebral venous sinus thrombosis is also an unusual complication of head injury associated with skull fracture extending to a dural sinus or the jugular bulb. It may be associated with ischemic damage to adjacent brain parenchyma. We report the case of growing fracture with leptomeningeal cyst associated with superior sagittal sinus thrombosis. A 2-year-old female child presented to the hospital following head trauma. The patient was drowsy and had hypotonia of all four limbs. Computed tomography was performed which showed a linear fracture of bilateral parietal bone with superior sagittal sinus thrombosis, subgaleal scalp collection in the bilateral parietal region, and ischemic changes in adjacent bilateral parietal lobes. Follow-up magnetic resonance imaging was done after 12 days of conservative treatment which showed similar findings. Surgical correction was done without any intraoperative or postoperative complications. As the delay in treatment may be associated with neurological complications, early diagnosis and prompt treatment are essential to prevent it and imaging modalities help in the early diagnosis.

Head injury in the elderly – an overview for the physician

Head injury is a common cause for hospital admission and additionally 250,000 UK inpatients fall during hospital admissions annually. Head injury most commonly occurs as a result of falls from standing height in older adults. Older adults are frequently frail and multi-morbid; many have indications for anticoagulation and antiplatelet agents. The haemorrhagic complications of head injury occur in up to 16% of anticoagulated patients sustaining a head injury. These patients suffer adverse outcomes from surgery as a result of medical complications. Although geriatric trauma models are evolving to meet the demand of an ageing trauma population, medical support to trauma services is commonly delivered by general physicians, many of whom lack experience and training in this field. Determining the role of surgery and interrupted anticoagulation requires careful personalised risk assessment. Appreciation of the opposing risks can be challenging; it requires an understanding of the evidence base in both surgery and medicine to rationalise decision making and inform communication. This article aims to provide an overview for the physician with clinical responsibility for patients who have sustained head injury.

Outcome of Posttraumatic Delayed Intracerebral Tension Pneumatocele: Prospective Study of Four Cases: Single Institutional Experience.

Aim:Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised intracranial pressure following trauma. However, it can cause herniation syndrome due to a sudden increase in intracranial pressure which requires emergent intervention. Pneumocephalus is a complication of head injury in 3.9%–9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h).Method:When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. In our case series, we demonstrated four cases of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan.Result:During this period, a total number of patients admitted of head injury are 1768 and hence, the incidence of DITP in our series is 0.226% which is very less as compared to previous literature. All patients are male; age ranging from 17 years to 55 years (mean age was 31.75 years). All patients have a history of head injury, and mode of injury had road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12–13 (mean GCS 12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients had gone to surgical intervention, and outcome assessed using Glasgow outcome score. All patients had a good outcome and average follow-up was 12.5 months.Conclusion:long term observation of patients with simple pneumocephalus following trauma is beneficial as there is an expected risk of developing delayed tension pneumocephalus which may manifest with raised intracranial pressure.

Delayed presenting traumatic Extradural Haematoma- whether surgery always necessary? – An experience in a tertiary care hospital.

Background: Extradural haematoma (EDH), considered being the most serious preventable complication of head injury, requiring immediate diagnosis and surgical intervention. Though surgical evacuation constitutes the definitive treatment of this condition but many patients who presented late to emergency can be saved from craniotomy with watchful repeated neurological assessments.Aims and Objectives: To evaluate the role of surgical and non surgical management of delayed presenting traumatic EDH at a tertiary care Hospital.Materials and Methods: This study was conducted from December 2015 to February 2017 at Nil Ratan Sircar medical College, Kolkata. A total 100 cases of traumatic Extradural Haematoma were admitted with history of prior head injury of greater than 8 hours duration. All the patients were assessed clinically on admission and by NECT brain either prior to or immediately after admission. All patients with traumatic EDH were evaluated by dedicated trauma team and by Neurosurgeons, patients who came to hospital facility with more than 8 hours history of incident with haematoma &lt;30 cm3, no associated midline shift and no signs of focal neurodeficits or papillary asymmetry with GCS 13-15, were initially managed conservatively, those who failed any of the chosen criteria treated by operative interventions.Results: Of all patients more 50% cases were associated with vehicular accident. Eighty percent cases were referred from primary or secondary care level hospitals and the remaining directly from accident site or scene of injury. Fifteen patients had post injury seizures, most of the cases were associated with additional intradural lesions like contusions or intracerebral haematoma. Approximately one forth patients presented with GCS &gt;13, all these patients experiences positive outcomes. In this series of EDH location was temporoparietal region constitute 45% of the total, in 36 % of cases there were associated skull fracture. 55% of the patients in this series underwent operative intervention and 45% treated non operatively. Overall, 78% patients had good recovery, whereas 12% patients remained moderate to severe disabled at 6 weeks follow up period.Conclusion: Although surgical management is the treatment of choice in EDH, in selected delayed presenting EDH patients can be managed non-operatively with good outcome.Asian Journal of Medical Sciences Vol.9(4) 2018 41-45

Prevalence of neurogenic pulmonary edema among patients who died from head injury – a retrospective chart review

Background:Neurogenic pulmonary edema is a less recognized complication of head injuries and is seldom considered in management protocols in most centers. We therefore conducted a study to determine the prevalence of Neurogenic Pulmonary Edema among patients who died from head injury at Mulago National Referral Hospital, Uganda.Methods:An observational study conducted from the 1stJune to 31stAugust 2013, with ethical approval. We consecutively enrolled patients who died of head injuries in the hospital. Demographic data, duration of illness, severity of illness, and patient management instituted were gathered from patient medical files. Autopsy results of the brain, lungs, heart, liver and kidneys performed within 24 hours after death were reviewed.Results:Twenty-six patients who died from head injury were enrolled in this study over the study period. Only one patient had preexisting hypertension and obesity while the rest had no known premorbid medical history. Intracranial abnormalities including raised intracranial pressure had been detected by CT scan in 18/26 of the patients while others had a normal scan (1/26) or did not have a scan done (7/26). Features of pulmonary edema were detected in 76.9% (20/26) of the bodies on gross lung examination. Pulmonary edema was bilateral in 85% of the bodies. Congestion was also noted in the liver, heart and kidneys.Conclusions:Pulmonary edema is highly prevalent in head injury patients and needs to be critically recognized early in the formulation of a management plan, as it contributes to morbidity and secondary brain injury through respiratory embarrassment.

Traumatic arteriovenous malformation of scalp: A case report

Scalp arteriovenous malformation (SAVM) as a rare lesion may be a complication of head injury. A case and its management are presented in this article and literature is reviewed. A 27-year-old man came to us with a slowly growing pulsatile mass in his right retroauricular and parietal region of the scalp. On examination, there was a compressible mass with loud bruit. Paraclinical studies revealed a large, tortuous tuft of vessels with two different feeders. Intracranial vessels were 3 normal. The lesion excised totally by direct surgical intervention after ligation of its feeders. The patient recovered and discharged without any abnormal findings. Increased number of reports of SAVM in the past decade may be due to improved diagnostic facilities; however, the high incidence of trauma and even its increasing pattern in developing countries may be another important factor.

Pattern of Injuries Due to Road Traffic Accidents Involving Motorized Two Wheeler Vehicles in Mangalore based on Autopsy Reports

Introduction: Motorized two wheeler accidents have become increasingly common, especially in developing countries like India. The main focus of this study was on motorized two wheeler accidents and the pattern of injuries caused due to it. Methodology: STUDY DESIGN: Retrospective analysis of autopsy reports of Road Traffic Accidents involving motorized two wheeler vehicles. STUDY SETTING: Study was carried out in Forensic Department of Kasturba Medical College, Mangalore. SAMPLE SIZE: 172 autopsy reports of motorized two wheeler accidents during 2015-2016. Results: A total of 172 autopsy reports were studied, majority of the victims were males. 82.65% of the accidents took place due to over speeding and negligence. City roads and junctions were most common site of such accidents. There were a total of 630 external injuries, 56.5% of which were abrasions. Complications of head injury accounted for 77.9% of cause of death in such cases. Linear fractures were most common type of fractures seen in the skull. Conclusion: Obeying the traffic rules, riding safely by wearing helmet and avoiding over speeding and negligence and taking necessary safety precautions such as wear safety gears while using two wheelers, can help in reducing such accidents to a great extent.