Extracranial Complications Research Articles

Acute head injuries in the elderly. An analysis of 136 consecutive patients.

136 patients older than 70 years, admitted to our neurosurgical ward directly after head trauma, were analysed. 40% of them were admitted with low GCS, below 9 points, and showed a mortality of 85%. 45 patients had intracranial mass lesions--the commonest was subdural haematoma, with a low incidence of epidural haematomas. In patients admitted with GCS above 12, mortality was 20%, mainly due to pneumonia. Satisfactory results were achieved in 30% of trauma victims. From patients with intracranial space occupying lesions and GCS below 9 points on admission practically all died, despite aggressive surgical treatment and intensive care. Thus, especially in departments with limited resources, therapy can be limited, or even no therapy may be introduced in this group. Surgical treatment can be limited only to patients who are conscious on admission. In patients with non-surgical lesions, low GCS--below 9 points--leads to mortality of 80%, and in this group we propose aggressive intensive care for 24 hours and the limitation of further "maximal" therapy only to those, who significantly improve within this period of time. If the patient has a non-surgical lesion and is conscious after trauma, aggressive treatment of extracranial complication is the most important, because brain injury can usually be well tolerated by these patients. If pneumonia or heart complications do not occur this group of old patients often have a good prognosis.

Death in hospital after head injury without transfer to a neurosurgical unit: who, when, and why?

Most studies of hospital deaths after head injury have been in patients transferred to neurosurgical units (NSU), but over 90 per cent of hospitalized head-injured patients are not transferred and some of these die. To assess the effectiveness of triage of seriously head-injured patients in Glasgow, we studied 270 patients who died after head injury in any of the six Glasgow general hospitals during 1979–1988 and who were not transferred to the regional NSU. The proportion of fatal cases of head injury who had not been to the NSU fell from 69 per cent in 1971–1975 to 45 percent in 1979–1988. Most of the untransferred patients were elderly, and most died from irremediable injuries or complications. Although 31 (11 per cent) had a significant intracranial haematoma, only seven of these might have been salvaged by neurosurgical intervention. Seven other patients died from potentially preventable extracranial injuries or complications. These findings suggest that a relatively satisfactory level of triage of seriously head-injured patients has been achieved, by promoting effective communication between neurosurgeons and other specialists, and by a continuous programme of audit and education.

Intracranial and extracranial complications of acute mastoiditis: Evaluation with computed tomography

Intracranial and extracranial complications of acute mastoiditis: Evaluation with computed tomography

Tuberculous Otitis Media Presenting as Complications: Report of 18 Cases

Tuberculous otitis media is a rare but treatable disease; delay in its diagnosis usually leads to complications. In the last 15 years we have come across 18 cases of tuberculous otitis media, which presented various intra- and extracranial complications. In the past, tuberculous otitis media had always been considered a discrete disease, but it is possible that tuberculosis may coexist or secondarily affect an already discharging ear. The following discussion illustrates the complications and clinical problems encountered in tuberculous otitis media.

Neurologic complications in mid-face fractures

The aim of this study was to discuss the various neurological complications after middle face fractures. The study is based on 186 patients with injuries of the middle face region, admitted to the ENT Department for clinical diagnosis and treatment. Only patients with apparently minor head injury (SHT I. degree) were included in this study. The neurological complications are divided into extracranial and intracranial neurological impairments. It was evident that extracranial neurological complications are frequent and that they decisively influence the surgical treatment (decompression of the N. infraorbitalis or N. opticus). The intracranial neurological complications, however, are rare, but most important for the prognosis quoad vitam, because a small number of patients with middle face fractures can develop a life-threatening intracranial haematoma that must be rapidly detected and removed.

Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power.

ABRs have proved to be very accurate prognostic indicators in severe head injury, even when predictions are based on single ABR recordings. In this study we submitted 30 severely head-injured patients to serial ABR recordings (during the clinical course of posttraumatic coma) in order to verify whether the ABR prognostic power may depend on test timing in relation to the injury. 15 patients (50%) died, 5 (16.7%) remained vegetative, 2 (6.6%) severely disabled and 8 (26.7%) recovered. All recovered patients had normal ABR throughout clinical course, while severely disabled and vegetative patients showed at least transently ABR abnormalities (namely, an interpeak latency of waves V-I greater than 4.48 ms). Among dead patients, 8 showed steady and 3 transient ABR abnormalities during the clinical course, while 2 of 3 patients with normal ABR dead from extracranial complications. ABRs were significantly related to the outcome at any time, but gave more accurate prognostic indications on days 3-6 after the injury. The use of serial ABR recordings appeared to improve the outcome predictions in comparison with single ABR tests. Finally our result confirm the previously reported existance of a breakpoint between reversible brainstem dysfunction and irreversible brainstem damage defined by an IPL V-I of about 4.50 ms.

Complications of acute middle ear infections.

Although acute mastoiditis and intracranial otogenic complications occur less frequently in our time than in the preantibiotic period, the disease is nevertheless still a rather severe medical problem. Its mortality rate remains relatively high and the severity of its symptoms is often underrated or misinterpreted by the inexperienced physician. On the basis of some personal clinical observations made during the last decade, attention has been drawn to the most common intracranial and extracranial otogenic complications in adults and children. It may therefore be concluded that otitis media must still be considered a dangerous disease, necessitating fundamental knowledge of its underlying pathology, which provides a basis of early correct diagnosis and adequate intensive therapy.

ORL, Aktuelle Probleme der Otorhinolaryngologie 6, B. Kellerhals, U. Fisch, J. Mann, P. Montandon, J.-P. de Reynier, G. Terrier (Eds.). Hans Huber, Berlin (1983), ISBN: 3-456-81279-5

The incidence of complications resulting from acute otitis media has significantly decreased since the introduction of antibiotics. The use of antibiotics has lead to decrease in the complications of acute mastoiditis as well as the mortality of the disease. The purpose of the study was to review our experience in the diagnosis and treatment of complications of acute mastoiditis in children. Study design. Retrospective clinical study.We present a retrospective study of 70 children with extracranial and intracranial complications of acute mastoiditis who were treated in the period from 1968 to 2006 at Department of Otolaryngology, Medical University of Gdansk. Their treatment has been documented with long period of otologic follow-up.Extracranial complications occurred in 41 (30,4%) of treated acute mastoiditis cases, and subperiostal abscess was the commonest one in 37 (90,2%) patients. Intracranial complications occurred in 29 (21,4%) of acute mastoiditis cases and facial paralysis was the commonest one in 14 (40,0%) cases, followed by sigmoid sinus thrombosis and perisinus abscess. Ear cultures grew in patients with otogenic complications, the most often Staphylococcus aureus, Streptococcus sp. and Pseudomonas aeruginosa were found. Mastoidectomy with myringotomy resolved the disease in 46 (65.7%) children, only myringotomy in 6 (8.6%) and canal wall down mastoidectomy in 18 (25.7%) children. Complete resolution was achieved in all cases.The persistent othorrea, otalgia and headache, prolonged high fever, neurological signs were the most common symptoms associated with the development of intracranial complications of acute mastoiditis in children. Computed tomography and MRI are necessary tools for diagnosis and surgery planning in every case of latent mastoiditis. Antibiotic treatment of acute mastoiditis does not prevent otogenic complications. Extracranial or intracranial complications of acute mastoiditis need surgical treatment and prolonged antibiotic therapy. The present study found evidence for decreased incidence of mastoiditis and their suppurative complications during last years.

RISKS OF LONG-TERM ORAL ANTICOAGULANT THERAPY IN ELDERLY PATIENTS AFTER MYOCARDIAL INFARCTION: Second Report of the Sixty Plus Reinfarction Study Research Group

The 32 intracranial events and 116 extracranial bleeding complications observed during a double-blind trial to assess long-term oral anticoagulant therapy in 878 elderly patients after myocardial infarction were studied in detail. Of the intracranial events, 12 occurred in the anticoagulant (AC) group and 20 in the placebo group, the number of definite haemorrhages being 8 and 1, respectively (p = 0·04). The 2 AC patients with a subdural haematoma recovered. The accumulated periods of neurological disablement amounted to 120 days in the AC group and 1204 days in the placebo group (p<0·01). Of the 106 extracranial bleeding episodes observed in the AC group 28 were referred to as major; none of the patients with major bleeds died but 10 required treatment in hospital, on average for a week. In the 4 placebo patients with a major extracranial haemorrhage no treatment was needed specific for bleeding. Minor episodes were noted 78 times in 56 AC patients and 6 times in 5 placebo patients. About 75% of the bleedings occurred when the prothrombin time was prolonged 2·7-4·5 times in terms of the international calibrated and British corrected ratios. Bleeding incidence was not related to sex or age, or to the duration of therapy. It is concluded that the bleeding risk associated with long-term oral anticoagulation as applied in the Sixty Plus Reinfarction Study does not materially detract from its beneficial effects with respect to the prevention of recurrent myocardial infarction.

Complications of otitis media.

Although intracranial otogenic complications occur less frequently than in the preantibiotic period, their mortality rate is still relatively high. On the basis of some personal clinical observations made during the last decade attention has been drawn to the most common intra- and extracranial otogenic complications (posterior fossa syndrome, labyrinthine fistula, labyrinthitis, facial palsy) mostly due to cholesteatoma, and a less frequent intracranial complication occurring mainly in children (otitic hydrocephalus) caused by chronic otitis media. It may therefore be concluded that otitis media must still be considered a dangerous disease, necessitating early diagnosis, intensive therapy and in case of a cholesteatoma complete and early eradication.

Extracranial complications of cerobrospinal fluid shunt function in childhood hydrocephalus: F. R. Murtagh, R. M. Quencer, and C. A. Poole. Am J Roentgenol 135:763–766, (October), 1980

Extracranial complications of cerobrospinal fluid shunt function in childhood hydrocephalus: F. R. Murtagh, R. M. Quencer, and C. A. Poole. Am J Roentgenol 135:763–766, (October), 1980

Insidious labyrinthine changes in otitis media.

For many decades the classical labyrinthine extracranial and intracranial complications of otitis media have been documented, initially by European otologists and then by otologists of other countries including the United States. What has not been fully appreciated or understood is the quiet development of sensori-neural hearing loss which can occur as a concomitant or sequela of otitis media. Out- hypothesis is that in certain patients toxins from otitis media are transported across the round window membrane, leading first to end organ dysfunction of the silent basal turn and ultimately to involvement of lower frequencies readily recognized through audiological testing. The purpose of this paper is to recount past and present studies in our laboratory and others which help explain this phenomenon.

Extracranial complications of cerebrospinal fluid shunt function in childhood hydrocephalus.

There were 112 separate hospital evaluations in 84 patients for suspected shunt malfunction: 96 evaluations were of ventriculoperitoneal shunts, 13 were of ventriculoatrial shunts, and three were of both types of shunts. In 45 (47%) of 96 ventriculoperitoneal shunts, complications eventually led to surgical revision; 20 (44%) of these were problems of the peritoneal end and therefore peculiar to this type of shunt. Peritoneal end problems included tubing disconnection, bowel obstruction, perforation, and abdominal cerebrospinal fluid pseudocyst. Of the 13 ventriculoatrial shunts, 10 (79%) required revision; eight (61%) of these were due to problems of the atrial end. These problems included relative shortening of the tubing due to patient growth, superior vena cava thrombosis, and disconnection. Ventriculoperitoneal shunts were used most frequently and had a lower complication rate (47%). Ventriculoatrial shunts were used less often and had a higher complication rate (79%) and more serious problems.

Extracranial injuries and complications.

Extracranial injuries and complications.

Head injuries in old age

Relato dos aspectos clínicos apresentados por 299 pacientes com mais de 50 anos de idade, que sofreram traumatismos cranianos. Em especial são abordadas as dificuldades no diagnóstico diferencial que os hematomas intracranianos apresentam nesse grupo etário (total de 42 casos). Complicações cerebrais e extra-cerebrais, isto é, extra-cranianas são discutidas, tendo-se especial cuidado nos casos com inconsciência secundária e/ou sinais neurológicos secundários. Comparação com grupos mais jovens é feita. São salientadas as medidas terapêuticas gerais que podem diminuir a alta quota de mortalidade.

PROGNOSIS AFTER HEAD INJURY BASED ON EARLY CLINICAL EXAMINATION

In an attempt to ascertain clinical factors of prognostic significance after traumatic head injury, a prospective study of 201 patients injured in road-traffic accidents was undertaken. Basic clinical signs, determined from the first neurological examination of the patient, the patient's age, and post-traumatic blood-pressure were related significantly to functional recovery 2-3 years after injury. In younger patients abnormal motor activity was the most important unfavourable sign, while for older patients it was unconsciousness. Increasing age and post-traumatic hypertension were both related to poor recovery, while major intracranial and extracranial surgical complications were associated with poor functional recovery and increased mortality, respectively. These results indicate that early clinical examination can reveal important prognostic information after head injury.