Head Injury Patients Research Articles

Head injury related ocular manifestations: A multicenter study

Head injury related ocular manifestations: A multicenter study - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.032, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Correlation of Initial Computed Tomography Findings with Outcomes of Patients with Acute Subdural Hematoma: A Prospective Study

Abstract Introduction In modern emergency service systems, patients are often treated with sedation, intubation, and ventilation at the accident site. But neurosurgical assessment before all these emergency services is important. Thus, this study was designed to investigate the relationships between various parameters of initial CT scan findings and the outcomes of the patients. Methodology A total of 56 adult patients of traumatic acute subdural hematoma (SDH) whose computed tomography (CT) scan was performed within 8 hours of injury were recruited. The patients with prolonged hypotension, open head injury or depressed skull fracture, bilateral side acute SDH, or contusions/hematoma/extradural hematoma on the contralateral side were excluded. Six separate CT findings were analyzed and recorded, including hematoma, midline shift, subarachnoid hemorrhage (SAH), presence of basal cistern obliteration (BCO), intraparenchymal hematoma/contusion in the same hemisphere, and presence of effacement of the sulcal spaces, and were followed up for three months for outcome analysis. Results The overall mortality and functional recovery rate were 27 and 50%, respectively. The patients with obliterated basal cisterns and the presence of underlying SAH in patients with acute SDH had statistically significant poorer outcomes as compared with others. However, the extent of midline shift, SDH thickness, and the presence of underlying contusions and sulcal effacement on initial CT scan showed no statistically significant correlation with patients’ outcomes. Conclusions BCO and presence of subarchnoid hemorrhage underlying acute SDH on the earliest scan in head injury patients signify the severity of brain parenchymal injury. Along with the initial Glasgow Coma Scale score after resuscitation, these two factors should be considered as the most significant ones for predicting the outcomes in traumatic acute SDH patients.

To Prognosticate the Final Outcome in a Traumatic Brain Injury Patient based on their Electrolyte Changes

Dyselectrolytemia is very common in head injuries patients and it is likely due to abnormality in serumsodium, potassium, calcium, phosphate, chloride. Serum Sodium is the most common and importantelectrolyte abnormality among these electrolytes. Proper management of dyselectrolytemia in such patientfollowing a head injury is most important . Proper in time detection followed by appropriate treatmentnot only improves neurological status but also decrease morbidity and mortality. Aims & Objective : Toprognosticate the final out come in a traumatic brain injury patient based on there electrolyte changes.Material & Method : A Hospital based Prospective type Cross Sectional Study . The study was conductedover a period of 18 month In our institute. This study includes all Traumatic Brain Injury patients withoutpoly trauma who were admitted through Emergency as well as OPD . This study exclude patients with anyco morbidity like diabetes mellitus, hypertension, thyroid derangement and poly trauma etc. Observation& Results : We observed significant difference of sodium, potassium, and chloride levels following TBIrecorded at the time of admission, 24 hours, after 4 days, 8 days, 12 days and 16 days . There was positivecorrelation of hyponatremia, hypokalemia, hypochloremia, with outcome of the patient. Conclusion : weconcluded that electrolyte imbalance following traumatic head injury is an important cause to look forin patient monitoring. Sodium potassium and chloride chief electrolyte of concern. Serum calcium andPhosphate levels also under goes notable changes.

Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital

Introduction: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes.
 Objective: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&C) department following intensive care with or without surgical intervention.
 Materials and Methods: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS).
 Results: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS<8 on admission), associated other injuries and delayed resuscitative care and interventions.
 Conclusion: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care.
 Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78

EFFECTS OF CASUALTY EVACUATION ON PATIENTS OF HEAD INJURY – A RETROSPECTIVE OBSERVATIONAL STUDY

Background: - A lot of patients of head injury are transferred to tertiary care centres for management by neurosurgeons. They are evacuated either by road or air. Many a time these patients arrive in a clinicoradilogical deteriorated state. Methods: - All patients of moderate and severe head injury that were transferred in from peripheral hospitals for management by Neurosurgeon between Jan 2017 to Dec 2017 were analyzed for their clinical status at the time of evacuation to their clinical status on arrival. Results:- 20 patients deteriorated, 19 required intervention, one was already intubated and his CT showed only increased edema, of the 19, 11 required surgery, 03 re-surgery, 5 required intubation and no surgery. Conclusion: - Neurosurgeons are not available at all hospitals thereby leading to the early evacuation of the patients. The frequent movements and travelling either by road or air can have fluctuations in the ICP and hypoxia/hypotension/hyper-hyothermia during travelling can aggravate secondary insult to brain. Although what effect these ICP fluctuations have on the brain is not confirmed but these are better avoided.

Monitoring Nyeri dengan Kamera Termal pada Pasien Cedera Kepala dengan Terapi Es Batu di RSUP dr. Wahidin Sudirohusodo Makassar

Headache is the most common somatic disorder in patients after head injury (29-54%). The use of acupuncture points has been used, especially in China in treating various health problems such as headaches. This study aims to determine the effect of ice cube therapy at Feng Fu GV 16 point on decreasing pain in patients with Head Injury who have Post Traumatic Headache in RSUP DR Wahidin Sudirohusodo Makassar with thermal camera monitoring indicators and VRS. This study uses the quasy experiment method. Sampling with accidental sampling with a total sample of 30 people (15 controls and 15 experimental groups). The experimental group was given analgesic + ice therapy at GV Feng Fu 16 point while the control group was only given analgesic. Data was tested by the Independent T Test statistical test with a confidence level of 95%. All data were analyzed using the SPSS version 21.0 program (SPSS, Inc. Chicago, IL). Mean changes in VRS intervention group (1.20 ± 0.56) and control group (0.80 ± 0.56) and mean changes in facial temperature with thermal camera monitoring of the intervention group (1.48 ± 5, 09) and the control group (0.93 ± 1.71). There was no difference in changes in VRS (p: 0.061) and Face Scale (p: 0.698) between the intervention group and the control group. Giving ice cube at Feng Fu GV 16 point is not significant to  reduction of pain in Head Injury patients who experience Post Traumatic Headache with VRS indicators and facial temperature with thermal camera monitoring compared to control group. By that, for practitioners in hospitals to be able to increase knowledge related to ice cube therapy at Feng Fu GV 16 point in reducing pain.

Risk factor assessment and outcome analysis in elderly (≥60 years) patients of severe head injury

Background: Incidence of head injuries is rising all over the world. Only few studies have been performed regarding severe head injury in elderly people. We aimed to study the epidemiology, mode of injury, management, co-morbidity, associated injuries which affects the outcomes. Severe head injury is unconsciousness >6 hours and GCS 3-8. In India 6.63% of the total population above 60 years is considered elderly. Falls are the major contributor to TBI in elderly but in India RTA is still the main contributor. Outcomes of TBI, both in terms of mortality and function, are significantly worse in the elderly.Methods: Objective of this study was to find the risk factors affecting the outcome in severe head injury. This was a prospective study and carried on 56 patient in Department of surgery of M. L. N. Medical College, Prayagraj from September 2018 to September 2019.Results: Male were most commonly affected but the gender had no significant prognostic effect on outcome. RTA were the most common cause of head injury. GCS at admission was directly related to outcome. Bilateral non-reactive pupils had poor outcome. Type of hematoma and midline shift had also affected the outcome. Operated cases had better outcome than non-operated cases. Any associated injury with TBI had worsened the outcome in patient. Any co-morbid condition associated with brain injury had slower recovery and worsen the outcome. Overall mortality in this series was 64.28% and unfavourable outcome was 76.79%.Conclusions: Severe head injury in elderly people had worst outcome.

Prognosis of Syncope With Head Injury: a Tertiary Center Perspective.

Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis.Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma.Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59–16.25], advancing age (per year) (OR 1.09; 95% CI 1.07–1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68–22.8), bone fracture (OR 4.72; 95% CI 2.13–10.5), and syncope (OR 3.70; 95% CI: 1;48–9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37–2.78).Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.

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

Analisa Kemampuan Perawat dalam Mengklasifikasi Pasien Cedera Kepala Berdasarkan Nilai Glasgow Coma Scale (GCS)

Cedera kepala merupakan penyebab utama kematian, angka mortalitas dan morbiditas cedera kepala ini mendekati sepertiga penyebab kematian pada pasien dengan multitrauma di berbagai Negara khususnya Indonesia. Data di RSUD Depati Hamzah Kota Pangkalpinang, Pada tahun 2015 jumlah total angka kejadian cedera kepala sebanyak 200 kasus, Pada tahun 2016 jumlah total angka kejadian cedera kepala sebanyak 262 kasus, Dan pada tahun 2017 jumlah total angka kejadian cedera kepala sebanyak 197 kasus. Tujuan penelitian ini adalah untuk menganalisa kemampuan perawat dalam mengklasifikasi pasien cedera kepala berdasarkan nilai GCS di IGD RSUD Depati Hamzah Kota Pangkalpinang tahun 2018. Jenis penelitian ini adalah penelitian deskriptif dengan pendekatan kualitatif. Sumber informan sebanyak 4 orang perawat pelaksana, 1 orang Kepala ruangan, 1 orang dokter, dan 1 Kasi Keperawatan. Pengumpulan data melalui wawancara mendalam. Hasil penelitian menunjukan bahwa perawat di IGD RSUD Depati Hamzah memiliki pengetahuan yang cukup baik, perawat melakukan tindakan sesuai dengan SOP (Standart Operasional Prosedur) yang ada, perawat minimal harus tersertifikasi pelatihan BTCLS, dan tidak ada supervisi di IGD RSUD Depati Hamzah Kota Pangkalpinang.Saran penelitian ini perlu adanya penyampaian sosialisasi tentang SOP kepada pegawai di IGD sehingga semua pegawai di IGD baik dokter ataupun perawat tau mengenai hal tersebut dan perlu adanya pengaktifan kembali sistem supervisi yang ada dirumah sakit, dan perlu adanya peningkatan pengetahuan dan keahlihan SDM melalui penambahan kuota pelatihan BTCLS.

ROLE OF COMPUTED TOMOGRAPHY IN PATIENT WITH MINOR HEAD INJURY IN TERTIARY CARE HOSPITAL

Aim: Approximately 2 million people sustain traumatic brain injury (TBI) annually in India. A CT scan of the head is the initial choice of radiological investigation to evaluate patients with suspected head injury. The need for neurosurgical intervention is based on the clinical status of the patient and the radiological finding on head CT.&#x0D; Material and Methods: This was a prospective observational study done over a period of 6 months. A total of 201 patients were included in the study. Patients of traumatic brain injury above 15 years of age who were subjected to two or more CT scans of the brain. Patients were followed for a maximum of up to 5 scans. The decision of repeat scan was taken by the treating neurosurgeon. Patients who were taken up for surgery based upon the findings of the first CT scan. Patients who were discharged or who expired after the first CT scan.&#x0D; Results: A total of 201 consequent head injury patients with 2 or more CT scans were studied. 192 were male. The mean age was 38.6 years (Range: 16e80). Road traffic accidents was the most common cause of trauma (134, 67%) followed by fall from height (47, 24%) and assault (17, 10%). Progression of lesion was seen more frequently in mixed lesions (21.8%), followed by SDH (12.5%) and EDH (6.2%).&#x0D; Conclusions: Repeat CT scans were found to be of value in detecting new lesions or enlargement of existing lesions resulting in change of management in a significant proportion of patients.&#x0D; Keywords: Computed Tomography, Minor Head Injury, Tertiary Care Hospital, Traumatic Brain Injury (TBI), Lesions.

A comparison of the time constant of the cerebral arterial bed using invasive and non-invasive arterial blood pressure measurements

Objective: The time constant of the cerebral arterial bed (τ), which is an index of brain haemodynamics, can be estimated in patients using continuous monitoring of arterial blood pressure (ABP), transcranial Doppler cerebral blood flow velocity (CBFV) and intracranial pressure (ICP) if these measures are available. But, in some clinical scenarios invasive measurement of ABP is not feasible. Therefore, in this study we aimed to investigate whether invasive ABP can be replaced with non-invasive ABP, monitored using the Finapres photoplethysmograph (fABP). Approach: Forty-six recordings of ICP, ABP, fABP, and CBFV in the right and left middle cerebral arteries were performed daily for approximately 30 min in 10 head injury patients. Two modelling approaches (constant flow forward [CFF, pulsatile blood inflow and steady blood outflow] and pulsatile flow forward [PFF, where both blood inflow and outflow are pulsatile]) were applied to estimate τ using either invasive ABP (τCFF, τPFF) or non-invasive ABP (fτCFF, fτPFF). Main results: Bland–Altman analysis showed quite poor agreement between the fτ and τ methods of estimation. The fτ method produced significantly higher values than the τ method when calculated using both the CFF and PFF models (p < .001 for both). The correlation between fτCFF and τCFF was moderately high (r s = 0.63; p < .001), whereas that between fτPFF and τPFF was weaker (r s = 0.40; p = .009). Significance: Our results suggest that using non-invasive ABP for estimation of τ is inaccurate in head injury patients.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India.

Objective:To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance.Study Design:Interventional and prospective.Methods:We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention.Results:A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause.Conclusion:Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

PENERAPAN SLOW DEEP BREATHING TERHADAP NYERI CKR DI IGD RUMAH SAKIT PKU MUHAMMADIYAH GOMBONG

Background: Minor head injury is a nervous system disorder caused by a violent blow or jolt to the head or body. As a consequence of this accident an individual will be losing his awareness signed by headache and pain. One way to overcome it is by giving nursing actions like slow deep breathing therapy.Purpose: getting the effect of slow deep breathing therapy to decrease the pain of minor head injury patient.Metode: this study was a quasi-experimental design with Pretest–posttest design with control group approach. A group of 40 respondents were recruited applying by consecutive sampling technique. The study was conducted between the period of June 25 to July 25 of 2007. The study instrument used a pain scale named NRS (numerical rating scale).Result: Based on the data presented that adult age group of intervention group was 60%, while in control group was 55%. Most of gender category was male, 70% of intervention and 75% of control group respectively. The result of paired samples t-test exam 1 received value sig.(2-tailed) = 0,000, it means that there was different of mean average of pre-test post-test group. Meanwhile, paired samples t-test exam 2 resulted value sig.(2-tailed) = 0,021 (sig&gt;0,05), it means that there was different of mean average of pre-test post-test group.Conclusion: There was effect of slow deep breathing to decrease the pain of minor head injury patient.

Utility of CT in Head Injury- A Prospective Study

Background: Head injury is defined as an impairment in brain function as a result of mechanical force. The dysfunction can be temporary or permanent, and may or may not result in underlying structural changes in the brain. Head injuries are a major public health problem worldwide. A limited amount of neurological damage occurs at the time of impact (primary injury). Subjects and Methods: The study was a prospective observational study took place in the Department of Radiology, over a 8 month period which involves all type of head injuries. Informed consent was obtained by the subjects who participated in the study. All head injury patients attending the emergency department were included, while those with no clear history of trauma as the primary event and neurologic deficit that could not be explained by head trauma were excluded. Results: A total of 1000 patients underwent CT for a head injury. Table 1 shows baseline characteristics as age, gender, referred cases, type of injury, mode of injury and clinical features where we observed 48.2% cases were in the age group between 21-40 years with 80% of male subjects. While observing for the mode of injury, we found most of the cases falls in the category of road traffic accidents (77%) with external injury (83.5%) and loss of consciousness (63.4%) as highly observed clinical features. Conclusion: This study showed a significant association of overall CT positivity with patients sociodemographic and clinical factors such as: male gender, elderly age group (&gt;60 years), history of alcohol consumption, LOC &gt;5 min, history of vomiting, history of seizures, evidence of ear bleed, evidence of nosebleed, and GCS 12 (moderate and Severe head injury). From the results of this study, we recommend the following indications for doing CT in head injury patients: (1) CT is indicated in all patients with moderate and severe head injury (GCS ≤12).

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury.

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

Clinical Profile and Management of Patients of Head Injury at a Tertiary Care Hospital – A Prospective Study

Head injury is one of the commonest emergencies in surgical practice. It is one of the most common cause of death and disability among the young population between the age of 15 to 25 years. This is a cross-sectional study among 100 patients with head injury at a medical college and tertiary care hospital. Aims and Objectives: To study the clinical profile and outcome of patients with head including the role of the Glasgow Coma Scale in their prognosis. To study the CT scan findings of the brain and the clinical outcome. Materials and Methods: This is a prospective observational study conducted at a Medical college and tertiary care hospital. 100 patients with head injury were enrolled in this study. Duration of the study was between December 2009 to November 2011. Conclusion: The commonest cause of head injury is road traffic accidents. Head injury is common in the young age of group of 21-30 years. Male: Female ratio of the head injury is 3:1 Almost one third of the patients had history of alcohol ingestion prior to the head injury. The commonest lesion in head injury is subdural hematoma. It is also the most lethal. Most of the head injuries were of mild type and only 5% patients required surgery. Only 10% of the patients had poor clinical outcome. Glasgow Coma Scale is very helpful in predicting the severity and clinical outcome of head injury patients.

Development and Implementation of a Pilot Radiation Reduction Protocol for Pediatric Head Injury

BackgroundTraumatic brain injury is the leading cause of morbidity and mortality for children in the United States. The aim of this study was to develop and implement a guideline to reduce radiation exposure in the pediatric head injury patient by identifying the patient population where repeat imaging is necessary and to establish rapid brain protocol magnetic resonance imaging as the first-line modality. MethodsA retrospective chart review of trauma patients between 0 and 14 y of age admitted at a pediatric level 2 trauma center was performed between January 2013 and June 2019. The guideline established the appropriateness of repeat scans for patients with Glasgow Coma Scale >13 with clinical neurological deterioration or patients with Glasgow Coma Scale ≤13 and intracranial hemorrhagic lesion on initial head computed tomography (CT). ResultsOur trauma registry included 592 patients during the study period, 415 before implementation and 161 after implementation. A total of 132 patients met inclusion criteria, 116 pre-guideline and 16 post-guideline. The number of patients receiving repeat head CTs significantly decreased from 34.5% to 6.3% (P < 0.02). There was also a significant decrease in the mean number of head CT/patient pre-guideline 1.63 (range 1-7) compared with post-guideline 1.06 (range 1-2) (P < 0.02). ConclusionsCT head imaging is invaluable in the initial trauma evaluation of pediatric patients. However, it can be overused, and the radiation may lead to long-term deleterious effects. Establishing a head imaging guideline which limits use with clinical criteria can be effective in reducing radiation exposure without missing injuries.

Computed Tomography Evaluation of Craniovertebral Junction in Asymptomatic Central Rural Indian Population.

Objectives Craniovertebral junction (CVJ) is a unique, mobile and complicated component of our spine which necessitates specific study pertaining to its structure as well as pathologies. This study aims to report the normative data detailing the CVJ anatomy among the rural population of Central India which would help us in understanding the joint dynamics. Materials and Methods A retrospective observational study was undertaken in the Department of Neurosurgery and Radiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, from December 2018 to May 2019. A total of 255 head injury patients with a normal CT brain cervical spine were included in this study. Anterior and posterior atlantodental interval (AADI/PADI), clivus length (CL), foramen magnum diameter (FMD), Boogard’s and basal angle (BOO & BA) were measured and analyzed. Statistical Analysis Statistical analysis was done using Microsoft Excel 2016. A web-based, open source application known as OpenEpi.com (version 3.01) was used for applying unpaired t -test. Results This study had a mean age of 42.9 years. The difference in mean value of AADI between male and female population was not found to be statistically significant, while in case of PADI, CL, FMD, BOO and BA, it was found to be significant ( p < 0.05). On comparison of cases with age ≤ 20 years and > 20 years, we found the difference in values of ADI, CL and FMD to be statistically significant ( p < 0.05). Conclusion Although there are some similarities, namely, AADI measurements as compared with other studies, there are differences in cutoff values of other parameters. Being a major draining reference center for rural population in India, this data can be extrapolated to a similar population for reference.

Clinical spectrum of paediatric head injury

Introduction: Traumatic Brain injury is considered as a major health problem which causes frequent deaths and disabilities in paediatric population with special concern to tribal regions of developing countries like India where etiology of traumatic brain injury in the paediatric population fall from height dominant over the road traffic accident as a major.&#x0D; Aim and objective: The aim is to analyse the epidemiology, mechanism, clinical presentation, severity and outcome of paediatric head injury in the tribal region of northern India that could help to make preventive policies to improve their care.&#x0D; Material methods: It is a prospective observational study of 345 children of up to 18 years of age admitted under Department of Neurosurgery from October 2017 to April 2019.&#x0D; Results: The study population comprised of 345 paediatric patients. Mean age was 9.25 years.36.81% patients were in 1-6-year age group and male to female ratio was 2.45. The most common cause for trauma was fall from height in 179(52%) cases followed by RTA in 141(41%) cases. The most common radiological finding was depressed skull fractures in 97(50%) cases. There was 35% mortality in severe head injury patients.&#x0D; Conclusion: This study through some light on the different scenario of head injury in Tribal regions of Developing country and will help to formulate effective strategies for prevention and better care of the patients.