Cases Of Head Trauma Research Articles

β-Amyloid Precursor Protein and Ubiquitin Immunohistochemistry Aid in the Evaluation of Infant Autopsy Eyes With Abusive Head Trauma

To investigate β-amyloid precursor protein (β-APP), ubiquitin, and glial fibrillary acid protein (GFAP) immunostaining as a diagnostic tool to aid in the discrimination between abusive head trauma and nonabusive head trauma in postmortem ocular histopathologic investigation. Retrospective cross-sectional study. Seventy-four eyes of 37 infants were studied for hemorrhage and immunohistochemical expression of β-APP, ubiquitin, and GFAP in the retina and optic nerve. Infants were assigned to abusive head trauma or control groups, according to published criteria. In the abusive head trauma group, positive β-APP and ubiquitin immunostaining of the retina was significantly more likely to be found than in the control group, odds ratio (OR) 11.4, confidence interval (CI) 2.9-44.3; P < .001 and OR 8.8, CI 2.2-34.5; P=.002, respectively. Positive correlations were found between retinal expression of β-APP and ubiquitin immunostaining and retinal hemorrhage. Vitreal hemorrhages, orbital fat hemorrhages, and macular folds could only be identified in abusive head trauma cases. Retinal hemorrhages were significantly more severe, occupied a larger proportion of the retina, and involved more retinal layers in abusive head trauma compared to controls (OR 2.7, CI 1.7-4.4; P < .001). This study shows correlations between positive retinal β-APP and ubiquitin immunostaining as a sign of axonal injury in abusive head trauma. Axonal injury is a useful pathologic feature that can be demonstrated in postmortem ocular investigation of deceased children using immunohistochemical staining for β-APP and ubiquitin with a high OR for abusive head trauma when compared to controls.

Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma.

The benefits of multiplanar reconstructed images (MPR) of unenhanced axial head computed tomography (CT) data have not been established in trauma patients younger than 3 years old, a population in which a reliable history and physical examination may be most difficult. We retrospectively evaluated unenhanced head CTs in pediatric trauma patients to investigate the various benefits of MPR in this age group. A total of 221 unenhanced head CTs performed for any case of head trauma (HT) on children younger than 3 years old were independently reviewed by two radiologists. Studies were reviewed first in the standard axial plane alone and then with the addition of MPR. Reviewers were asked to determine if the MPR affected the ability to make findings of hemorrhage, incidental findings, and artifacts. MPR improved the detection of hemorrhage in 14 cases (6.5 %, p-value < 0.01) and incidental findings in five cases (2.3 %, p-value < 0.05) as well as helped prove artifacts in five cases (2.3 %, p-value < 0.05). Routine use of MPR in HT patients younger than 3 years old has the potential to increase the detection of acute and incidental imaging findings.

Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review

Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.

Correlation Between Brain Imaging and Glasgow Coma Scale in Traumatic Head Injury in Pediatrics

Objectives: The aim of this work is to study the relationship between the initial GCS and admission brain CT findings and MRI brain findings if indicated in head trauma patients at pediatric age group. Background: Trauma is a leading cause of death in children older than 1 year, with head trauma representing 80% or more of the injuries. In approximately 5% of head trauma cases, patients die at the site of the accident. Head trauma has a high emotional, psychosocial and economic impact because these patients often have comparatively long hospital stays. Methods: This prospective study included 100 patients with head trauma at pediatric age group; the patients were evaluated with respect to their initial GCS and admission brain CT findings and correlated with clinical data. Some patients were further evaluated with MRI of brain when needed. Results: Male to female ratio was 73:27, their ages ranged from 1 day to 18 years with a mean age of 9.1 years. Of the 100 cases included in this study 21 cases were with normal CT examination and 79 were with abnormal imaging findings. 54% of the cases classified as mild TBI, 8% of the cases classified as moderate TBI and 38% of the cases classified as severe TBI. Imaging findings such as subgaleal hematoma, skull fractures, subarachnoid hemorrhage, cerebral contusion, intracerebral hemorrhage, extra-axial blood collection and diffuse cerebral edema were observed in 79% of the patients. Conclusion: Statistical significance was observed between GCS and the imaging findings, the lower the GCS score, the more severe were the TBI and imaging findings. MRI has been shown to be superior to CT in the detection of non-hemorrhagic brain injury and cases of diffuse axonal injury.

Validation of a clinical prediction rule for pediatric abusive head trauma.

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT. Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.

Abusive head trauma: past, present, and future.

Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis.

QUANTITATIVE MORPHOLOGICAL AND MOLECULAR PATHOLOGY OF THE HUMAN THYMUS CORRELATE WITH INFANT CAUSE OF DEATH.

The objective of this study was to investigate and quantify the morphological and molecular changes in the thymus for common causes of human infant death. Thymic architecture and molecular changes apparent in human infant head trauma victims were assessed by microscopy and quantified by image analysis of digital whole slide images. Thymuses from victims of SIDS and suffocated infants displaying normal thymus architecture were used for comparison. Molecular expression of proliferation and serotonin receptor and transporter protein markers was evaluated. Duplicate morphological and molecular studies of rodent thymuses were completed with both mouse and rat models. Quantification of novel parameters of digital images of thymuses from human infants suffering mortal head trauma revealed a disruption of the corticomedullary organization of the thymus, particularly involving dissolution of the corticomedullary border. A similar result was obtained for related mouse and rat models. The human thymuses from head trauma cases also displayed a higher percentage of Ki-67-positive thymocytes. Finally, we determined that thymus expression of the human serotonin receptor, and the serotonin transporter, occur almost exclusively in the thymic medulla. Head trauma leads to a disruption of the thymic, corticomedullary border, and molecular expression patterns in a robust and quantifiable manner.

Koala retrovirus related diseases in European zoo-based koalas (Phascolarctos cinereus)

European zoos have housed koalas (Phascolarctos cinereus) for almost 25 years. From the time the first individual arrived on the old continent to the present population of 30 (15.15) animals, medical knowledge has improved significantly. During this time, 57 koala deaths have been recorded. With the discovery of the koala endogenous retrovirus (KoRV), the question remains whether it is involved in the various diseases found in captive population and specifically whether it was involved in the 57 deaths. This question is unfortunately difficult to answer as no real time tests were performed before and during the course of the diseases. A study of the detailed information of these records shows that almost half of them concern very young animals probably mainly because of joeys falling from the pouch and maternal neglect. A few deaths have no recorded information or are clearly not related to any infectious cause. 44% are due to neoplastic and opportunistic or non-opportunistic bacterial infectious process. While KoRV is thought to cause immunosuppression and tumour induction (mainly lymphomas), the link between disease and the virus has not been clearly established. Mulot, Baptiste. 2014. Koala retrovirus related diseases in European zoo-based koalas (Phascolarctos cinereus). In The Koala and its Retroviruses: Implications for Sustainability and Survival, ed. Geoffrey W. Pye, Rebecca N. Johnson and Alex D. Greenwood. Technical Reports of the Australian Museum, Online 24: 51–54. The San Diego Zoo loaned the first koalas to European zoos in 1989 (Hamlin Andrus, 2011) to the London zoo. The first breeding pair arrived in 1991 at the Jardim Zoologico de Lisbon, Portugal. Twenty-five years later, seven institutions house 30 animals (15.15) (Hamlin Andrus, 2011). Over the past 25 years, our knowledge in husbandry and care of this unique species has greatly improved. One of the major recent discoveries was the presence of an active endogenous retrovirus in the genome of a large portion of wild koalas and most (if not all) captive koalas (Canfield et al., 1988; Hanger et al., 2000; Tarlinton et al., 2005). This retrovirus is thought to be responsible for an innate immunosuppression and neoplastic induction, especially, but not only, lymphoma (Tarlinton et al., 2005). This detailed retrospective study of koala deaths that have occurred in the European captive population aims to look for a possible association with the presence of the retrovirus. In 25 years, 57 deaths have been recorded in the European population (a list of every death with details can be found in Table 1). While every adult death has been examined in detail, some joey deaths, mainly during the first days of life, are missing, depending on the keepers observations. Among these 57 deaths, 4% (2) have no record. 5% (3) are clearly not related to the retrovirus: one case of bladder stone with death occurring post surgery, one case of head trauma with hydrocephalus internus associated, and one case of ileum and colon torsion. Deaths of joeys accounted for 47% (27) of all deaths. Most of these cases have no details, but we can assume most of them are related to joey falling from the pouch or maternal neglect (absence of pouch cleaning, joey rejected, etc.). A few cases have bacterial culture recorded and the results are listed among the other bacterial results (Table 2).

Case of Fatal Head Trauma Experienced During Japanese Judo

Case of Fatal Head Trauma Experienced During Japanese Judo

Ophthalmic complications among cases of head trauma in north-eastern Iran

The aim of this study was to investigate the prevalence and pattern of ocular complications in patients with head trauma admitted to the main trauma centre in north-eastern Iran. A total of 459 head-injured patients (36.56 ± 19.30 years of age) with at least one ocular manifestation were recruited. Each individual patient was examined by a neurosurgeon and an ophthalmologist to confirm the type of ocular complication. In addition, all patients were analysed for age, gender, and cause of head injury in addition to the ophthalmic and neurosurgical examinations. Of the 459 patients, 142 (31 %) were female and 317 (69 %) were male. The maximum rate of ocular complications was during the third decade of life and minimum during childhood and in the elderly (>71 years) population. The leading cause of head trauma was motor vehicle accidents, predominant in male adults aged 21-40 years. Ocular complications observed were classified into three major groups: soft-tissue injuries to the globe and adnexae (n = 434), orbital complications (n = 45) and neuro-ophthalmic complications (n = 152). In conclusion, our data provides a useful estimation of the rate and pattern of ocular complications among patients with head injuries seen in trauma centres in north-eastern Iran. Understanding the pattern of ocular complications helps us to design more appropriate preventive methods.

Abusive head trauma: Differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys

ObjectivesTo determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. MethodsWe included all AHT cases in the Netherlands in the period 2005–2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. ResultsWe identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. ConclusionsNeuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.

Parestesi pada fraktur kompleks zigomatikomaksilaris Paresthesia in zygomaticomaxillary complex fractures

Head trauma cases can involve os.zygoma and maxilla. Injury to the nerves is one of the complications that can beencountered as a result of the fracture fragments shift. This paper reported one case of n.infraorbitalis paresthesiafollowing zygomaticomaxillary complex fracture. A 30 years old man was referred to the Department of Oral Surgery,Dr.Sardjito Hospital with a history of traffic accident two weeks before admission. The patient complained of rightcheek area feels numbness, bite changed and there was a protrusion of bone under his right eye. Clinical examinationfound paresthesias of right n.infraorbitalis, left posterior open bite, and bone displace at right infraorbital rim. At theWater's x-ray and 3D CT scan visualized fractures involving the right maxillary and infraorbital rim. Open reductioninternal fixation (ORIF) zygomaticomaxillary complex fracture, with miniplate supported by arch bar as a device toachieve individually normal occlusions, was performed under general anesthesia. Postoperative follow up indicateparesthesia symptoms gradually decreased and totally recover within 5 months. Prognosis for this case was bonam. Itwas concluded that ORIF with miniplate, combined with mounting arch bar can support paresthesia correction due tothe displacing of fracture fragment zygomaticomaxillary complex.

History of an Abusive Head Trauma Including a Lucid Interval and a Retinal Hemorrhage Is Most Likely False

A lucid interval (LI) is the period of time between regaining consciousness after a short period of unconsciousness, resulting from a head injury and deteriorating after the onset of neurologic signs and symptoms caused by that injury. The incentive for this study was the case of a father who left his 14-week-old infant with the nanny in whose custody the infant had collapsed. The nanny denied involvement in the injury, and the father became a suspect. Of 47 abusive head trauma (AHT) cases, 8 were found to have an LI in the past. The history of the cases were thoroughly analyzed and compared with evidence in the literature. An LI is not compatible with an inertial brain injury. Shaking has either an immediate effect or no effect, which means that an LI occurs only in pure impact or blunt injuries. When "shaking lesions" are found including a retinal hemorrhage while the history mentions an LI, the story most likely is false, regardless of whether the perpetrator confesses. The finding of an LI may change the assessment of an AHT case. Lucid interval is a valuable variable in the diagnostic accuracy of an AHT.

Ethical Issues in Forensic Testimony Involving Abusive Head Trauma

Medical examiners provide critical diagnostic and testimonial information in abusive head trauma cases. Courtroom challenges to these diagnostic criteria and contested expert testimony have raised concerns about ethical and professional conduct of practitioners. Legal evidentiary standards for expert testimony, ethical guidelines established by medical organizations, and proposed standards for ethical practice provide a background for examination of several common challenges and testimonial claims in these cases.

High‐Anxiety Head and Neck Trauma Cases: Lessons Learned

Program Description: The management of head and neck trauma patients is challenging, and critically important trauma lessons have been learned in Iraq, Afghanistan, and busy U.S. trauma centers. These lessons learned are relevant to all otolaryngologists who may be faced with such challenges resulting from trauma to the airway, the neck, and the craniofacial skeleton. High-anxiety head and neck trauma cases will be presented, and the audience will use an interactive format to generate discussion on the best treatment options. The goal is to review the trauma pearls learned in the combat zone and in busy U.S. trauma centers. Educational Objectives: 1) Apply the lessons learned with the head and neck trauma surgery performed in Iraq, Afghanistan, and busy U.S. trauma centers. 2) Implement trauma surgery pearls dealing with the traumatic airway, penetrating neck trauma, and fractures of the craniofacial skeleton. 3) Select the safest and most effective treatment option for challenging head and neck trauma cases presented to the audience.

Abusive head trauma in young children in the Netherlands: evidence for multiple incidents of abuse

We investigated the prevalence of risk factors for and the prevalence of prior abuse in abusive head trauma victims in the Netherlands. We performed a retrospective file review of all abusive head trauma cases in the Netherlands in which forensic medical expertise was requested by the courts, between 2005 and 2010. Outcome measures were risk factors and indicators for prior abuse. Eighty-nine cases were included; 62% boys, median age 3.5months. Impact trauma was found in 48% of cases, with a male perpetrator in 79%. Prematurity, dysmaturity and twins/triplets were found in 27%, 23% and 10% of cases, respectively, maternal age under 20years in 17%. Of the parents, 60% had completed only primary or secondary education, 38% of the families were known to child welfare authorities. There was evidence for prior abuse in 81% of the cases. The high number of families with prior abuse indicates that both the healthcare system and child welfare authorities failed to protect some of the children that have been in their care. Our results highlight the importance of training healthcare and child welfare professionals in recognizing physical abuse, as well as the importance of optimizing abusive head trauma prevention strategies.

Incidence of Retinal Hemorrhages in Abusive Head Trauma

To evaluate whether a relationship exists between the presence of retinal hemorrhages and confessions and/or identified perpetrators in cases of abusive head trauma. A retrospective chart review was conducted of all abusive head trauma cases. All cases that met criteria for abusive head trauma were placed into one of three categories: perpetrator confessed (category A), perpetrator identified without confession (category B), and no perpetrator identified (category C). Forty-eight cases met the criteria for abusive head trauma, with 18, 16, and 14 cases in categories A, B, and C, respectively. Retinal hemorrhages were identified in 16 of 18 (88%) cases in category A, 12 of 16 (75%) in category B, and 6 of 14 (43%) in category C. A statistically significant difference regarding the presence of retinal hemorrhages was seen for perpetrator identified (28 of 34 or 82%) compared to no perpetrator identified (6 of 14 or 43%) (P = .034). The difference in retinal hemorrhages was correlated to the higher incidence of acute presentation in the perpetrator identified group (31 of 34 or 91%) compared to that in the perpetrator not identified group (9 of 14 or 64%) (P = .023). The incidence of retinal hemorrhages in abusive head trauma for identified perpetrators, regardless of a confession, is similar. However, there is a statistically significant decrease in the incidence of retinal hemorrhages in abusive head trauma when comparing identified perpetrators to non-identified perpetrators. This decreased incidence of retinal hemorrhages was statistically correlated to a lower incidence of acute presentation in victims of abusive head trauma without an identified perpetrator.[J Pediatr Ophthalmol Strabismus 2013;50(3):169-172.].

Significance of computed tomography scans in head injury

Background: In view of the growing population and increased vehicle use, traumatic brain injury is becoming the most common and devastating problem especially in young healthy people. It has occupied second place next to cancer as leading cause of death. In this new era of radiology, computed tomography has become the primary modality of choice in the initial assessment of head injury patients as it is widely available, faster and highly accurate in detecting skull fractures and acute intracranial hemorrhage. Aim: It is to demonstrate the importance of ct scanning in the initial treatment planning, follow up and long term management of patients with acute head injury of varying severity. Patients: A retrospective study has been carried out of 100 cases of acute head trauma with positive CT scanning referred to Narayana medical college and hospital, Nellore, India between 30th April 2012 to 1st May 2013 [1 year retrospective study]. Results: The post traumatic intracranial consequences have been collected, reviewed and analyzed, where in 82% of cases males were involved , and most of the injured people belong to the first three decades of life, the main cause being road traffic accident which is growing in incidence in this 21st century. Most of the cases which were studied showed skull fractures, which indicates that there has been significant trauma and in a single case more than one pathology related to cranium has been seen. The most common post traumatic consequences found in the study of adults are contusions, brain edema and intracerebral hematomas, while other sequelae such as subarachnoid hematomas, subdural hematomas and extradural hematomas are encountered less. Diffuse and focal cerebral edema was being the most common pathology following trauma in children. Conclusion: CT scanning is the primary modality of choice in the diagnostic work up of patients with acute head trauma for identifying the various intracranial consequences following head injury especially within 48 hours which helps in the initial assessment, treatment planning, follow up and long term management of patients.

Extramedullary Hematopoiesis in Abusive Head Trauma

was observed in an otherwise clear cut case of abusive head trauma with bilateral retinal hemorrhage, optic nerve sheath hemorrhage and peripapillary intrascleral hemorrhage. Review of 60 archival cases of suspected abusive head trauma identified two more examples of extramedullary hematopoiesis in abusive head trauma that initially had been diagnosed as uveitis. Extramedullary hematopoiesis of the choroid may have a relation to premature birth, possible anemia or may be a reaction to intraocular bleeding due to earlier trauma. Choroidal extramedullary hematopoiesis may easily be confused for choroiditis and interpreted as a sign of infectious disease. Awarenes of the possibiliy of extramedullary hematopoiesis of the choroid should prevent misdiagnosis.

A case of head trauma found after treatment of acute myocardial infarction

A case of head trauma found after treatment of acute myocardial infarction