Traumatic Cerebral Infarction Research Articles

Application of artificial hibernation technology in acute brain injury.

Controlling intracranial pressure, nerve cell regeneration, and microenvironment regulation are the key issues in reducing mortality and disability in acute brain injury. There is currently a lack of effective treatment methods. Hibernation has the characteristics of low temperature, low metabolism, and hibernation rhythm, as well as protective effects on the nervous, cardiovascular, and motor systems. Artificial hibernation technology is a new technology that can effectively treat acute brain injury by altering the body's metabolism, lowering the body's core temperature, and allowing the body to enter a state similar to hibernation. This review introduces artificial hibernation technology, including mild hypothermia treatment technology, central nervous system regulation technology, and artificial hibernation-inducer technology. Upon summarizing the relevant research on artificial hibernation technology in acute brain injury, the research results show that artificial hibernation technology has neuroprotective, anti-inflammatory, and oxidative stress-resistance effects, indicating that it has therapeutic significance in acute brain injury. Furthermore, artificial hibernation technology can alleviate the damage of ischemic stroke, traumatic brain injury, cerebral hemorrhage, cerebral infarction, and other diseases, providing new strategies for treating acute brain injury. However, artificial hibernation technology is currently in its infancy and has some complications, such as electrolyte imbalance and coagulation disorders, which limit its use. Further research is needed for its clinical application.

Predictive factors for bone flap infection after cranioplasty

Bone flapinfection is often experienced as a complication of cranioplasty.The aim of this study was to investigate predictors of graft infection,including patient-specific and surgery-specific factors. We retrospectively reviewed cases at our institutionwho underwent cranioplasty following craniectomyfor traumatic brain injury, epidural hematoma, subdural hematoma, intracranial hemorrhage, cerebral infarction, subarachnoid hemorrhage, arteriovenous malformation, and bone flap infection after craniotomy. A total of 192 patients were included in this analysis.The graft infection rate was 8.3% (16/192).Smoking(odds ratio [OR] 3.09, 95% confidence interval [CI] 1.03–12.24; p = 0.04), allergy (OR 6.15, 95% CI 1.50–17.31; p < 0.01),and body temperature on postoperative day 1(OR 2.57, 95% CI 1.14–5.78; p = 0.02) were found to be independent predictors forgraft infection.Based on receiver operating characteristic analysis, a body temperature on postoperative day 1 higher than 38.0 °C was selected as the optimal cut-off value for predicting infection after cranioplasty. The sensitivity and specificity were 68% and 72%, respectively. Smoking, allergy, and body temperature on postoperative day 1predicted complications leading to graft infection. Patients with a fever of 38 °C or higher on day 1 after cranioplasty should be carefully monitored for graft infection.

TO DEVELOP FORENSIC CRITERIA FOR THE DIFFERENTIAL DIAGNOSIS OF INTRACEREBRAL HEMORRHAGE OF TRAUMATIC AND NON-TRAUMATIC ORIGIN USING MUELLER-MATRIX MICROSCOPY OF LINEAR DICHROISM

Differential diagnosis of intracerebral hemorrhage due to traumatic and non-traumatic origin is a challenging issue, especially in the absence of visible body injuries and other signs of violence. For a forensic expert-practitioner, the main thing is objectivity, accuracy, and speed of obtaining the result, which could fully satisfy the methods of laser polarimetry in the case of differential diagnosis of hemorrhages of traumatic and non-traumatic origin in the human brain matter.&#x0D; The purpose: To develop forensic criteria for the differential diagnosis of intracerebral hemorrhage of traumatic and non-traumatic origin using Mueller-matrix microscopy of linear dichroism.&#x0D; Materials and methods: The object of the study was brain matter samples, collected in 115 corpses of both sexes aged 22 to 86 years with accurately known causes of death. The causes of death included coronary artery disease, traumatic brain hemorrhage, ischemic brain infarction, and non-traumatic brain hemorrhages. Brain matter samples have been frozen rapidly, and histological sections have been made using a freezing microtome. The slices have been evaluated using the method of azimuthal-invariant Mueller-matrix microscopy, followed by mathematical and statistical processing of the results. &#x0D; Results: significant topographic heterogeneity of Mueller-matrix invariants of brain matter samples linear dichroism maps among all research groups have been found. Individual and significant variations of dispersion, asymmetry, and kurtosis magnitude have confirmed the heterogeneity of Mueller-matrix invariants. The difference of images and histograms among groups is explained by the presence of necrotic changes in the case of ischemic brain necrosis and blood cells in the brain matter samples. For the set of central statistical moments of the 1st, 3rd, and 4th orders, which characterize the distributions of circular dichroism, the method of MM-microscopy in the differentiation of samples of non-hemorrhage and hemorrhage groups reaches a satisfactory level - 78% - 84%.&#x0D; Conclusions: Brain matter samples Muller-matrix microscopy of linear dichroism is effective for solving diagnostic problems of forensic medicine related to evaluating the cause of death from intracerebral hemorrhage of various origins. Diagnostic efficiency of Mueller-matrix mapping of polarization manifestations of linear dichroism method for intergroup differentiation of samples of deaths from traumatic hemorrhage (Group 2) and ischemic cerebral infarction (Group 3) reaches a satisfactory level of 79 - 84%.

Use of azimuthal-invariant Mueller-matrix images of linear dichroism of histological sections of brain substance for diagnosis of hemorrhage genesis

Differential diagnosis of the cause of death (CD) from ischemic cerebral infarction (ICI), hemorrhages of traumatic (HTG) and non-traumatic (HNG) genesis exclude the violent nature of death. The aim of our work was to develop forensic criteria for hemorrhage differentiation of traumatic and non-traumatic genesis and ICI by azimuthal-invariant Mueller-matrix images of linear dichroism of histological sections of brain substance (HBS). For the study were used native sections of HBS from 130 corpses in the case of: death from coronary heart disease – 40 of native sections (group 1 – control); HTG – 30 sections (group 2), ICI – 30 native sections (group 3), HNG – 30 native sections (group 4). Measuring the coordinate allocation meanings of parameters of polarization in the points of microscopic images was carried out at the location of the standard stokes-polarimeter. The effectiveness of intergroup differentiation of samples of deaths from traumatic hemorrhage and ischemic cerebral infarction reaches a satisfactory level and is 76-83%. Efficiency between group differentiation of samples of deaths from nontraumatic and traumatic hemorrhages reaches a satisfactory level and is 75-82%. As for differentiation between ischemic cerebral infarction and nontraumatic hemorrhages thise method is ineffective.

Clinical and imaging features of cerebral infarction in children

To summarize and analyze the etiology, clinical manifestations and imaging features of children with cerebral infarction. A retrospective analysis was performed for the clinical data of 54 children with cerebral infarction, including etiology, clinical manifestations, distribution of infarcts, type of infarcts and clinical outcome. Of the 54 children, 93% had a clear cause, among whom 46% had the coexistence of multiple factors, and the top three causes were infection (54%), vascular disease (40%) and trauma (26%). Major clinical manifestations included limb paralysis (85%), pyrexia (20%), disturbance of consciousness (19%) and convulsion (17%). As for the location of infarcts, 80% of the infarcts were located in the cerebral cortex and 52% in the basal ganglia. Major types of infarcts were small-area infarcts (74%) and multifocal infarcts (56%). Viral encephalitis was the most common cause of cerebral infarction caused by infection, with the cerebral cortex as the most common location of infarcts (21/23, 91%) and multiple infarcts as the most common type of infarcts (13/23, 57%). Among the 12 children with cerebral infarction caused by nonspecific endarteritis, 10 (83%) had infarcts located in the basal ganglia and only one child had multiple infarcts. Among the five children with cerebral infarction caused by moyamoya disease, four children (80%) had infarcts located in the cerebral cortex, and large-area infarction (4/5, 80%) and multifocal infarction (4/5, 80%) were the major types of infarcts. Among the children with traumatic cerebral infarcts, 92% had infarcts located in the basal ganglia, and small-area infarcts (92%) and single infarcts (85%) were the major types of infarcts. Among the 46 children with limb paralysis, 34 (74%) had infarcts located in the basal ganglia; 50% of the children with disturbance of consciousness had infarcts located in the basal ganglia. Subcortical infarcts were observed in all six children with epilepsy. Seventy-five percent of the infarcts located in the cerebral cortex and 87% of the infarcts located in the basal ganglia had a good prognosis. Among the two children with cerebral infarcts located in the brainstem, one had the sequela of hemiplegia and the other had the sequela of cognitive impairment. Eighty-eight percent of the children with cerebral infarction caused by infection and 82% of the children with traumatic cerebral infarction tended to have a good prognosis, and 83% of the children with cerebral infarction caused by nonspecific endarteritis had good prognosis. Recurrence was observed in all three children with cerebral infarction caused by vascular malformations. Of the five children with cerebral infarction caused by moyamoya disease, one child died and four children survived with the sequela of localized brain atrophy, among whom one child also had the sequela of epilepsy. Infection, vascular disease and trauma are the most common causes of cerebral infarction in children, and limb paralysis is the most common clinical manifestation. Cerebral cortex is the most common infarct site, and small-area infarcts and multifocal infarcts are the most common types of infarcts, which tend to have a better prognosis.

Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report

BackgroundSubdural effusion with hydrocephalus (SDEH) is a rare complication of traumatic brain injury, especially following decompressive craniectomy (DC) for posttraumatic cerebral infarction. The diagnosis and treatment are still difficult and controversial for neurosurgeons.Case presentationA 45-year-old man developed traumatic cerebral infarction after traumatic brain injury and underwent DC because of the mass effect of cerebral infarction. Unfortunately, the complications of traumatic subdural effusion (SDE) and hydrocephalus occurred in succession following DC. Burr-hole drainage and subdural peritoneal shunt were performed in sequence because of the mass effect of SDE, which only temporarily improved the symptoms of the patient. Cranioplasty and ventriculoperitoneal shunt were performed ultimately, after which SDE disappeared completely. However, the patient remains severely disabled, with a Glasgow Outcome Scale of 3.ConclusionsIt is important for neurosurgeons to consider the presence of accompanying hydrocephalus when treating patients with SDE. Once the diagnosis of SDEH is established and the SDE has no mass effect, timely ventriculoperitoneal shunt may be needed to avoid multiple surgical procedures, which is a safe and effective surgical method to treat SDEH.

Risk factors of post traumatic cerebral infarction after craniotomy for severe traumatic brain injury

Objective To investigate the risk factors associated with post traumatic cerebral infarction (PTCI) after craniotomy hematoma evacuation for severe traumatic brain injury (sTBI) so as to provide clinical reference for the early prevention of postoperative PTCI. Methods A retrospective case control study was conducted to analyze the clinical data of 558 sTBI patients who received craniotomy hematoma evacuation admitted to Changsha Hospital of Traditional Chinese Medicine from October 2006 to June 2016. There were 340 males and 218 females, aged 15-71 years, with an average of 47.8 years. Among them, 75 patients were at the age of less than 30 years, 315 were at 30-50 years, and 168 were above 50 years. According to the Glasgow coma score (GCS), there were 127 patients with 3-4 points, 124 with 5-6 points, and 307 with 7-8 points. The patients were divided into PTCI group (51 patients) and non-PTCI group (507 patients). The related indicators of the two groups of patients after admission were collected, including gender, age, injury cause, GCS, skull base fracture, traumatic subarachnoid hemorrhage (tSAH), cerebral hernia, hypotension, the time from injury to craniotomy, and whether decompressive craniectomy was performed. Univariate analysis was first performed for these factors, followed by multivariate logistic regression analysis. Results There were no significant differences in gender, age, injury cause, skull base fracture, and decompressive craniectomy between PTCI group and control group (P>0.05). In the PTCI group, there were 29 patients with GCS of 3-4 points, 17 with 5-6 points, and five with 7-8 points; there were 48 patients with tSAH, 37 patients with cerebral hernia, and 18 patients with hypotension. In terms of the time from injury to craniotomy, it took 12 hours in four. In the non-PTCI group, there were 98 patients with GCS of 3-4 points, 107 with 5-6 points, and 302 with 7-8 points. There were 34 patients with tSAH, 117 with cerebral hernia, and 35 with hypotension. In terms of the time from injury to craniotomy, it took 12 hours in 15. The differences between the two groups were statistically significant (P<0.05). Multivariate logistic regression analysis indicated that GCS of 3-6 points, tSAH, cerebral hernia, time from injury to craniotomy, and hypotension were significantly associated with PTCI after operation for sTBI (P<0.01). Conclusions GCS of 3-6 points, tSAH, cerebral hernia, duration from injury to craniotomy, and hypotension time >3 hours are the high risk factors of PTCI in sTBI patients after craniotomy. For patients with these high risk factors, craniotomy should be performed in time, and the perioperative blood pressure and intracranial pressure stability should be maintained so as to relieve vasospasm. Key words: Brain injuries; Decompressive craniectomy; Cerebral infarction; Hypotension

Head Rules Over the Heart: Cardiac Manifestations of Cerebral Disorders.

ABSTRACTThe Brain-Heart interaction is becoming increasingly important as the underlying pathophysiological mechanisms become better understood. “Neurocardiology” is a new field which explores the pathophysiological interplay of the brain and cardiovascular systems. Brain-heart cross-talk presents as a result of direct stimulation of some areas of the brain, leading to a sympathetic or parasympathetic response or it may present as a result of a neuroendocrine response attributing to a clinical picture of a sympathetic storm. It manifests as cardiac rhythm disturbances, hemodynamic perturbations and in the worst scenarios as cardiac failure and death. Brain-Heart interaction (BHI) is most commonly encountered in traumatic brain injury and subarachnoid hemorrhage presenting as dramatic electrocardiographic changes, neurogenic stunned myocardium or even as ventricular fibrillation. A well-known example of BHI is the panic disorders and emotional stress resulting in Tako-tsubo syndrome giving rise to supraventricular and ventricular tachycardias and transient left ventricular dysfunction.In this review article, we will discuss cardiovascular changes caused due to the disorders of specific brain regions such as the insular cortex, brainstem, prefrontal cortex, hippocampus and the hypothalamus; neuro-cardiac reflexes namely the Cushing's reflex, the Trigemino-cardiac reflex and the Vagal reflex; and other pathological states such as neurogenic stunned myocardium /Takotsubo cardiomyopathy. There is a growing interest among intensivists and anesthesiologists in brain heart interactions as there are an increasing number of cases being reported and there is a need to address unanswered questions, such as the incidence of these interactions, the multifactorial pathogenesis, individual susceptibility, the role of medications, and optimal management.Key MessagesBHI contribute in a significant way to the morbidity and mortality of neurological conditions such as traumatic brain injury, subarachnoid hemorrhage, cerebral infarction and status epilepticus. Constant vigilance and a high index of suspicion have to be exercised by clinicians to avoid misdiagnosis or delayed recognition. The entire clinical team involved in patient care should be aware of brain heart interaction to recognize these potentially life-threatening scenarios.How to cite this articleHrishi AP, Lionel KR, Prathapadas U. Head Rules Over the Heart: Cardiac Manifestations of Cerebral Disorders. Indian J Crit Care Med 2019;23(7):329–335.

Effects of mild hypothermia in secondary brain injury in patients with severe brain injury

Objective To evaluate the effect of mild hypothermia combined with hypbaric oxygen (HBO) treatment on secondary brain injury in patients with severe craniocerebral injury. Methods A prospective study was conducted in this study. Forty-two patients with severe craniocerebral injury admitted to hospital within 8 hours were randomly divided into sub-hypothermia combined with HBO treatment group and conventional HBO control group, 21 cases in either group. Cerebral hemorrhage and brain edema were calculated by reviewed head CT on the 1st day, 15th day and 30th day after injury. GCS (Glasgow Coma Scale) score was calculated at the same time. The number of cases of cerebral infarction was counted in the two groups. GOS (Glasgow Outcome Score) prognosis was scored for both groups of patients six months after injury. Two groups of sample rates were compared using a chi-square test with continuous correction, The intergroup comparisons were analyzed by independent sample t test by using SPSS version 13.0 software.Differences were considered statistically significant if P<0.05. Results (1) The amount of cerebral hemorrhage and edema in the treatment group were significantly lower than those in the control group on the 15th day and 30th day after injury [(21.71±4.3)vs.(26.33±5.23); (14.33±1.93)vs.(16.86±2.86), P<0.05]. (2) The GCS score of the treatment group was higher than that of the control group on the 15th day and 30th day after injury[ (4.62±0.49) vs.(2.49±0.56); (9.76±1.37)vs.(8.57±0.92), P<0.05]; (3) There were 2 cases of traumatic cerebral infarction in the treatment group and 9 cases in the control group (χ2=4.434, P=0.035). The GOS score in the treatment group was higher than that in the control group six months after injury[(4.29±0.84)vs.(3.38±0.74), P=0.001]. Conclusions Mild hypothermia combined with hyperbaric oxygen treatment can reduce the secondary brain injury and improve the prognosis of patients with severe craniocerebral injury. It is worth further study, the mechanism of hypothermia remains to be further studied. Key words: Mild hypothermia; Hyperbaric oxygen; Severe craniocerebral injury; Secondary brain injury; Temperature management; Cerebral infarction; Glasgow Coma Scale; Glasgow Outcome Score

Abstract TP360: Clot Evacuation With or Without Decompressive Craniectomy for Spontaneous Supratentorial Intracerebral Hemorrhage: A Single Center, Prospective, Randomized, Controlled Trial

Introduction: The optimum management for patients with spontaneous intracerebral hemorrhage (ICH) has not been well established. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure, which has been shown to be effective for patients with traumatic brain injury or malignant middle cerebral artery infarction. Some studies suggest that DC following surgical clot evacuation help relieve intracranial pressure and benefit the patients suffered ICH, especially with big hematoma. However some studies indicate that DC may not be essential after the hematoma is surgically evacuated, which induces long hospital stay and a second surgery for cranioplasty. Hypothesis: To compare the effect of clot evacuation with DC or without DC (non-DC) on the outcome of patients with spontaneous supratentorial intracerebral hemorrhage (ICH). Methods: 89 consecutive spontaneous supratentorial ICH patients were randomized into DC or non-DC groups. We compared hematoma volume, operative duration, operation bleeding volume, the intracranial pressure fluctuation, mRS after 3 months, and postoperative complications. Statistical analysis was done using the t-test or Chi-square test, and the odds ratio was calculated. Results: Mean hematoma volume was 51.4±17.5 mL in DC group and 49. 8±14.6 mL in non-DC group. Clot clearance rate was 94.2±4.6% in DC group and 92.6±3.9% in non-DC group. Mean operation duration and bleeding volume in DC group were more than that in Non-DC group. After 3 months, the outcome of DC group was worse than that in non-DC group. Finally, intracranial pressure monitoring showed that intracranial pressure within five days after surgery fluctuated within 8.9∼16.1 mmHg in DC group and within 9.5∼18.9 mmHg in non-DC group (no significant difference). Conclusions: It is not necessary to do decompressive craniectomy in patients with supratentorial ICH when surgically performing hematoma evacuation.

PICCO for patients with severe brain injury complicated with hemorrhagic shock

Objective To study the clinical significance of PICCO for patients with severe brain injury complicated with hemorrhagic shock.Methods 48 patients with severe brain injury complicated with hemorrhagic shock were randomly divided into a treatment group and a control group.The control group took routine neurological treatment or surgical treatment and were infused fluid monitoring center venous pressure (CVP).PICCO was used in the treatment group.The effect of fluid resuscitation,GCS score,time to demachine,incidence of traumatic cerebral infarction,and mortality were compared between the 2 groups.Results One week after the treatment,the treatment group recovered better from hemorrhagic shock than the control group;GCS score was higher in the treatment group than in the control group; the treatment group de-machined earlier than the control group; the incidence of traumatic cerebral infarction and mortality were lower in the treatment group than in the control group; with statistical differences (P ＜ 0.05).Conclusions PICCO for patients with severe brain injury complicated with hemorrhagic shock can decrease the mortality and improve the prognosis. Key words: PICCO; Severe brain injury; Hemorrhagic shock

Age-related brain activity in patients after traumatic brain injury and cerebral infarction

Stroke and traumatic brain injury are disabling diseases that determine the medical and social relevance of the rehabilitation. Age is one of the important risk factors for the development and clinical course of strokes. The aim of this study was to research the features of the restoration of cognitive function and brain activity in patients who underwent ischemic stroke and traumatic brain injury. 72 individuals were examined (43 males and 29 females with a mean age of 37.51 ± 42.97 years). Brain DC potentials were recorded in all patients before and after rehabilitation treatment. Age factor plays an important role in the process of cerebral recovery after brain injury. In patients aged 40 and younger, rehabilitation was connected with increasing activity in the right hemisphere. In patients older than 40 years, the restoration of cerebral function was connected with the activity of the left hemisphere of the brain.

Traumatic entrapment of the anterior cerebral artery: A case report

Traumatic entrapment of the anterior cerebral artery is an xtremely rare clinical entity and only one previous case is reported n the literature [1]. There are reported cases of entrapment of the ertebrobasilar artery in patients with longitudinal clival fractures 2]. In the 12 reported cases of vertebrobasilar artery entrapment, 6% (8/12) were identified at autopsy while the 4 other cases surived but with various neurologic deficits [2]. Traumatic cerebral infarction is rare with an incidence of .2–1.6% most common in the internal carotid artery, followed by he middle cerebral artery and then the vertebral and basilar arteres [3]. Traumatic infarction in the anterior cerebral artery territory s extremely rare. Fractures along the skull base are also known to potentially ause the formation of pseudoaneurysms due to direct vessel wall njury [1,4,5]. We present the extremely rare case of a traumatic ntrapment of the anterior cerebral artery, associated with small seudoaneurysms, along with our treatment strategy.

Traumatic Entrapment of the Anterior Cerebral Artery—A Case Report

Traumatic entrapment of the anterior cerebral artery is an xtremely rare clinical entity and only one previous case is reported n the literature [1]. There are reported cases of entrapment of the ertebrobasilar artery in patients with longitudinal clival fractures 2]. In the 12 reported cases of vertebrobasilar artery entrapment, 6% (8/12) were identified at autopsy while the 4 other cases surived but with various neurologic deficits [2]. Traumatic cerebral infarction is rare with an incidence of .2–1.6% most common in the internal carotid artery, followed by he middle cerebral artery and then the vertebral and basilar arteres [3]. Traumatic infarction in the anterior cerebral artery territory s extremely rare. Fractures along the skull base are also known to potentially ause the formation of pseudoaneurysms due to direct vessel wall njury [1,4,5]. We present the extremely rare case of a traumatic ntrapment of the anterior cerebral artery, associated with small seudoaneurysms, along with our treatment strategy.

Decompressive Craniectomy in Children

Abstract BACKGROUND: Decompressive craniectomy (DC) is performed as a life-saving procedure in patients with intractably increased intracranial pressure after traumatic brain injury, bleeding, cerebral infarction, or brain swelling of other causes. However, the application of DC is as controversial in the pediatric population as it is in adults. OBJECTIVE: To find factors influencing the outcome in pediatric patients who underwent DC because of sustained high intracranial pressure. METHODS: Between April 2000 and December 2009, 34 pediatric patients (age 0-18 years) underwent DC. Patients were stratified according to the indication for DC. Outcome was assessed according to the modified Rankin Scale score at 6 months. MEDLINE was searched for published studies or reports of DC in pediatric patients to gain a larger population. Two reviewers independently extracted data. RESULTS: Literature data, including the current series, revealed a total of 172 pediatric patients. Overall, a favorable outcome was achieved in 106 of 172 patients (62%). A favorable outcome was achieved in 25 of 36 patients without traumatic brain injury vs 81 of 136 patients with traumatic brain injury (69% vs 60%). Patients without signs of cerebral herniation had a better outcome than patients with unilateral or bilateral dilated pupils (73% vs 60% vs 45%, respectively). CONCLUSION: The current data indicate that DC in children with traumatic or nontraumatic brain swelling might be warranted, regardless of the underlying cause. Despite mydriasis, a favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.

Traumatic Cerebral Infarction - Basketball

HISTORY: A 19 year old white male was struck by an elbow in his left neck during a basketball game. He was knocked to the ground but did not lose consciousness or sustain head trauma. He did, however, immediately develop right-sided hemiparesis and dysarthria. His symptoms improved after a short period of time and he went home. The next day the patient still had difficulty speaking and noticed right-sided visual loss. He was taken to the hospital where MRI/MRA of his brain was negative for carotid dissection but did show a left occipital lobe infarct. Subsequent CT angiogram revealed a sub-acute occlusive thrombus in the left posterior communicating artery. The patient was started on intravenous heparin and transferred to a tertiary care center where he was medically stabilized and underwent additional diagnostic testing that confirmed the thrombus and cerebral infarction. PHYSICAL EXAMINATION: His PHYSICAL EXAMINATION was significant for left hemiparesis and ataxia and right homonymous hemianopsia with moderate expressive aphasia, dysarthria and parasphasic errors. He also displayed significant cognitive deficits. DIFFERENTIAL DIAGNOSIS: 1. Vertebral Artery Dissection 2. Cerebral Vascular Accident 3. Epidural Hematoma 4. Traumatic Brain Injury TEST AND RESULTS: VIR arteriography: Slight dilation of the left internal carotid artery without clearly demonstrated dissection. Complete occlusion of the left posterior cerebral artery without partial filling around a clot. Occlusion is complete and posterior cerebral artery was likely fetal, filling from the internal carotid artery. MR angiography neck: Subtle contour abnormality of the left internal carotid artery but no findings to suggest acute dissection. CT head/brain without contrast: Small infarction in the left occipital lobe. FINAL WORKING DIAGNOSIS: Traumatic left posterior cerebral artery thrombosis with occipital lobe infarction. TREATMENT AND OUTCOMES: The patient was treated with intravenous heparin therapy and gradually showed improvement with functional restoration measures including multi-disciplinary therapy and rehabilitation. More rapid recognition of the possibility of this condition in the field of play could lead to potentially improved neurologic outcomes with thrombolytic therapy.

Progress on children traumatic cerebral infarction

There are many causes of children cerebral infarction, including cerebrovascular malformation,autoimmune cerebrovascular phlogistic, infection, trauma and the high state of blood coagulation. Because the brain development is not mature, the children is the high-risk group of traumatic cerebral infarction. The early diagnosis of traumatic cerebral infarctions relies on the dynamic performance of the clinical observation, taking head CT or MRI quickly, especially diffusion-weighted imaging, which is more sensitive on the judgement of acute cerebral infarction period. Common sites of traumatic cerebral infarction are basal ganglia. The infarcts are usually small. Treatment on traumatic cerebral infarction must give priority to non-operation. Early diagnosis and prompt treatment can provide better prognosis than adults. Key words: Children; Craniocerebral injury; Cerebral Infarction

Risk Factors Analysis of Traumatic Cerebral Infarction

Objective To find out risk factors of traumatic cerebral infarction(TCI). Methods 126 cases in severe craniocerebral trauma were analyzed, risk factors of TCI were screened by single factor and Logis-tic regression analysis. Results TCI was found in 47 patients. There was significant difference on low blood pressure, contusion and laceration of brain, subarachnoid hemorrhage, brain herniation, duration of low blood pressure, duration of brain herniation, DM(or duration of blood glucose more than11.1 mmol/L≥24 h), dura-tion of mechanical ventilation after trauma or operation <48 h between TCI group and non-TCI group (P<0.05), Logistic regression analysis of them indicated that contusion and laceration of brain, duration of mechani-cal ventilation after trauma or operation <48 h, duration of low blood pressure, duration of brain hernia were in-dependent risk factors. Conclusion The contusion and laceration of brain, duration of mechanical ventilation after trauma or operation <48 h,low blood pressure and its duration, brain herniation and its duration, subarach-noid hemorrhage, DM (or duration of blood glucose more than11.1 mmol/L≥24 h)were the risk factors of TCI, and the contusion and laceration of brain, duration of mechanical ventilation after trauma or operation <48 h, du-ration of low blood pressure, duration of brain hernia were independent risk factors. Key words: Severe craniocerebral trauma; Traumatic cerebral infarction; Risk factors

Overview of head injury caused by the major earthquake of Wenchuan and the diagnostic value of multi-slice spiral CT

Objective To evaluate the information of head injury caused by the major earthquake of Wenehuan and the diagnostic value of muhi-slice spiral CT(MSCT). Methods A total of 1557 earthquake victims were hospitalized, of which head CT scan was performed in 292 eases, and abnormalities were found in 225 of them. The composition, type of injury and MSCT findings of head injury were retrospectively analyzed. Results CT abnormalities were found in 225 victims, including 66 cases of skull fracture,50 eases of cerebral contusion and laceration, 55 eases of intracranial hematoma, 16 cases of subaraehnoid hemorrhage, 16 eases of subdural collection of fluid,20 eases of foreign substance of scalp,and 2 eases of traumatic cerebral infarction. Operation was performed in 22 of them. Conclusion The incidence of head injury in earthquake was high, and most of them were not severe. The examination of MSCT was rapid, MPR and 3D images can clearly show the lesion of craniocerebral trauma. MSCT can provide more valuable information for clinical therapy in craniecerebral trauma caused by earthquake. Key words: Cranioeerebral trauma; Natural disasters; Tomography, X-ray computed

Evaluation of multislice computed tomographic perfusion imaging and computed tomographic angiography on traumatic cerebral infarction

To evaluate the application value of multislice computed tomographic perfusion imaging (MSCTPI) and multislice computed tomographic angiography (MSCTA) on traumatic cerebral infarction. MSCTA was performed on 10 patients who were initially diagnosed as traumatic cerebral infarction by normal conventional computed tomography (NCCT), among whom, 3 patients were examined by MSCTPI simultaneously. Reconstructed images of the intracranial artery were made with techniques of maximum intensity projection (MIP) and volume rendering (VR) from MSCTA scanning data. Then the graph of function of four parameters, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), and time to peak (TTP), acquired by the perfusing analysis software was obtained. Among the 10 patients with traumatic cerebral infarction, 6 showed complex type on NCCT, which depicted abnormality on MSCTA, and 4 showed simple type on NCCT, which had negative results on MSCTA. Among the 4 patients with abnormal great vessels, 2 suffered from stenosis or occlusion of the middle cerebral artery, 1 from spasm of the anterior cerebral artery, and 1 from spasm of the vertebral-basal artery. The image of MSCTPI of 1 patient with massive cerebral infarction on the right cerebral hemisphere confirmed by CT was smaller than those of the other patients, which showed occlusion of the ipsilateral middle cerebral artery on MSCTA. Among the 6 patients whose MSCTA showed no abnormality, 4 showed simple infarction and 2 showed complex infarction. The infarction focus of 5 patients occurred in the basal ganglia and 1 in the splenium of corpus callosum. Among the 2 cases of small cerebral infarction volume on NCCT, one was normal, the other showed hypoperfusion on MSCTPI and was normal on MSCTA. The combination of MSCTPI and MSCTA is very useful for evaluating the change of intracranial artery in ischemic regions and assessing the cerebral hemodynamic information of traumatic cerebral infarction.