Role of coagulopathy in patients with head trauma.

Coagulation disorders are a well known complication in patients with head injuries. A prospective study was undertaken to determine the incidence and prognostic value of haemostatic abnormalities in this group of patients. Clotting mechanisms in 105 patients with an isolated head injury were evaluated using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APPT), thrombin clotting time (TCT), plasma fibrinogen concentration (Fib), level of fibrin-fibrinogen degradation products (FDP) and increased consumptive coagulopathy grade (ICCG) in the first 24 h after injury. The clinical severity of the head injuries was represented by the post-resuscitation Glasgow coma score (GCS) divided into four coma groups (CG). Test results were compared between two outcome groups of patients: discharged and dead. The incidence of disseminated intravascular coagulation (DIC) by laboratory criteria in the two groups was 12% and 38%, respectively. The differences between mean values of the discharged and dead patients for GCS, APTT, FDP and ICCG were statistically significant (P < 0.001). There was a very strong correlation between the GCS and values of the FDP, APTT, TCT and ICCG (P < 0.01). Stepwise logistic regression analysis demonstrated that GCS, FDP level, and ICCG predicted outcome in 84% of cases. Other tests did not provide additional predictive value. We conclude that evaluation of coagulation and fibrinolysis in patients with head injuries is not only important in identifying the occurrence of coagulopathy, but also useful in predicting head injury outcome.

Surgical treatment of acute subdural hygroma in children.

During the years 1967-1984, 91 children were operated on because of acute compressive traumatic intracranial hematoma: 16 (17%) had traumatic acute subdural hygromas. These were unilateral in 12 cases and bilateral in 4. The causes of injury were traffic accidents in 11 children, a fall in 1, and acute deceleration injuries in 5. Nine children suffered multiple injuries to the thorax, inferior extremities, and pelvis. Clinical manifestations and evolution of clinical symptoms included changes in conscious level, palsy, high fever, nystagmus, maximum dilation of either pupil and spontaneous, irregular breathing. The diagnosis was made on the basis of the clinical picture and supplementary clinical investigations: CT, EEG, echoencephalography, isotope cisternography, and arteriography. Treatment was by simple trephination of the cranium and evacuation of hygromatous liquid. All children survived the surgical treatment; 1 child died after the operation and 2 developed hydrocephalus.

Surgical treatment of intraventricular meningiomas in childhood.

In the last ten years (1973-1983) we operated and followed up 6 patients with intraventricular meningiomas, of these 4 were children and 2 adults. In 3 of the children the meningiomas occupied the lateral ventricles and were attached to the choroid plexus and the medial brain structures. The fourth childhood tumor was localized in the posterior third of the third ventricle. The first three children were operated by the established procedure for ventricular tumors, while the fourth was subjected to the procedure of Cl. Lapras (Lyon, France) for meningiomas and other tumors in the posterior part of the third ventricle. All four children survived the procedure. In the follow-up period they showed normal mental and physical development.

[Voluminous intraventricular hydatid cysts in children]. / Kystes hydatiques intraventriculaires volumineux chez l'enfant.

During the last 10 years (1973-1982), we have surgically treated 9 children for large echinococcus cysts with intraventricular localization. In 7 cases the cysts were localized in lateral ventricles and in 2 cases in IVth ventricle and cerebellum. The children were from 3 to 11 years old. All cases were with signs of mental retardation and immediately before surgical treatment with signs of brain incarceration. In 7 children there was a disorder of consciousness, from drowsiness to deep sleep. The treatment was conducted with two surgical methods. All children survived the surgical treatment.

Surgical treatment of spinal lipomas in infancy and childhood.

The clinical course and surgical treatment of 48 children with lipomatous lesions of spinal dysraphism are presented. Preoperative studies consisted of complete neurological examination, IVP, myelography and CT scan if indicated. The complete clinical course and surgical treatment of the children with lipomatous lesions of the lower spine is reviewed. The surgical aim was to free all intra- and extradural adhesions by dural grafting if necessary. The results of surgical treatment are dependent upon the time of treatment (as early as possible), the location and extent of the malformation and the quality of surgical treatment.

[Diagnosis and surgical treatment of endocranial compressive hemorrhage]. / Dijagnostika i hirursko lecenje endokranijalnih kompresivnih krvavljenja.

Authors present results of diagnosis at surgical treatment of 122 patients with compressive intracranial haemorrhages, observed and treated in the course of last five years. All patients have been admitted and treated at the Department for intensive care of patients, and have been under care of one neurosurgeon and anestetists duty and radiologists. 18 patients had chronical subdural haematoma, and 104-patients had acute compressive intracranial haemorrhages: epidural, subdural and intracerebral, one more haemorrhages in the same patient, hygromas, and sclopetar wounds with fast evolution. Out of 104 patients, 25 died (mortality rate 24%), and 26 patients died out of 122 patients (mortality rate being 21,3%). Authors enphesize the value of eho-encefalography and CAT of brain in the manengement of compressive inte cranial haemorrhages in the state of peace and in the state of war.