Asunto(s)
Enfermedades del Oído , Hemorragia , Fractura Craneal Basilar , Humanos , Enfermedades del Oído/diagnóstico , Enfermedades del Oído/diagnóstico por imagen , Enfermedades del Oído/etiología , Hemorragia/diagnóstico , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Fractura Craneal Basilar/diagnóstico , Fractura Craneal Basilar/diagnóstico por imagen , Fractura Craneal Basilar/etiología , Oído Medio/diagnóstico por imagen , Masculino , Adolescente , Otoscopía , Accidentes por Caídas , Pérdida Auditiva/etiologíaRESUMEN
OBJECTIVES: To evaluate the specific mechanism and trend of injury resulting in pediatric basilar skull fractures. STUDY DESIGN: Retrospective chart review of a trauma database. SETTING: Tertiary care children's hospital. METHODS: Patients ≤18 years old with basilar skull fractures were identified via the trauma database for admissions from 2007 to 2018. Patients were identified with ICD-9 codes (801.0, 801.1, 801.2, 801.3 or 801.4) and ICD-10 codes (S02.1, S02.10, S02.11, S02.19) for skull base fractures (International Classification of Diseases, Ninth Revision and Tenth Revision). RESULTS: A total of 729 patients were included: 251 females and 478 males. The 2 most common mechanisms of injury are multilevel falls and unhelmeted rider falls. Multilevel falls occur more in the toddler age group (average age, 4 years), and unhelmeted rider falls are seen in the older age group (average age, 11.2 years). Helmeted rider and motor vehicle accident basilar skull injuries are relatively uncommon. There was a spike in television/entertainment center mechanisms of injury in toddlers from 2007 to 2011 but has since decreased. CONCLUSION: Pediatric basilar skull fractures are costly to the health care system, as patients spent more time in intensive care unit beds with a charge limited to hospital rooms between $1.7 and $2.7 million per year. The protective effect of helmets is demonstrated by unhelmeted rider injuries being the second-most common mechanism of basilar skull fractures and by helmeted rider injuries being rare. The small proportion of basilar skull fractures from motor vehicle accidents is an example of policy and behavioral changes resulting in decreased injury.
Asunto(s)
Fractura Craneal Basilar/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Fractura Craneal Basilar/etiología , Factores de TiempoRESUMEN
Basilar fractures are one of the consequences of craniocerebral injury, which is serious enough to cause death. Legal examiners often pay attention to basilar fractures at autopsy and analyze the relationship between them and death. It is noteworthy whether the fracture is premortem or postmortem. Here, we describe a rarely reported case of basilar fracture due to freezing. In this case, a 30-year-old man was frozen (-18°C) for 6 months after death. At autopsy, external examination showed no trauma. However, on internal examination, there was a basilar fracture which caused controversy but turned out to be a postmortem injury. We provide the case description and discussion on antemortem or postmortem basilar fractures as a differential for these cases.
Asunto(s)
Criopreservación , Fractura Craneal Basilar/etiología , Adulto , Humanos , Masculino , Cambios Post Mortem , Fractura Craneal Basilar/patologíaRESUMEN
The skull base is uniquely positioned to absorb force imparted to the craniofacial skeleton, thereby reducing brain injury. Less well understood is the effect of the direction of force imparted to the craniofacial skeleton on the severity of brain injury. Eighty-one patients from two UK major trauma centres who sustained a fronto-basal fracture were divided into two groups: those struck with predominantly anterior force and those by predominantly lateral force. The first recorded Glasgow Coma Score (GCS), requirement for intubation, and requirement for decompressive craniectomy were used as markers of the severity of brain injury. An average GCS of 5 was found in the lateral group and 14 in the anterior group; this difference was statistically significant (P<0.001). There was an increased need for both intubation and decompressive craniectomy in the lateral group compared to the anterior group (absolute risk difference 46.6% and 15.8%, respectively). These results suggest that the skeletal anatomy of the fronto-basal region influences the severity of head injury. The delicate lattice-like structure in the central anterior cranial fossa can act as a crumple zone, absorbing force. Conversely in the lateral aspect of the anterior cranial fossa, there is a lack of collapsible interface, resulting in an increased energy transfer to the brain.
Asunto(s)
Lesiones Encefálicas/etiología , Craniectomía Descompresiva , Hueso Frontal/lesiones , Puntaje de Gravedad del Traumatismo , Base del Cráneo/lesiones , Fracturas Craneales/etiología , Adulto , Fenómenos Biomecánicos , Fosa Craneal Anterior , Femenino , Hueso Frontal/cirugía , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Base del Cráneo/cirugía , Fractura Craneal Basilar/etiología , Fractura Craneal Basilar/cirugía , Fracturas Craneales/cirugía , Reino Unido , Adulto JovenRESUMEN
The combination of abducens nerve palsy and ipsilateral Horner syndrome was first described by Parkinson and considered as a localizing sign of posterior cavernous sinus lesions. The authors present a case with right abducens nerve palsy with ipsilateral Horner syndrome in a patient with carotid-cavernous fistula because of head trauma. The patient was referred to the ophthalmology clinic with diplopia complaint after suffering a head trauma during a motorcycle accident. Cerebral angiography showed low-flow carotid-cavernous fistula.
Asunto(s)
Enfermedades del Nervio Abducens/etiología , Fístula del Seno Cavernoso de la Carótida/etiología , Traumatismos Craneocerebrales/complicaciones , Síndrome de Horner/etiología , Parálisis/etiología , Accidentes de Tránsito , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Angiografía Cerebral/métodos , Humanos , Masculino , Motocicletas , Fractura Craneal Basilar/etiología , Adulto JovenRESUMEN
It is a well-documented fact that pontomedullary lacerations (PML) occur as a result of severe craniocervical injury, but their underlying mechanism has yet to be fully clarified. The aim of this prospective study has been to give greater insight into the underlying mechanism of PML through determining the site of blunt head-impact, as well as the presence of concomitant head and neck injuries in cases of brainstem PML. A total of 56 cases with partial PML have been analysed for this study. The case group was composed of 40 men and 16 women, averaging in age 44.2 ± 19.2 years and consisting of 7 motorcyclists, 4 bicyclists, 18 car occupants, 16 pedestrians, and 10 victims of falls from a height, as well as 1 victim of a fall from standing height. The presented study has shown that there are several possible mechanisms of PML. Impact to the chin, with or without a skull base fracture, most often leads to this fatal injury, due to the impact force transmission either through the jawbone or vertebral column; most likely in combination with a fronto-posterior hyperextension of the head. Additionally, lateral head-impacts with subsequent hinge fractures and PML may also be a possible mechanism. The jawbone and other facial bones are able to act as shock absorbers, and their fracture may diminish the energy transfer towards the skull and protect the brain and brainstem from injury. The upper cervical spine can act as damper and energy absorber as well, and may prevent any occurrence of fracture to the base of the skull.
Asunto(s)
Traumatismos Craneocerebrales/patología , Patologia Forense , Laceraciones/patología , Bulbo Raquídeo/lesiones , Traumatismo Múltiple , Traumatismos del Cuello/patología , Puente/lesiones , Heridas no Penetrantes/patología , Accidentes por Caídas/mortalidad , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Causas de Muerte , Vértebras Cervicales/lesiones , Distribución de Chi-Cuadrado , Traumatismos Craneocerebrales/etiología , Traumatismos Craneocerebrales/mortalidad , Femenino , Patologia Forense/métodos , Humanos , Laceraciones/etiología , Laceraciones/mortalidad , Masculino , Fracturas Mandibulares/etiología , Fracturas Mandibulares/patología , Persona de Mediana Edad , Traumatismos del Cuello/etiología , Traumatismos del Cuello/mortalidad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Serbia , Fractura Craneal Basilar/etiología , Fractura Craneal Basilar/patología , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/patología , Heridas no Penetrantes/etiología , Heridas no Penetrantes/mortalidad , Adulto JovenAsunto(s)
Hueso Etmoides/lesiones , Traumatismo Múltiple , Procedimientos Neuroquirúrgicos/métodos , Fractura Craneal Basilar/diagnóstico por imagen , Heridas por Arma de Fuego/diagnóstico por imagen , Accidentes Domésticos , Niño , Hueso Etmoides/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Fractura Craneal Basilar/etiología , Fractura Craneal Basilar/cirugía , Tomografía Computarizada por Rayos X , Índices de Gravedad del Trauma , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/cirugíaRESUMEN
140 patients with fractures of the upper jaw have been observed regarding terms of their admission to special department in the hospital, age, sex, and reasons of damages. The ration of fractures of the upper jaw to damages of other bones of facing part of the skull and soft tissues, as well complications from it have been studied.
Asunto(s)
Accidentes Domésticos , Accidentes de Tránsito , Huesos Faciales/lesiones , Fracturas Maxilares/diagnóstico , Traumatismo Múltiple/diagnóstico , Fractura Craneal Basilar/diagnóstico , Accidentes Domésticos/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Fracturas Maxilares/epidemiología , Fracturas Maxilares/etiología , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/etiología , Fractura Craneal Basilar/epidemiología , Fractura Craneal Basilar/etiología , Adulto JovenRESUMEN
INTRODUCTION: Battle's sign is a classical clinical sign that has long been held to be synonymous with fracture of the basal skull. As such the presence of Battle's sign is a strong indicator that a basal skull fracture could be present in the head injured patient, as exemplified by its inclusion as a major risk factor in scoring systems designed to assess the likelihood of basal skull fracture. DISCUSSION: We present a case that describes the occurrence of this classic clinical sign in an unlikely setting and, for the first time since it was described more than 120 years ago, re-examine the pathologic basis for its appearance.
Asunto(s)
Trastornos de la Coagulación Sanguínea/etiología , Edema Encefálico/complicaciones , Encefalopatía Hepática/complicaciones , Fractura Craneal Basilar/etiología , Anciano , Edema Encefálico/diagnóstico por imagen , Reacciones Falso Positivas , Femenino , Humanos , Examen Físico , Fractura Craneal Basilar/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The authors describe a 25-year old patient with blunt trauma-induced bilateral, distal segment internal carotid artery (ICA) lacerations, resulting in a left-sided direct carotid-cavernous sinus fistula (CCF) and presenting with massive oronasal bleeding. The combination of severe oronasal bleeding, with air in the carotid canal should alarm the treating physician to the presence of a distal internal carotid artery laceration.
Asunto(s)
Traumatismos de las Arterias Carótidas/etiología , Seno Cavernoso/lesiones , Malformaciones Vasculares del Sistema Nervioso Central/etiología , Embolia Aérea/etiología , Traumatismos Cerrados de la Cabeza/complicaciones , Base del Cráneo/lesiones , Accidentes de Tránsito , Adulto , Ciclismo , Traumatismos de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna/patología , Arteria Carótida Interna/fisiopatología , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Malformaciones Vasculares del Sistema Nervioso Central/fisiopatología , Angiografía Cerebral , Embolia Aérea/diagnóstico , Embolia Aérea/fisiopatología , Embolización Terapéutica , Epistaxis/etiología , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/lesiones , Huesos Faciales/patología , Resultado Fatal , Humanos , Laceraciones/diagnóstico , Laceraciones/etiología , Laceraciones/fisiopatología , Masculino , Boca/fisiopatología , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/lesiones , Senos Paranasales/patología , Valor Predictivo de las Pruebas , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Fractura Craneal Basilar/diagnóstico por imagen , Fractura Craneal Basilar/etiología , Fractura Craneal Basilar/patología , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
The incidence of basilar skull fractures and their clinical and prognostic aspects were studied in victims with varying severity of brain injury. Of 947 cases, 449 (46%) patients were diagnosed as having basilar skull fracture and 181 (18.6%) had basal spinal fluid leakage. The frequency of fractures and basal spinal fluid leakage increased in proportion to the severity of brain injury. The above 14-day history of spinal fluid leakage was an absolute indication for surgical fistula closure.
Asunto(s)
Otorrea de Líquido Cefalorraquídeo/etiología , Fractura Craneal Basilar/etiología , Adolescente , Adulto , Otorrea de Líquido Cefalorraquídeo/epidemiología , Otorrea de Líquido Cefalorraquídeo/cirugía , Niño , Preescolar , Personas con Discapacidad/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Meningitis/etiología , Pronóstico , Estudios Retrospectivos , Fractura Craneal Basilar/epidemiología , Fractura Craneal Basilar/cirugíaRESUMEN
We present a case of clival and sellar complex fracture produced by an indirect mechanism. This previously healthy patient had an occipital trauma followed by epistaxis. CT showed a clival and sellar fracture with pneumatocephalus. The probable fracture mechanism was contre-coup injury, linked to cerebral shock-wave transmission. This type of fracture is generally observed in the anterior part of the skull base, in a low resistance area. Severe osteoporosis probably accounted for the unusual fracture site in this patient. A mechanism of direct clival transmission is discussed, together with the usual complications of sphenoid injuries.
Asunto(s)
Traumatismos Cerrados de la Cabeza/complicaciones , Neumocéfalo/diagnóstico , Neumocéfalo/etiología , Silla Turca/lesiones , Fractura Craneal Basilar/diagnóstico , Fractura Craneal Basilar/etiología , Anciano , Epistaxis/etiología , Femenino , Humanos , Osteoporosis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
A woman who was the lap/shoulder belt-restrained driver of a car equipped with a full-size air bag was involved in an oblique frontal collision with a tractor-trailer combination. She was extremely out of position, i.e., witnessed to be slumped over the steering wheel before impact. This preimpact positioning led to fatal injuries resulting from the inflating air bag. Postmortem examination showed an unusual partial ring fracture of the base of the skull, which to the authors' knowledge has not previously been reported.