Utility of Routine Surveillance Head Computed Tomography After Receiving Therapeutic Anticoagulation in Patients with Acute Traumatic Intracranial Hemorrhage.

INTRODUCTION: Patients with traumatic intracranial hemorrhage (tICH) are at increased risk of venous thromboembolism and may require anticoagulation. We evaluated the utility of surveillance computed tomography (CT) in patients with tICH who required therapeutic anticoagulation. METHODS: This single institution, retrospective study included adult patients with tICH who required anticoagulation within 4 weeks and had a surveillance head CT within 24 hours of reaching therapeutic anticoagulation levels. The primary outcome was hematoma expansion (HE) detected by the surveillance CT. Secondary outcomes included 1) changes in management in patients with HE on the surveillance head CT, 2) HE in the absence of clinical changes, and 3) mortality due to HE. We also compared mortality between patients who did and did not have a surveillance CT. RESULTS: Of 175 patients, 5 (2.9%) were found to have HE. Most (n = 4, 80%) had changes in management including anticoagulation discontinuation (n = 4), reversal (n = 1), and operative management (n = 1). Two patients developed symptoms or exam changes prior to the head CT. Of the 3 patients (1.7%) without preceding exam changes, each had only very minor HE and did not require operative management. No patient experienced mortality directly attributed to HE. There was no difference in mortality between patients who did and those who did not have a surveillance scan. CONCLUSIONS: Our findings suggest that most patients with tICH who are started on anticoagulation could be followed clinically, and providers may reserve CT imaging for patients with changes in exam/symptoms or those who have a poor clinical examination to follow.

The Effect of 4-Factor Prothrombin Complex Concentrate to Reverse Factor Xa Inhibitors in Patients With Traumatic Intracranial Hemorrhage.

The utility of 4-factor prothrombin complex concentrate (4F-PCC) for reversal in patients on factor Xa inhibitors (XaI) is unclear, specifically in mild traumatic brain injury (mTBI). This is a retrospective review over 6 years at a level 1 trauma center of patients presenting with mTBI on XaI comparing outcomes for those that received 4F-PCC to those that did not. 140 patients were included, 103 (74%) of these patients received 4F-PCC while 37 (26%) did not. There was no significant difference in neurologic decline within 48 hours of admission or need for neurosurgical intervention. Interestingly, there was no difference in ICH progression (16% vs 14%, P = .77). In this study, 4F-PCC given after mild traumatic brain injury did not impact ICH progression, neurologic decline, or need for neurosurgical intervention. Although limited in numbers, this study suggests that 4F-PCC is not necessarily required in mTBI and further studies are indicated.

Traumatic intracranial hemorrhage in pediatrics: Implications of factor XIII deficiency and consumptive coagulopathy in abusive head trauma evaluation.

For infants that present with intracranial hemorrhage in the setting of suspected abusive head trauma (AHT), the standard recommendation is to perform an evaluation for a bleeding disorder. Factor XIII (FXIII) deficiency is a rare congenital bleeding disorder associated with intracranial hemorrhages in infancy, though testing for FXIII is not commonly included in the initial hemostatic evaluation. The current pediatric literature recognizes that trauma, especially traumatic brain injury, may induce coagulopathy in children, though FXIII is often overlooked as having a role in pediatric trauma-induced coagulopathy. We report an infant that presented with suspected AHT in whom laboratory workup revealed a decreased FXIII level, which was later determined to be caused by consumption in the setting of trauma induced coagulopathy, rather than a congenital disorder. Within the Child Abuse Pediatrics Research Network (CAPNET) database, 85 out of 569 (15 %) children had FXIII testing, 3 of those tested (3.5 %) had absent FXIII activity on qualitative testing, and 2 (2.4 %) children had activity levels below 30 % on quantitative testing. In this article we review the literature on the pathophysiology and treatment of low FXIII in the setting of trauma. This case and literature review demonstrate that FXIII consumption should be considered in the setting of pediatric AHT.

Evaluating CAPO®: A biocompatibility, transparency, and fitment assessment for use with CEREBO® in traumatic intracranial injury detection.

Healthcare-associated infections (HAIs) are a global concern affecting millions of patients, requiring robust infection prevention and control measures. In particular, patients with traumatic brain injury (TBI) are highly susceptible to nosocomial infections, emphasizing the importance of infection control. Non-invasive near infrared spectroscopy (NIRS) device, CEREBO® integrated with a disposable component CAPO® has emerged as a valuable tool for TBI patient triage and this study evaluated the safety and efficacy of this combination. Biocompatibility tests confirmed safety and transparency assessments demonstrated excellent light transmission. Clinical evaluation with 598 enrollments demonstrated high accuracy of CEREBO® in detecting traumatic intracranial hemorrhage. During these evaluations, the cap fitted well and moved smoothly with the probes demonstrating appropriate flexibility. These findings support the efficacy of the CAPO® and CEREBO® combination, potentially improving infection control and enhancing intracranial hemorrhage detection for TBI patient triage. Ultimately, this can lead to better healthcare outcomes and reduced global HAIs.

Is reversal of anticoagulants necessary in neurologically intact traumatic intracranial hemorrhage?

INTRODUCTION: Falls are the leading cause of injury in older individuals, with intracranial hemorrhage (ICH) being a common complication. Anticoagulants, such as vitamin K antagonist and direct oral anticoagulants, are increasingly utilized, and clinicians may question the necessity of reversal in patients with minor ICH, especially in the setting of increased risk of adverse events. This study aimed to identify a population of patients with minor traumatic ICH at low risk for poor-neurologic status where anticoagulant reversal may not improve outcomes. METHODS: This retrospective cohort study utilized data accessed from 35 trauma centers from 2018 to 2021. Patients included had a preinjury anticoagulant regimen, ICH due to blunt trauma, Glasgow Coma Scale score of 15, an Abbreviated Injury Scale (AIS) head score from 2 to 4, and an AIS of ≤1 for non-head regions within 24 h of hospital arrival. Patients were excluded if they required an emergent neurosurgical procedure or were on a preinjury purinergic-P2 receptor-12 protein (P2Y12) inhibitor. The primary outcome was the rate of in-hospital mortality or hospice. RESULTS: There were 654 patients on preinjury anticoagulation who were included with a minor traumatic ICH without neurologic deficits. Overall, 263 patients were reversed and 391 were not reversed. Twelve (4.6%) patients with in-hospital mortality or hospice were reversed compared with 19 (4.91%) patients who were not reversed (p = 0.861). A composite of hospital complications occurred in 21 (8%) reversed patients and 34 (8.7%) not reversed patients (p = 0.748). The average intensive care unit length of stay was 1.4 ± 3.4 days in the reversed group and 1.1 ± 1.8 days in the not reversed group (p = 0.069). CONCLUSION: This study found no difference in hospital outcomes between patients with minor traumatic ICH on oral anticoagulants who were neurologically intact that were reversed versus those who were not reversed. Further studies should continue to define the subset of traumatic ICH patients who may not require reversal of anticoagulation.

ECMO in severe trauma patient with intracranial bleeding requiring surgery / ECMO en trauma grave con sangrado intracraneal amenazante que requiere cirugía

No disponible

Expressions of plasma cystatin C, D-dimer and hypersensitive C-reactive protein in patients with intracranial progressive hemorrhagic injury after craniocerebral injury, and their clinical significance / Expressões da cistatina C plasmática, dímero D e proteína C reativa hipersensível em pacientes com lesão hemorrágica progressiva intracraniana após trauma crânio-encefálico e seus significados clínicos

ABSTRACT Objective To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. Methods Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. Results The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). Conclusion The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.

RESUMO Objetivo Investigar as expressões da cistatina C plasmática (Cys-C), dímero-D (D-D) e proteína C-reativa hipersensível (hs-CRP) em pacientes com lesão hemorrágica progressiva intracraniana (IPHI) após lesão craniocerebral e seus significados clínicos. Métodos Quarenta e dois pacientes com IPHI e 20 indivíduos saudáveis (controle) foram incluídos. A gravidade e o resultado do IPHI foram determinados de acordo com a Escala de Coma de Glasgow (GCS) e Escala de Resultados de Glasgow (GOS), e os níveis plasmáticos Cys-C, hs-CRP e D-D foram detectados. Resultados Os níveis plasmáticos de Cys-C, D-D e hs-CRP no grupo IPHI foram significativamente maiores do que no grupo controle (P <0,01). Houve diferença significativa entre os níveis plasmáticos de Cys-C, D-D e hs-CRP entre os diferentes pacientes com IPHI de acordo com a GCS e entre os diferentes pacientes com IPHI de acordo com o GOS, respectivamente (todos P <0,05). Em pacientes com IPHI, os níveis plasmáticos de Cys-C, D-D e hs-CRP foram positivamente correlacionados entre si (P <0,001). Conclusão O aumento dos níveis plasmáticos de Cys-C, D-D e hs-CRP pode estar envolvido no IPHI após trauma crânio-encefálico. A detecção precoce desses índices pode ajudar a entender a gravidade e o resultado do IPHI.

Spinal Subarachnoid Hemorrhage Migrated from Traumatic Intracranial Subarachnoid Hemorrhage / 대한신경손상학회지

Very rarely, spinal subarachnoid hemorrhage (SSAH) can occur without any direct spinal injury in patients with traumatic intracranial SAH. A-59-year-old male with traumatic intracranial subarachnoid hemorrhage (SAH) presented with pain and numbness in his buttock and thigh two days after trauma. Pain and numbness rapidly worsened and perianal numbness and voiding difficulty began on the next day. Magnetic resonance imaging showed intraspinal hemorrhage in the lumbosacral region. The cauda equina was displaced and compressed. Emergent laminectomy and drainage of hemorrhage were performed and SSAH was found intraoperatively. The symptoms were relieved immediately after the surgery. Patients with traumatic intracranial hemorrhage who present with delayed pain or neurological deficits should be evaluated for intraspinal hemorrhage promptly, even when the patients had no history of direct spinal injury and had no apparent symptoms related to the spinal injury in the initial period of trauma.

Hematomas intracraneanos traumáticos y el tipo de intervención quirúrgica efectuada para su tratamiento, en el Servicio de Neurocirugía del Hospital Nacional Dos de Mayo, Lima - Perú periodo 2008 - 2013 / Traumatic intracranial hematomas and the type of surgical intervention effected for its treatment, in the Neurosurgery Service of the National Hospital Dos de Mayo, Lima - Peru period 2008 - 2013

Introducción.- Los Hematomas Intracraneanos Traumáticos son la patología más frecuente del área de Neurotrauma en la especialidad de Neurocirugía, estos Hematomas son lesiones primarias que se producen como consecuencia directa del traumatismo craneoencefálico, sobre las que el médico no tiene ningún tipo de control, es decir son inevitables, su tratamiento es primordial para poder salvar la vida de los afectados. Las diferentes clases de hematomas requieren intervenciones quirúrgicas distintas; conocer el tipo de intervención quirúrgica permite estandarizar el manejo de estos casos y principalmente reducir la morbi-mortalidad de los pacientes. Método.- Estudio descriptivo, observacional, transversal y retrospectivo. Se revisaron las historias clínicas de 457 pacientes que fueron intervenidos quirúrgicamente con diagnóstico de Hematomas Intracraneanos Traumáticos en el Servicio de Neurocirugía del Hospital Nacional Dos de Mayo, en el periodo enero del 2008 a diciembre del 2013. A través de la ficha de recolección de datos se ha obtenido la información y fue procesada estadísticamente con ayuda de programas como SPSS versión 22.0. Objetivo General: Determinar las Clases de Hematomas Intracraneanos Traumáticos que se presentaron y el resultado de los diferentes tipos de intervenciones quirúrgicas efectuadas para su tratamiento en el periodo de estudio. Objetivos Específicos: Determinar la casuística de los Hematomas Epidurales, Subdurales (agudos, subagudos, crónicos), Contusiones Hemorrágicas, hematomas mixtos; y el resultado de las Intervenciones Quirúrgicas efectuadas para su tratamiento. Resultados.- Las Clases de Hematomas Intracraneanos Traumáticos encontrados son: Los Hematomas Subdurales Crónico en un 34 por ciento, Hematomas Epidurales 25.6 por ciento, Contusiones Intracerebrales un 12.3 por ciento, Hematomas Mixtos 11.6 por ciento, Hematomas Subdurales Subagudos con un 11.4 por ciento, y Hematomas Subdurales Agudos con un 5 por ciento de los casos...

Introduction: Traumatic Intracranial hematomas are the most common area of Neurotrauma Neurosurgery specializing in pathology, these bruises are primary lesions that occur as a direct result of head trauma, on which the doctor does not have any control, it is they say are inevitable, treatment is essential to save the lives of those affected. Different kinds of hematomas require different operations; know the type of surgery it allows standardize the management of these cases and mainly reduce the morbidity and mortality of patients. Method: Descriptive, observational, cross-sectional and retrospective study. The medical records of 457 patients who underwent surgery with diagnosis of Traumatic intracranial hematomas in the Neurosurgery Service at National Hospital Dos de Mayo, in the period January 2008 to December 2013. Through the data collection sheet were reviewed information has been obtained and was processed statistically using SPSS version 22.0 programs like. General Objective: To determine the Class of Traumatic intracranial hematomas that were presented and the results of the different types of surgery performed for treatment in the study period Specific. Objectives: To determine the casuistry of epidural hematoma, Subdural (acute, subacute, chronic), hemorrhagic contusions, mixed hematomas; and the outcome of surgical procedures performed for treatment. Results: Classes Traumatic intracranial hematomas are found: Chronic subdural hematomas 34 per cent, 25.6 per cent Epidural hematoma, intracerebral contusions 12.3 per cent, 11.6 per cent Mixed hematomas, Subacute subdural hematomas with 11.4 per cent, and Acute subdural hematomas 5 per cent of cases. We should mention the casuistry of Bilateral Traumatic intracranial hematomas in this study was 14.6 per cent of 457 cases. The type of surgery depended mainly on the type and location of hematoma, Epidural hematomas in craniotomy was performed primarily, chronic subdural hematomas in and subacute...

Clinical Decision Rules for Paediatric Minor Head Injury: Are CT Scans a Necessary Evil?

<p><b>INTRODUCTION</b>High performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population.</p><p><b>MATERIALS AND METHODS</b>This is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices.</p><p><b>RESULTS</b>A total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6).</p><p><b>CONCLUSION</b>The CDRs demonstrated high accuracy in detecting children with positive CT findings but direct application in areas with low rates of significant traumatic brain injury (TBI) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.</p>

Risk Factors for Reoperation after Traumatic Intracranial Hemorrhage / 대한신경손상학회지

OBJECTIVE: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. METHODS: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. RESULTS: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. CONCLUSION: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.

Use of Continuous Venovenous Hemodiafiltration to Enhance the Elimination of Serum Pentobarbital before Diagnosis of Brain Death / 대한이식학회지

Continuous venovenous hemodiafiltration (CVVHDF) was used to eliminate pentobarbital from the blood of a 30-year-old potentially brain dead male patient with traumatic intracranial hemorrhage after a motorcycle accident. The Acute Physiology and Chronic Health Evaluation (APACHE) II score of hospital day 1 was 24, but by day 8 it was 36, when the patient was considered to be brain dead. To control seizures and reduce intracranial pressure, pentobarbital had been administered in a continuous flow (2,880 mg/day for 5 days). Coma can be induced by pentobarbital at a serum level of 1~5 mg/dL. However, drug intoxication should be excluded from a brain death evaluation; therefore, the patient was not given any drug for approximately 88 hrs after ceasing pentobarbital in order for serum level to dip below 0.5 mg/dL (which is the hypnotic level). At 48 hours from CVVHDF, the pentobarbital level was close to the hypnotic level (0.1~0.5 mg/dL). Before stopping, the serum level of pentobarbital was 3.89 mg/dL and between 48 and 72 hours from CVVHDF, 4 cycles of pentobarbital half-life elimination (0.24 mg/dL) could be measured. Therefore, we suggest that in case of potential brain dead patients who have been administered pentobarbital, CVVHDF can enhance the elimination of pentobarbital from the circulatory system and shorten the waiting time for a brain death evaluation.

Factores que influyen en la evolución de los pacientes con contusiones cerebrales en el Hospital María Auxiliadora. Lima - Perú 2008 - 2009 / Factors that influence in the evolution of the patients with cerebral contusions at the Hospital Maria Auxiliadora. Lima - Peru 2008 - 2009

Objetivo: Identificar y evaluar variables clínicas, tomográficas y laboratoriales que influyen en el pronóstico de los pacientes con contusiones cerebrales. Métodos: Se realizó un estudio descriptivo, observacional, longitudinal y retrospectivo; donde se seleccionó una muestra de 45 pacientes que ingresaron por emergencia desde enero del 2008 a Abril del 2009. Se evaluaron factores clínicos, tomográficos y laboratoriales y para el pronóstico la condición al egreso de los pacientes con contusión cerebral. Se utilizó según las variables pruebas de Chi cuadrado, T de Student o varianza, pruebas no paramétricas; así como, análisis de regresión logística determinando factores asociados al pronóstico. Resultados: 71.1 por ciento son varones, entre las edades de 25 a 58 años con media de 40 años. La causa principal fue los accidentes de tránsito. Los 3 mejores predictores de que el paciente tenga una mala condición al egreso dentro de las variables tomográficas son 2: la desviación de la línea media y el incremento en el grado de severidad según la escala de Marshall y el tercer predictor es la condición de ingreso a UCI, es decir con mayor gravedad clínica. Conclusiones: El modelo reafirma la importancia de la valoración global, clínica, laboratorial y tomográfica de este tipo de pacientes categorizando las variables más importantes que se relacionan con una condición final mala; siendo la desviación de la línea media que multiplica esta probabilidad en 1.4 veces por cada milímetro de desviación, el incremento de un grado menor a uno mayor en la escala de Marshall multiplica la probabilidad en 2.2, y los pacientes que ingresaron a UCI que son los más graves, multiplicaron su probabilidad de peor pronóstico en 16.5 veces.

¿Se puede predecir clínicamente qué niños pueden presentar complicaciones intracraneales después de sufrir un traumatismo craneal leve? / Is it possible to predict clinically which children may have intracranial complications after suffering a mild head trauma?

Conclusiones de los autores del estudio: la alteración en el nivel de conciencia, la presencia de focalidad neurológica y los cambios de conducta se han asociado con la aparición de complicaciones intracraneales en niños con traumatismo craneal leve (TCL). Debido a la falta de consenso, las reglas de decisión clínica pueden ser una herramienta útil para indicar a qué pacientes se deben realizar pruebas de imagen o indicar su ingreso hospitalario para observación. Comentario de los revisores: en este estudio se establecen los principales datos clínicos que pueden predecir la aparición de complicaciones intracraneales en niños con TCL. Las reglas de decisión clínica encontradas en la literatura y las propuestas por los autores parecen útiles para unificar la práctica clínica en el manejo de esta patología. Sin embargo, existe cierta variabilidad, por lo que sería deseable realizar más estudios para elaborar reglas de decisión clínica útiles o que validen las ya existentes(AU)

One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. METHODS: From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. RESULTS: Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. CONCLUSION: In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.

Tratamento das lesões focais intracranianas no traumatismo craniencefálico / Treatmento of focal intracranial lesions in cranioencephalic traumatism

O traumatismo craniencefálico pode resultar em lesões intracranianas difusas ou focais, representando afecções traumatoógicas graves, em parte necessitando de atendimento e conduta neurocirúrgica de emergência. As principais lesões focais de indicação cirúrgica são os hematomas epidurais, os hematomas subdurais agudos e as contusões cerebrais. Há ainda controvérsias sobre o tratamento em muitas situações. Os autores realizaram revisão da literatura descrevendo os princípios do tratamento cirúrgico de lesões focais secundárias ao trauma de crânio.

Head trauma presents in some cases, intracranial lesions, diffuse and focal. The more important lesions are acute epidural hematoma, subdural hematoma and brain contusions. There is controversy about the surgical treatment. In this study, the authors describe a critical review of literature about principles for surgical management for focal lesions by head trauma.

Traumatismo craneoencefálico en la infancia / Head trauma in children

El trauma craneoencefálico (TCE) es un motivo de consulta frecuente en las urgencias pediátricas. El principal reto para el pediatra radica en detectar lesiones intracraneales (LIC), sobre todo, en niños con TCE leve. La escala del coma de Glasgow es la mejor herramienta para valorar la gravedad del TCE y la posibilidad de existencia de LIC. En general, siempre que exista una puntuación en la escala de Glasgow < 15, estará indicada la realización de una tomografía computarizada (TAC). La presencia de focalidad neurológica tras el TCE es otra indicación de TAC. Otros síntomas, como cefalea y vómitos, son muy comunes y, en general, su presencia no incrementa la posibilidad de LIC. Aunque la presencia de una fractura craneal incrementa la incidencia de LIC, su ausencia no la descarta. La radiografía de cráneo tiene un papel muy secundario en la valoración del TCE y únicamente estaría indicada en el lactante asintomático ante la presencia de un cefalohematoma importante o la sospecha de maltrato (AU)

Head trauma (HT) is a common reason for medical evaluation in a paediatric emergency department. The main challenge for the paediatrician is to identify children on risk of intracranial lesion (IL) especially in those who have suffered a minor head trauma. Glasgow Coma Scale (CGS) is the best independent tool to evaluate HT severity and therefore the possibility of IL. A punctuation in CGS under 15 and the presence of a focal neurological abnormality are the best predictors of IL and therefore an indication of brain CT. Posttraumatic vomiting and headache are very common symptoms but they are not independent factors for predicting IL. The presence of a cranial fracture increases the possibility of IL but its absence doesn’t permit to rule out this condition. Cranial radiograph should be not obtained in most cases, only it should be ordered in infants with a significant cephalohematom and in those cases where abuse is suspected (AU)

Deciding not to Operate in Head Injuries and Legal Considerations

It is not the best way to treat a hopeless patient with life-sustaining medical devices until the heart beats stop. Advanced medical technology may prolong the life for a significant period without recovery from the disease. However, it would give an unbearable economic burden to the family and the society. In 2006, we decided not to operate 9 patients with traumatic intracranial hematomas. We examined those patients with special references to possible legal and ethical problems. It is reasonable to withhold a treatment after documentation that the family never wants any life sustaining treatment when the treatment does not guarantee the meaningful life.

Expression of synaptophysin in experimental diffuse brain injury / 法医学杂志

OBJECT@#To investigate the changes in the expression_level of synaptophysin following diffuse brain injury (DBI) in rats and to correlate the changes of the synaptophysin expression_level with the post injury time interval.@*METHODS@#Wister rats were used as a DBI model induced by Marmarou method. The changes of synaptophysin immunoreactivity on coronal sections of the rats sampled at different post-injury time intervals were used as a marker. The densitometry of the synaptophysin immunoreactivity was documented by imaging technique and analyzed by SPSS software.@*RESULTS@#The expression level of synaptophysin in DBI rats showed dynamic changes following DBI as well as during the repairing period.@*CONCLUSION@#The changes of synaptophysin level may be used as a marker for estimation of the post injury time interval in DBI.

The Relationship Between Type and Size of Scalp Injury and Intracranial Injury Among Patients who Visited the Emergency room due to head Trauma

PURPOSE: Traumatic head injury is very common in the emergency room. Early diagnosis and treatment can significantly reduce mortality and morbidity. When diagnosis is delayed, however, it could be critical to the patients. In reality, it is difficult to take a brain CT for all patients with head trauma, so this study examined the relationship between type and size of scalp injury and intracranial injury. METHODS: This prospective study was conducted from May 2005 to July 2005. The participants were 193 patients who had had a brain CT. Head trauma included obvious external injury or was based on reports of witnesses to the accident. Children under three years of age were also included if there was a witness to the accident. The size of the injury was measured based on the maximum diameter. RESULTS: Out of the total of 193 patients, patients with scalp bleeding totaled 126 (65.2%), and patients without scalp bleeding totaled 67 (34.8%). Among patients with scalp bleeding, patients with intracranial injuries numbered nine, and among patients without scalp bleeding, patients with intracranial injuries numbered 17 (P=0.001). Among patients who showed evidence of scalp swelling with no scalp bleeding, the relationship between the size of the scalp swelling and intracranial injury was statistically significant when the size of the scalp swelling was between 2 cm and 5 cm. CONCLUSION: Among patients who visit an emergency medical center due to traumatic head injury, patients with no scalp bleeding, but with scalp swelling between 2 cm and 5 cm, should undergone more accurate and careful examination, as well as as a brain CT.