RESUMO
Traumatic brain injury (TBI) constitutes a heterogeneous condition that affects the most complex organ of the human body. It is commonly classified by its location as focal injury (e.g. epidural hematoma) and diffuse injury (e.g. diffuse axonal shearing injury) as well as by primary and secondary tissue injury. Accordingly, direct mechanical force causes the primary insult. The tissue damage occurring afterwards is subsumed under the term secondary brain damage. Some of these processes are overlapping and include in the early phase local cerebral ischemia resulting in excitotoxicity, which together with the triggered neuroinflammatory cascade causes the formation of cerebral edema and ultimately increased intracranial pressure once the intracranial compliance is exhausted. In survivors the long-term sequelae of the late stage include seizures caused by synaptic reorganization (incidence depending on the severity of TBI), persistent neuroinflammation promoting further neurodegeneration and increased risk for Alzheimer's disease probably because of TBI-related protein misfolding (tauopathy). Acute phase biomarkers of TBI should ideally originate from the injured brain. They should help distinguish disease severity and predict morbidity and mortality; however, the most commonly used biomarkers (S-100ß and neurone-specific enolase) show a low specificity. In theory their successors (i. e. GFAP, pNF-H) seem more specific; however, these "new kids on the block" still need to be thoroughly investigated in large scale studies.
Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Biomarcadores/metabolismo , Encéfalo/fisiopatologia , Dano Encefálico Crônico/fisiopatologia , Edema Encefálico/classificação , Edema Encefálico/fisiopatologia , Lesões Encefálicas Difusas/fisiopatologia , Lesões Encefálicas Traumáticas/classificação , Proteína Glial Fibrilar Ácida/metabolismo , Hematoma Epidural Craniano/classificação , Hematoma Epidural Craniano/fisiopatologia , Hematoma Subdural/classificação , Hematoma Subdural/fisiopatologia , Humanos , Pressão Intracraniana/fisiologia , Proteínas de Neurofilamentos/metabolismo , Fosfopiruvato Hidratase/metabolismo , Subunidade beta da Proteína Ligante de Cálcio S100/metabolismo , Sinapses/fisiologia , Tauopatias/fisiopatologiaRESUMO
Posterior fossa injury is rare, occurring in less than 3 % of head injuries. We retrospectively reviewed patients' clinical and radiological findings, management, and outcomes. The aim of the present study was to investigate the features of posterior fossa hematoma, including posterior fossa epidural hematoma (EDH), posterior fossa subdural hematoma (SDH), and intracerebellar hematoma. From January 1995 to January 2009, 4,315 patients with head trauma were hospitalized at our institution. The -present study focused on 41 patients (1.0 %) with traumatic hematomas of the posterior fossa. Eighteen patients had EDH, 10 patients had SDH, and 17 patients had intracerebellar hematomas. In each type of injury, occipital bone fractures were seen in many patients, and hematoma enlargement was often observed within a few days of the injury. In addition, a high frequency of associated lesions and a high poor outcome rate were features of intracerebellar hematomas and -posterior fossa SDH. The present study suggests that repeat CT imaging and careful management are necessary until the lesion is stabilized, and patients showing lesions with mass effects should therefore be immediately treated with surgery.
Assuntos
Fossa Craniana Posterior/patologia , Hematoma Epidural Craniano/patologia , Hematoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cerebelo/patologia , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/classificação , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
This article describes the imaging tools for efficient diagnostic management of head trauma victims. The basic mechanisms of brain injuries are explained and the imaging features are described. Computed tomography remains the most important method for the initial screening and follow-up investigation. Though magnetic resonance imaging has a higher sensitivity to most traumatic lesions, it does not play an important role in the acute phase of head trauma patients. In the first part of this paper clinical classifications, imaging modalities, extra-axial injuries, and contusions are described. In the second part of this paper intra-axial and secondary injuries are discussed.
Assuntos
Traumatismos Craniocerebrais/classificação , Diagnóstico por Imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Encéfalo/patologia , Concussão Encefálica/classificação , Concussão Encefálica/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Escala de Coma de Glasgow , Hematoma Epidural Craniano/classificação , Hematoma Epidural Craniano/diagnóstico , Hematoma Subdural/classificação , Hematoma Subdural/diagnóstico , Humanos , Hemorragia Intracraniana Traumática/classificação , Hemorragia Intracraniana Traumática/diagnóstico , Imageamento por Ressonância Magnética , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XAssuntos
Lesões Encefálicas/cirurgia , Hipertensão Intracraniana/cirurgia , Pressão Sanguínea/fisiologia , Encéfalo/irrigação sanguínea , Dano Encefálico Crônico/classificação , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/prevenção & controle , Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico , Hemorragia Cerebral Traumática/classificação , Hemorragia Cerebral Traumática/diagnóstico , Hemorragia Cerebral Traumática/cirurgia , Terapia Combinada , Escala de Coma de Glasgow , Hematoma Epidural Craniano/classificação , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural/classificação , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirurgia , Humanos , Unidades de Terapia Intensiva , Hipertensão Intracraniana/classificação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/fisiologia , Prognóstico , TrepanaçãoRESUMO
The authors report eight cases of chronic epidural hematoma, classified according to macroscopical operative findings and histological studies of the hematomas. Clinical, radiological, and pathological findings are described. A review of 63 cases of the literature is presented, and the accepted concepts for classification and management of these lesions are discussed.
Assuntos
Hematoma Epidural Craniano/classificação , Adolescente , Adulto , Fatores Etários , Criança , Doença Crônica , Traumatismos Craniocerebrais/complicações , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/patologia , Hematoma Epidural Craniano/cirurgia , Humanos , Radiografia , Fatores de TempoRESUMO
The postoperative progress of 3 patients with spinal epidural hemorrhage, but without spinal fracture or dislocation, is presented. From the literature, 158 cases were collected of spontaneous spinal epidural hematoma treated surgically. Postoperative return of motor function was noted in 95.3%, 87%, and 45.3% of the patients with incomplete sensorimotor, incomplete sensory but complete motor, and complete sensorimotor lesions, respectively. Complete sensorimotor recovery occurred in 41.9%, 26.1%, and 11.3% of these 3 groups of patients, respectively. Recovery following surgical treatment depends on the severity of neurological deficits before treatment. However, the absence of motor or sensorimotor functions preoperatively does not necessarily indicate a poor prognosis.
Assuntos
Hematoma Epidural Craniano/fisiopatologia , Hematoma Epidural Craniano/cirurgia , Desempenho Psicomotor , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Adulto , Hematoma Epidural Craniano/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Doenças da Medula Espinal/classificação , Resultado do TratamentoRESUMO
Fourteen cases of vertex epidural hematomas encountered in patients admitted over a 12-year period (1964-1976) at the University of Genoa Neurosurgical Clinic are presented. Special emphasis is put on the large number of cases (nine) without a free interval. Clinical and neuroradiological findings, treatment and results are reported. A clinical classification of this traumatic pathology according to the epidural hematoma classification of Pecker et al is proposed.