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1.
J Surg Res ; 249: 99-103, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31926402

RESUMO

BACKGROUND: Guidelines for management of intracranial hemorrhage do not account for bleed location. We hypothesize that parafalcine subdural hematoma (SDH), as compared to convexity SDH, is a distinct clinical entity and these patients do not benefit from critical care monitoring or repeat imaging. METHODS: We identified patients presenting to a single level I trauma center with isolated head injuries from February 2016 to August 2017. We identified 88 patients with isolated blunt traumatic parafalcine SDH and 228 with convexity SDH. RESULTS: Demographics, comorbidities, and use of antiplatelet and anticoagulant agents were similar between the groups. As compared to patients with convexity SDH, patients with parafalcine SDH had a significantly lower incidence of radiographic progression, and had no cases of neurologic deterioration, neurosurgical intervention, or mortality (all P < 0.005). Compared to patients admitted to the intensive care unit, patients with parafalcine SDH admitted to the floor had a shorter length of stay (2.0 ± 1.6 versus 3.8 ± 2.9 d, P < 0.005) with no difference in outcomes. CONCLUSIONS: Patients presenting with a parafalcine SDH are a distinct and relatively benign clinical entity as compared to convexity SDH and do not benefit from repeat imaging or intensive care unit admission.


Assuntos
Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/diagnóstico , Hemorragia Intracraniana Traumática/diagnóstico , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Escala de Coma de Glasgow , Hematoma Subdural/etiologia , Hematoma Subdural/mortalidade , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragia Intracraniana Traumática/etiologia , Hemorragia Intracraniana Traumática/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neuroimagem/normas , Neuroimagem/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos
2.
J Surg Res ; 249: 114-120, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31927389

RESUMO

INTRODUCTION: Guidelines for imaging anticoagulated patients following a traumatic injury are unclear. Interval CT head (CTH) is often routinely performed after initial negative CTH to assess for delayed intracranial hemorrhage (ICH-d). The rate of ICH-d for patients taking novel oral anticoagulants (NOACs) is unknown. We hypothesized that the incidence of ICH-d in patients on NOACs would be similar, if not lower to that of warfarin, and routine repeat CTH after initial negative would not change management, and thus, may not be indicated. MATERIALS AND METHODS: Anticoagulated patients presenting with blunt trauma to a level I trauma center between 2016 and 2018 were evaluated. Exclusion criteria included: positive initial CTH and those taking nonoral anticoagulation or antiplatelet agents alone (without warfarin or NOAC). Outcomes included: ICH-d, discharge GCS, administration of reversal agents, neurosurgical intervention, readmission, and death. Multivariable regression was performed to evaluate patient factors associated with the development of ICH-d. RESULTS: A total of 332 patients met the inclusion criteria. Patients were divided into a warfarin group (n = 191) and NOAC group (n = 141). The incidence of ICH-d in the warfarin group was 2.6% (5/191) and 2.1% (3/141) in the NOAC group (P = 0.77). There were no reversal agents administered, neurosurgical interventions, readmissions, or deaths in the NOAC group. CONCLUSIONS: Little is known about the impact of NOACs in the setting of trauma, especially regarding risks of ICH-d following traumatic injury. In the NOAC group, ICH-d occurred only 2.1% of the time. In addition, there were no reversal agents given, neurosurgical interventions, or deaths. These data, taken together, suggest the limited utility of repeat imaging in this patient population.


Assuntos
Anticoagulantes/efeitos adversos , Traumatismos Cranianos Fechados/complicações , Hemorragias Intracranianas/epidemiologia , Tomografia Computadorizada por Raios X/normas , Administração Oral , Idoso , Feminino , Cabeça/diagnóstico por imagem , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/economia , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Varfarina/efeitos adversos
4.
Ann Emerg Med ; 75(3): 354-364, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959538

RESUMO

STUDY OBJECTIVE: We determine the prevalence of significant intracranial injury among adults with blunt head trauma who are receiving preinjury anticoagulant or antiplatelet medications. METHODS: This was a multicenter, prospective, observational study conducted from December 2007 to December 2015. Patients were enrolled in 3 emergency departments (EDs) in the United States. Adults with blunt head trauma who underwent neuroimaging in the ED were included. Use of preinjury aspirin, clopidogrel, and warfarin was recorded. Data on direct oral anticoagulants were not specifically recorded. The primary outcome was prevalence of significant intracranial injury on neuroimaging. The secondary outcome was receipt of neurosurgical intervention. RESULTS: Among 9,070 patients enrolled in this study, the median age was 53.8 years (interquartile range 34.7 to 74.3 years) and 60.7% were men. A total of 1,323 patients (14.6%) were receiving antiplatelet medications or warfarin, including 635 receiving aspirin alone, 109 clopidogrel alone, and 406 warfarin alone. Compared with that of patients without any coagulopathy, the relative risk of significant intracranial injury was 1.29 (95% confidence interval [CI] 0.88 to 1.87) for patients receiving aspirin alone, 0.75 (95% CI 0.24 to 2.30) for those receiving clopidogrel alone, and 1.88 (95% CI 1.28 to 2.75) for those receiving warfarin alone. The relative risk of significant intracranial injury was 2.88 (95% CI 1.53 to 5.42) for patients receiving aspirin and clopidogrel in combination. CONCLUSION: Patients receiving preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those receiving aspirin alone. Clinicians should have a low threshold for neuroimaging when evaluating patients receiving warfarin or a combination of aspirin and clopidogrel.


Assuntos
Anticoagulantes/efeitos adversos , Lesões Encefálicas/epidemiologia , Traumatismos Cranianos Fechados/complicações , Inibidores da Agregação de Plaquetas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Lesões Encefálicas/etiologia , Clopidogrel/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Varfarina/efeitos adversos
5.
World Neurosurg ; 134: 211-214, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678447

RESUMO

BACKGROUND: Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. CASE DESCRIPTION: We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. CONCLUSIONS: Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.


Assuntos
Artéria Carótida Interna/cirurgia , Fístula Carotidocavernosa/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Neuroendoscopia/métodos , Seio Esfenoidal , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Epistaxe/etiologia , Exoftalmia/etiologia , Traumatismos Cranianos Fechados/complicações , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
6.
World Neurosurg ; 135: e664-e670, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881342

RESUMO

BACKGROUND: The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated. METHODS: A trauma registry was queried for patients with blunt head trauma in 2013-2017. Initial GCS score and toxicology screening from the database were reviewed. Next recorded GCS score from the neurosurgery evaluation and change in GCS score (ΔGCS) were compared. RESULTS: We reviewed 468 patients. In 217 (46.4%) patients, no toxic substances were found, whereas >1 toxic substance was found in 104 (22.2%) patients. Alcohol level above the legal limit was found in 109 (23.3%) patients, marijuana was found in 105 (22.4%) patients, benzodiazepines were found in 94 (20.1%) patients, opiates were found in 48 (10.3%) patients, and cocaine was found in 41 (8.8%) patients. Mean change in GCS score was significantly higher in impaired patients compared with patients with a negative screening test (1.74 ± 2.4 vs. 0.75 ± 2.7, P < 0.001); this is despite both groups having a similar initial GCS score (6.23 ± 3.86 in impaired group vs. 6.47 ± 3.52 in sober group, P = 0.677). Initial GCS score was 3 in 187 patients, of whom 150 had a positive toxicology screen. Change in GCS score was significantly higher in the impaired group (2.75 ± 2.7 vs. 1.19 ± 1.8, P < 0.001). CONCLUSIONS: Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and intoxicating substances should be reversed or allowed to wear off before GCS score is recorded for benchmarking or quality reporting.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Escala de Coma de Glasgow , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intoxicação Alcoólica/complicações , Criança , Pré-Escolar , Feminino , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Sistema de Registros , Hemorragia Subaracnóidea/complicações , Estados Unidos , Adulto Jovem
7.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31588759

RESUMO

A definitive diagnosis of extensive suture line exostoses affecting the nasofrontal, nasolacrimal, nasomaxillary, frontolacrimal, lacrimozygomatic and lacrimomaxillary suture lines in a 7-year-old Thoroughbred mare with chronic bilateral epiphora and facial deformation was achieved using standing computed tomography (CT) examinations. Positive contrast dacryocystorhinography using CT revealed partial bilateral obstruction of the nasolacrimal ducts. Minimally displaced depression fractures of the right nasal bone, the right maxillary bone and right frontal bone were also demonstrated. The cosmetic appearance of the periosteal reaction associated with the suture line exostosis and epiphora significantly improved within 3 months of diagnosis and treatment.


Assuntos
Exostose/veterinária , Fraturas Ósseas/veterinária , Traumatismos Cranianos Fechados/veterinária , Doenças dos Cavalos/etiologia , Cavalos/lesões , Obstrução dos Ductos Lacrimais/veterinária , Animais , Exostose/etiologia , Exostose/terapia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Traumatismos Cranianos Fechados/complicações , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/terapia , Obstrução dos Ductos Lacrimais/complicações , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Ducto Nasolacrimal/lesões , África do Sul , Resultado do Tratamento
9.
World Neurosurg ; 130: 351-357, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330332

RESUMO

BACKGROUND: Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data. CASE DESCRIPTION: We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy. CONCLUSIONS: Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.


Assuntos
Neoplasias Ósseas/cirurgia , Hemangiossarcoma/cirurgia , Osso Temporal/cirurgia , Neoplasias Ósseas/patologia , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/patologia , Hemangiossarcoma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/cirurgia , Reoperação , Osso Temporal/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
J Clin Neurosci ; 67: 263-265, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31248785

RESUMO

Isolated traumatic medial rectus palsies associated with closed head injury is rarely reported in literature. We report the case of a 48 year-old male with an isolated right medial rectus palsy following a mechanical fall with occipital headstrike. Bifrontal and bitemporal haemorrhagic contusions were seen on computed tomography (CT). Magnetic resonance imaging (MRI) revealed a T2 hyperintense lesion at the right paramedian dorsal midbrain, with changes on diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC), suggestive of ischaemic changes in the oculomotor nucleus. He was followed up at two- and six-weeks.


Assuntos
Traumatismos Cranianos Fechados/diagnóstico , Músculos Oculomotores/fisiopatologia , Paralisia/diagnóstico , Imagem de Difusão por Ressonância Magnética , Traumatismos Cranianos Fechados/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Mesencéfalo/diagnóstico por imagem , Pessoa de Meia-Idade , Paralisia/etiologia , Tomografia Computadorizada por Raios X
11.
Ulus Travma Acil Cerrahi Derg ; 25(3): 311-315, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135947

RESUMO

A venous air embolism can occur as a result of circumstances that include blunt head or chest trauma, thoracentesis, arterial catheterization, neurosurgery, cardiac surgery, and Caisson disease. The formation of a venous air embolism requires an air source, interaction between the air source and the vessel, and a pressure gradient supporting air migration into the vessel. Air enters through the impaired venous structure and travels to the right side of the heart and the pulmonary arteries, and depending on the amount of air, may occasionally be fatal. This report is the description of the case of a 3-year-old child who developed a fatal venous and cerebral embolism during neurosurgery for the treatment of skull fractures with epidural and subdural bleeding due to blunt head and chest trauma resulting from a television falling on her. The pathophysiology of death and notes regarding the medico-legal autopsy procedure in such cases are discussed. Meticulous autopsy techniques must be used to determine the presence of an air embolism in cases of blunt trauma, especially in patients with blunt trauma to the head who die during neurosurgery, and possible future malpractice claims should be kept in mind.


Assuntos
Embolia Aérea , Traumatismos Cranianos Fechados , Embolia Intracraniana , Procedimentos Neurocirúrgicos/efeitos adversos , Acidentes , Pré-Escolar , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Evolução Fatal , Feminino , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/cirurgia , Humanos
12.
Am J Case Rep ; 20: 525-530, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30988275

RESUMO

BACKGROUND Intraosseous cavernous skull hemangiomas are rare benign vascular tumors that are usually found incidentally on imaging, with an asymptomatic and slow-growing course. We present a case in which the patient had a mass on her forehead for many years, which began to grow rapidly after head trauma. Imaging characteristics play a crucial role in the diagnosis and description of this disease, and in differentiating it from other more common calvarial lesions that may present with a similar clinical picture. Here, we report an unusual presentation of a large skull hemangioma and discuss the different radiologic imaging findings and pathologic correlations. CASE REPORT A 58-year-old female with history of a lump on her forehead since childhood, which began to grow rapidly after experiencing a closed-head injury. Due to its large size, she went on to seek further management. Radiologic images revealed a frontal skull lesion suggestive of an intraosseous hemangioma. She underwent embolization of the tumor, and 2 days later underwent bilateral frontal craniectomy and cranioplasty. Histopathologic findings confirmed this diagnosis. CONCLUSIONS Intraosseous skull hemangioma may be confidently diagnosed and differentiated from other skull lesions by its imaging characteristics. An accurate diagnosis is essential to selecting correct management and avoiding complications.


Assuntos
Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/patologia , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/patologia , Feminino , Traumatismos Cranianos Fechados/complicações , Hemangioma Cavernoso/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Cranianas/cirurgia , Tomografia Computadorizada por Raios X
13.
AJNR Am J Neuroradiol ; 40(4): 601-608, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30923084

RESUMO

BACKGROUND AND PURPOSE: The effects of multiple head impacts, even without detectable primary injury, on subsequent behavioral impairment and structural abnormality is yet well explored. Our aim was to uncover the dynamic changes and long-term effects of single and repetitive head injury without focal contusion on tissue microstructure and macrostructure. MATERIALS AND METHODS: We introduced a repetitive closed-head injury rodent model (n = 70) without parenchymal lesions. We performed a longitudinal MR imaging study during a 50-day study period (T2-weighted imaging, susceptibility-weighted imaging, and diffusion tensor imaging) as well as sequential behavioral assessment. Immunohistochemical staining for astrogliosis was examined in a subgroup of animals. Paired and independent t tests were used to evaluate the outcome change after injury and the cumulative effects of impact load, respectively. RESULTS: There was no gross morphologic evidence for head injury such as skull fracture, contusion, or hemorrhage on micro-CT and MR imaging. A significant decrease of white matter fractional anisotropy from day 21 on and an increase of gray matter fractional anisotropy from day 35 on were observed. Smaller mean cortical volume in the double-injury group was shown at day 50 compared with sham and single injury (P < .05). Behavioral deficits (P < .05) in neurologic outcome, balance, and locomotor activity were also aggravated after double injury. Histologic analysis showed astrogliosis 24 hours after injury, which persisted throughout the study period. CONCLUSIONS: There are measurable and dynamic changes in microstructure, cortical volume, behavior, and histopathology after both single and double injury, with more severe effects seen after double injury. This work bridges cross-sectional evidence from human subject and pathologic studies using animal models with a multi-time point, longitudinal research paradigm.


Assuntos
Concussão Encefálica/complicações , Concussão Encefálica/patologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos das Sensações/etiologia , Animais , Estudos Transversais , Imagem de Tensor de Difusão/métodos , Modelos Animais de Doenças , Substância Cinzenta/patologia , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/patologia , Estudos Longitudinais , Masculino , Ratos , Ratos Sprague-Dawley , Substância Branca/patologia
14.
J Med Imaging Radiat Oncol ; 63(3): 311-317, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30874340

RESUMO

INTRODUCTION: The aim of this study was to assess the association between intrasinus gas and dural venous sinus thrombosis (DVST) in patients with blunt head trauma. METHODS: One hundred and two consecutive patients with blunt head trauma imaged with non-enhanced CT and CT head venography at our institution between 1 July 2011 and 30 June 2016 were included. Image review was performed by two independent reviewers to assess for the presence of intrasinus or perisinus gas and DVST. Skull fractures involving a dural venous sinus, sinus hyperdensity, extraaxial haematoma, and/or extrinsic dural venous sinus compression were also recorded. Univariate and multivariate analyses estimated the associations between the imaging variables and DVST. RESULTS: Thirty-seven cases of DVST were confirmed with CT venography: 10 (27.0%) occlusive, and 27 (73.0%) non-occlusive. We detected 24 cases of intrasinus gas, all occurring with skull fractures. Gas localized to the sinus involved by the fracture in 23 (95.8%) of 24 cases. Additional gas within a contiguous sinus was present in nine (37.5%) cases. The association between intrasinus gas and DVST of the respective sinus was statistically significant (OR: 11.3, CI: 3.9-32.9, P < 0.0001). DVST was also significantly associated with the presence of a skull fracture (P = 0.04), fractures involving the sigmoid sinus (P = 0.0001), and sinus hyperdensity (P < 0.0001). CONCLUSION: Traumatic intrasinus gas is associated with DVST in patients with blunt head trauma. Its detection on non-enhanced CT examinations in the emergency care setting infers a higher risk of DVST and should prompt consideration of CT venography.


Assuntos
Cavidades Cranianas/diagnóstico por imagem , Gases , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/diagnóstico por imagem , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/etiologia , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Meios de Contraste , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Flebografia , Estudos Retrospectivos
15.
Pediatr Emerg Care ; 35(4): e76-e78, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30870340

RESUMO

Of the multitude of neurologic injuries related to roller-coaster rides, a majority of them are reported about adults. In this case, we present a patient who presented to the pediatric emergency department with new-onset seizure and hemiplegia 2 days after a roller-coaster ride. She was ultimately diagnosed with a subdural hematoma. The acceleration and G forces of roller coasters are hypothesized to cause enough stress and shearing forces that are thought to directly cause subdural hemorrhage.Advances in roller-coaster technology may surpass the passenger's physical capacity for acceleration and rotary forces, and we may see an increased number of medical complications after these rides. We recommend that emergency and pediatric health care providers consider amusement park thrill rides as a possible cause of subdural hematomas in previously healthy patients with new neurologic complaints.


Assuntos
Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/diagnóstico , Adolescente , Encéfalo/diagnóstico por imagem , Feminino , Hematoma Subdural/etiologia , Humanos , Parques Recreativos , Tomografia Computadorizada por Raios X
16.
J Emerg Med ; 56(5): 554-559, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30890373

RESUMO

BACKGROUND: Studies cite the incidence of pediatric blunt cerebrovascular injuries (BCVI) ranges from 0.03% to 1.3%. While motor vehicle incidents are a known high-risk mechanism, we are the first to report on football injuries resulting in BCVI. CASE REPORT: Case 1 is a 14-year-old male football player who presented with slurred speech and facial droop 16 h after injury that had resulted in unilateral stinger on the field. The patient had a negative brain computed tomography (CT) at the onset of symptoms. Given progression of symptoms over the next 24 h, re-evaluation with CT angiography (CTA) of brain and neck showed left internal carotid artery (ICA) dissection, and magnetic resonance imaging of the brain showed left middle cerebral artery infarct. Case 2 is a 16-year-old male football player who presented with headache and right hemiparesis immediately following a tackle injury. CT brain and neck were negative at an outside hospital, but he was transferred to us for progressive symptoms, and then CTA showed a left ICA dissection with distal emboli, including occlusive involvement of the intracranial left ICA. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The diagnosis of BCVI requires a high level of suspicion. Focal neurologic deficits are consistently a risk factor across all screening criteria, including the Denver, Utah, Memphis, and Eastern Association for the Surgery of Trauma. These current screening criteria, however, may not be sufficient to diagnosis BCVI in children. The addition of the mechanism of injury and attention to the patient's clinical presentation and examination are important to prevent missed diagnosis and poor neurologic outcomes.


Assuntos
Comportamento do Adolescente/psicologia , Traumatismos Cranianos Fechados/diagnóstico , Adolescente , Angiografia por Tomografia Computadorizada/métodos , Futebol Americano/lesões , Futebol Americano/psicologia , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/psicologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Distúrbios da Fala/etiologia
17.
J Neurochem ; 149(5): 660-678, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30702755

RESUMO

Following mild traumatic brain injury (mTBI), further mild impacts can exacerbate negative outcomes. To compare chronic damage and deficits following increasing numbers of repeated mTBIs, a closed-head weight-drop model of repeated mTBI was used to deliver 1, 2 or 3 mTBIs to adult female rats at 24 h intervals. Outcomes were assessed at 3 months following the first mTBI. No gross motor, sensory or reflex deficits were identified (p > 0.05), consistent with current literature. Cognitive function assessed using a Morris water maze revealed chronic memory deficits following 1 and 2, but not 3 mTBI compared to shams (p ≤ 0.05). Oxidative damage to DNA was assessed immunohistochemically in the dentate hilus of the hippocampus and splenium of the corpus callosum; no changes were observed. IBA1-positive microglia were increased in size in the cortex following 1 mTBI and in the corpus callosum following 2 mTBI compared to shams (p ≤ 0.05); no changes were observed in the dentate hilus. Glial fibrillary acidic protein (GFAP)-positive astrocyte immunoreactivity was assessed in all three brain regions and no chronic changes were observed. Integrity of myelin ultrastructure in the corpus callosum was assessed using transmission electron microscopy. G ratio was decreased following 2 mTBIs compared to shams (p ≤ 0.05) at post hoc level only. The changing patterns of damage and deficits following increasing numbers of mTBI may reflect dynamic responses to small numbers of mTBIs or a conditioning effect such that increasing numbers of mTBIs do not necessarily result in worsening pathology. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/. Cover Image for this issue: doi: 10.1111/jnc.14508.


Assuntos
Concussão Encefálica/metabolismo , Concussão Encefálica/patologia , Animais , Concussão Encefálica/etiologia , Feminino , Traumatismos Cranianos Fechados/complicações , Aprendizagem em Labirinto , Transtornos da Memória/etiologia , Ratos
18.
J Neuroinflammation ; 16(1): 21, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704505

RESUMO

BACKGROUND: The incidence of traumatic brain injuries (TBIs) is on the rise in the USA. Concussions, or mild TBIs without skull fracture, account for about 75% of all TBIs. Mild TBIs (mTBIs) lead to memory and cognitive deficits, headaches, intraocular pressure rises, axonal degeneration, neuroinflammation, and an array of cerebrovascular dysfunctions, including increased vascular permeability and decreased cerebral blood flow. It has been recently reported that besides vascular dysfunction in the cerebral circulation, mTBI may also cause a significant impairment of endothelial function in the systemic circulation, at least within mesenteric microvessels. In this study, we investigated whether mTBI affects endothelial function in aortas and determined the contribution of transient receptor potential canonical (TRPC) channels to modulating mTBI-associated endothelial dysfunction. METHODS: We used a model of closed-head mTBI in C57BL/6, 129S, 129S-C57BL/6-F2 mice, and 129S-TRPC1 and 129S-C57BL/6-TRPC6 knockout mice to determine the effect of mTBI on endothelial function in mouse aortas employing ex vivo isometric tension measurements. Aortic tissue was also analyzed using immunofluorescence and qRT-PCR for TRPC6 expression following mTBI. RESULTS: We show that in various strains of mice, mTBI induces a pronounced and long-lasting endothelial dysfunction in the aorta. Ablation of TRPC6 protects mice from mTBI-associated aortic endothelial dysfunction, while TRPC1 ablation does not impact brain injury-induced endothelial impairment in the aorta. Consistent with a role of TRPC6 activation following mTBI, we observed improved endothelial function in wild type control mice subjected to mTBI following 7-day in vivo treatment with larixyl acetate, an inhibitor of TRPC6 channels. Conversely, in vitro treatment with the pro-inflammatory endotoxin lipopolysaccharide, which activates endothelial TRPC6 in a Toll-like receptor type 4 (TLR4)-dependent manner, worsened aortic endothelial dysfunction in wild type mice. Lipopolysaccharide treatment in vitro failed to elicit endothelial dysfunction in TRPC6 knockout mice. No change in endothelial TRPC6 expression was observed 7 days following TBI. CONCLUSIONS: These data suggest that TRPC6 activation may be critical for inducing endothelial dysfunction following closed-head mTBI and that pharmacological inhibition of the channel may be a feasible therapeutic strategy for preventing mTBI-associated systemic endothelial dysfunction.


Assuntos
Acetatos/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Endotélio Vascular , Naftalenos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Canais de Cátion TRPC/antagonistas & inibidores , Doenças Vasculares/etiologia , Doenças Vasculares/prevenção & controle , Acetatos/farmacologia , Animais , Aorta Torácica/fisiopatologia , Traumatismos Cranianos Fechados/complicações , Contração Isométrica , Lipopolissacarídeos/farmacologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Naftalenos/farmacologia , Fármacos Neuroprotetores/farmacologia , Canais de Cátion TRPC/genética , Receptor 4 Toll-Like/metabolismo , Vasodilatação/efeitos dos fármacos
19.
Forensic Sci Med Pathol ; 15(2): 243-248, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30649694

RESUMO

Cerebral capillary telangiectasia (CCT) is a type of vascular malformation that is incidentally encountered in clinical practice. Diseased vessels are small and usually clinically benign over the course of a patient's life. Although most CCT patients are asymptomatic, the situation becomes complicated when trauma is encountered. A case of sudden death due to an epileptic episode after very mild head trauma is reported, including a retrospective study of 12 cases, to remind peers to pay close attention to CCT especially when located in important functional regions of the brain. After immunohistochemical staining and pathological examination, we speculated that the epileptogenic mechanism of CCT may be similar to that of hippocampal sclerosis. As the definite epileptogenic mechanism of CCT in the hippocampus is still elusive, we suggest that more research should be conducted on CCT.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/patologia , Morte Súbita/etiologia , Hipocampo/patologia , Convulsões/etiologia , Feminino , Traumatismos Cranianos Fechados/complicações , Humanos , Pessoa de Meia-Idade , Abuso Físico , Convulsões/complicações
20.
Neurorehabil Neural Repair ; 33(1): 15-26, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30499355

RESUMO

BACKGROUND: Cerebrolysin is a neuropeptide preparation with neuroprotective and neurotrophic properties. Our previous study demonstrates that cerebrolysin significantly improves functional recovery in rats after mild traumatic brain injury (mTBI). OBJECTIVE: To determine histological outcomes associated with therapeutic effects of cerebrolysin on functional recovery after TBI. METHODS: In this prospective, randomized, blinded, and placebo-controlled study, adult Wistar rats with mild TBI induced by a closed head impact were randomly assigned to one of the cerebrolysin dose groups (0.8, 2.5, 7.5 mL/kg) or placebo, which were administered 4 hours after TBI and then daily for 10 consecutive days. Functional tests assessed cognitive, behavioral, motor, and neurological performance. Study end point was day 90 after TBI. Brains were processed for histological tissue analyses of astrogliosis, axonal injury, and neurogenesis. RESULTS: Compared with placebo, cerebrolysin significantly reduced amyloid precursor protein accumulation, astrogliosis, and axonal damage in various brain regions and increased the number of neuroblasts and neurogenesis in the dentate gyrus. There was a significant dose effect of cerebrolysin on functional outcomes at 3 months after injury compared with saline treatment. Cerebrolysin at a dose of ⩾0.8 mL/kg significantly improved cognitive function, whereas at a dose of ⩾2.5 mL/kg, cerebrolysin also significantly improved sensorimotor function at various time points. There were significant correlations between multiple histological and functional outcomes 90 days after mTBI. CONCLUSIONS: Our findings demonstrate that cerebrolysin reduces astrogliosis and axonal injury and promotes neurogenesis, which may contribute to improved functional recovery in rats with mTBI.


Assuntos
Aminoácidos/farmacologia , Concussão Encefálica/tratamento farmacológico , Traumatismos Cranianos Fechados/tratamento farmacológico , Fármacos Neuroprotetores/farmacologia , Aminoácidos/administração & dosagem , Animais , Concussão Encefálica/etiologia , Concussão Encefálica/patologia , Concussão Encefálica/fisiopatologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/patologia , Traumatismos Cranianos Fechados/fisiopatologia , Masculino , Fármacos Neuroprotetores/administração & dosagem , Distribuição Aleatória , Ratos , Ratos Wistar
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