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1.
Internist (Berl) ; 61(1): 91-95, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31673730

RESUMO

This article reports the case of a 43-year-old woman who presented to the emergency room with headache and paresthesia after a fall on the head while skiing. She had clinical signs of volume depletion and blood test showed severe hyponatremia. Cerebral imaging was unremarkable. The diagnosis of cerebral salt-wasting syndrome (CSWS) was made, which is defined by the presence of extracellular volume depletion due to a tubular defect in renal sodium transport in patients with normal adrenal and thyroid function. The disease is mostly secondary to a neurological disease or head trauma. The patient rapidly improved after volume therapy and treatment with mineralocorticoids. The differentiation of CSWS from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion can be challenging but the distinction is important because treatment options are very different.


Assuntos
Traumatismos Craniocerebrais/complicações , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Esqui/lesões , Acidentes , Adulto , Feminino , Humanos
2.
Acta Neurochir Suppl ; 127: 191-194, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407084

RESUMO

The aim of the study was to assess the time constant of cerebral arterial bed in TBI patients with cerebral vasospasm (CVS) with and without intracranial hematomas (ICH).We examined 84 patients with severe TBI (mean 35 ± 15 years, 53 men and 31 women). The first group included 41 patients without ICH and the second group included 43 patients with epidural (7) and subdural (36) hematomas.Perfusion computed tomography (PCT) was performed in 1-12 days after TBI in the first group and in 2-8 days after craniotomy in the second group. Arteriovenous amplitude of regional cerebral blood volume oscillation was calculated as the difference of arterial and venous blood volume in the "region of interest." Mean arterial pressure was measured and the flow rate of middle cerebral artery was recorded with Transcranial Doppler after PCT. Time constant was calculated by the formula modificated by M. Kasprowicz. Results and Conclusion: The τ was shorter (p < 0.005) in both first and second group in comparison with normal values. The τ in the second group on ipsilateral side former hematoma with CVS was shorter than in the first group and in the second group on contralateral side former hematoma without CVS (р = 0.024).


Assuntos
Traumatismos Craniocerebrais , Vasoespasmo Intracraniano , Traumatismos Craniocerebrais/complicações , Feminino , Hematoma , Humanos , Masculino , Artéria Cerebral Média , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/etiologia
3.
Ulus Travma Acil Cerrahi Derg ; 25(6): 622-627, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701501

RESUMO

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT. METHODS: In our study, we included 198 patients, who were referred to our hospital's emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients' age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined. RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients' GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05). CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.


Assuntos
Traumatismos Craniocerebrais , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Imagem Corporal Total/estatística & dados numéricos , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/epidemiologia
4.
Georgian Med News ; (294): 10-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687941

RESUMO

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Abscesso Encefálico/tratamento farmacológico , Traumatismos Craniocerebrais/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/complicações , Adulto , Bactérias/classificação , Bactérias/isolamento & purificação , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/microbiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Ucrânia/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia
5.
Acta Chir Orthop Traumatol Cech ; 86(5): 342-347, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748109

RESUMO

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Algoritmos , Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Humanos , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X , Raios X
6.
Cir Cir ; 87(S1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501621

RESUMO

Introduction: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. Objective: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. Method: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. Conclusions: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.


Assuntos
Transfusão de Componentes Sanguíneos/métodos , Choque/terapia , Tromboelastografia/métodos , Tempo de Coagulação do Sangue Total/métodos , Adolescente , Afibrinogenemia/tratamento farmacológico , Afibrinogenemia/etiologia , Plaquetas/fisiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Soluções Cristaloides/administração & dosagem , Emergências , Transfusão de Eritrócitos/métodos , Evolução Fatal , Feminino , Fibrinogênio/uso terapêutico , Humanos , México , Plasma , Choque/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
7.
Chin J Traumatol ; 22(5): 286-289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521457

RESUMO

PURPOSE: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. METHODS: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. RESULTS: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. CONCLUSION: SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.


Assuntos
Lesões Encefálicas Traumáticas/etiologia , Traumatismos Craniocerebrais/complicações , Hemorragias Intracranianas/etiologia , Base do Crânio/lesões , Fraturas Cranianas/etiologia , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Masculino , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem
8.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556495

RESUMO

BACKGROUND Due to its long intracranial course, the abducens nerve is vulnerable in case of acceleration injury of the head. In rare cases, this may lead to posttraumatic paralysis of this cranial nerve. CASE DESCRIPTION A 4-year-old girl visited the emergency department after sustaining a head trauma. Neurological examination revealed no focal abnormalities at first. Three days later, she experienced diplopia, the consequence of isolated abducens nerve paralysis. CT and MRI brain imaging revealed no abnormalities. We treated her with an eye patch for a short time. At examination after 1 year, she was no longer experiencing any symptoms and the paralysis had almost completely disappeared. CONCLUSION Isolated paralysis of the abducens nerve may occur until up to 6 days after a trauma, without any visible intracranial abnormalities revealed by imaging. Even though only few children with this condition have been described, prognosis seems to be favourable and symptoms disappear in the majority of patients. Frequent follow-up by the ophthalmologist and the orthoptist is recommended, possibly with symptomatic treatment of the diplopia.


Assuntos
Traumatismo do Nervo Abducente/complicações , Traumatismos Craniocerebrais/complicações , Diplopia/etiologia , Paralisia/complicações , Traumatismo do Nervo Abducente/etiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Exame Neurológico , Paralisia/etiologia , Prognóstico , Tomografia Computadorizada por Raios X
9.
Artigo em Inglês | MEDLINE | ID: mdl-31547202

RESUMO

AIMS: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) following the admission for head injury of patients with depression. DESIGN: We analyzed the NHIRD data of patients aged ≥20 years who had received depression diagnoses between 2000 and 2010. They were divided into cohorts of those with admission for head injury (DHI) and those without it (DWI) during the follow-up period and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from the general population. SETTING: The Taiwan National Health Insurance Research Database (NHIRD). Participants/Cases: We analyzed the NHIRD data of patients (≥20 years) who had received depression diagnoses between 2000 and 2010. INTERVENTION(S): Regular interventions. MEASUREMENTS: We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of SA and SDO in these cohorts after adjustment for age, sex, and comorbidities. FINDINGS: Up to the end of 2011, our results revealed extremely high incidences of SA and SDO with 63.3 and 88.6 per 10,000 person-years, respectively, in the DHI cohort. The DHI cohort had a 37.4-times higher risk for SA and a 17.1-times higher risk for SDO compared with the comparison group and had aHRs of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort. Patients with DHI aged <50 years, of female sex, with high incomes, living in more urbanized areas, and without other comorbidities had extraordinarily higher risks for SA. CONCLUSIONS: The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan. Our findings provide crucial information to implement efficient suicide prevention strategies in the future.


Assuntos
Traumatismos Craniocerebrais/complicações , Depressão/complicações , Transtorno Depressivo/complicações , Overdose de Drogas/etiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Comorbidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/psicologia , Bases de Dados Factuais , Depressão/psicologia , Transtorno Depressivo/psicologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/psicologia , Feminino , Humanos , Incidência , Renda , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia
10.
World Neurosurg ; 132: e391-e398, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476468

RESUMO

OBJECTIVE: To compare clinical and radiologic characteristics and prognosis of patients with chronic subdural hematoma (CSDH) with and without a history of head trauma. METHODS: Clinical and radiologic characteristics and prognosis of patients with CSDH with a history of head trauma (HT group) and without a history of head trauma (WHT group) were comparatively analyzed. RESULTS: Mean age in the WHT group was 70.23 ± 11.53 years, which was significantly older than mean age 67.56 ± 11.18 years in the HT group (P = 0.008). Stroke, uremia, anticoagulant therapy, and antiplatelet therapy were encountered more often in the WHT group than the HT group. Motor weakness was more prevalent in the WHT group (P = 0.011). Modified Rankin Scale score of 2-3 was more common in the WHT group (P = 0.03), whereas a score of 4-5 was more common in the HT group (P = 0.014). Hematoma density on CT was mainly homogeneous in the 2 groups, with significantly more homogeneous density in the HT group compared with the WHT group (P = 0.014). There was significantly more mixed density in the WHT group (P = 0.001). Patients with CSDH in the WHT group had higher mortality (P = 0.026) and lower Glasgow Outcome Scale score (P = 0.033). CONCLUSIONS: Patients with CSDH with or without a history of head trauma presented with different clinical and radiologic characteristics. Patients with CSDH without a history of head trauma had a higher mortality and lower GOS score, which indicates these patients warrant more attention.


Assuntos
Traumatismos Craniocerebrais/complicações , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
11.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 198-201, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183587

RESUMO

El Pott's puffy tumor (PPT) es una rara entidad que en la actualidad representa un abombamiento del cuero cabelludo asociado a un absceso subperióstico y a una osteomielitis craneal, pudiendo acompañarse o no de infección intracraneal. Suele asociarse a la sinusitis frontal, tratándose de una complicación típica, aunque poco frecuente de la misma. Por su parte las osteomielitis causadas por Actinomyces son raras y suelen tener lugar a nivel mandibular, no encontrándose apenas casos de osteomielitis craneal causada por este género bacteriano, en especial tras traumatismo craneoencefálico. Presentamos un caso especialmente poco usual al tratarse de un PPT frontal tras traumatismo cerrado, con componente intracraneal y en el que tras cirugía se aisló Actinomyces como copartícipe de dicha infección, junto con Fusobacterium y Propionibacterium


Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Osteomielite/complicações , Actinomyces/patogenicidade , Actinomyces/isolamento & purificação , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Antibacterianos/administração & dosagem
12.
J Craniofac Surg ; 30(5): 1549-1551, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299764

RESUMO

Retrobulbar emphysema is a rare condition compared to the more common orbital emphysema. It is often associated with medial orbital wall fracture with rupture of the periosteum. In some severe patients, retrobulbar emphysema can increase the intraorbital pressure and lead to orbital compartment syndrome. Less extreme patients require only conservative treatment with careful observation. There is still no standard protocol for the management of orbital emphysema in general or specifically for retrobulbar emphysema. Visual acuity is the most widely used indicator to determine whether surgical intervention is needed. The patient presented here suffered from large retrobulbar intraconal emphysema and exophthalmos without visual loss after head trauma and nose blowing. He was observed closely without surgical intervention. After the emphysema had resolved, the patient's medial orbital wall defect was reconstructed using unsintered hydroxyapatite particles/poly L-lactide via the transcaruncular approach. The postoperative course has been uneventful with more than 1 year of follow-up to date.


Assuntos
Enfisema/cirurgia , Exoftalmia/cirurgia , Fraturas Orbitárias/cirurgia , Idoso , Traumatismos Craniocerebrais/complicações , Enfisema/etiologia , Exoftalmia/etiologia , Humanos , Masculino , Fraturas Orbitárias/complicações , Acuidade Visual
13.
J Craniofac Surg ; 30(5): e397-e400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299790

RESUMO

The fourth ventricle outlet obstruction (FVOO) is a rare but well-established cause of obstructive tetra-ventricular hydrocephalus, characterizing with dilatation or large cerebrospinal fluid collection of the foramina of Magendie and Luschka. In children, it is usually the consequence of posterior cerebral fossa malformations; while in adult, the occlusion is rather acquired than congenital, mostly linked to an inflammatory process, intraventricular hemorrhage, head trauma, brain tumors or Arnold-Chiari malformation. However, idiopathic FVOO is extremely rare, and only 6 such cases have been reported in the English literature. Hereby, we described an extraordinarily rare case of idiopathic FVOO in a 15-year-old patient successfully treated with direct microsurgical excision of the obstruction membrane. Furthermore, the clinical characteristics and treatment for this rare disease were investigated and reviewed.


Assuntos
Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Neoplasias Encefálicas/patologia , Hemorragia Cerebral/complicações , Traumatismos Craniocerebrais/complicações , Humanos , Doenças Raras/patologia
14.
Neurol India ; 67(3): 738-743, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347546

RESUMO

Background: Posttraumatic movement disorders (PTMDs) are frequently associated with severe head injury. There are very few studies on the clinical phenomenology and radiological correlation of PTMD. Aims: To study the clinical phenomenology of patients with PTMD and correlate it with the site of lesion on brain imaging. Materials and Methods: This was a prospective study of patients with suspected PTMD. All of these patients underwent neurological evaluation to characterize the phenomenology and imaging, such as computed tomography/magnetic resonance imaging (CT/MRI), to localize the site of lesion. Results: The age of the patients was 32.6 ± 16.4 years and the age at onset was 29.1 ± 16.0 years. Right upper limb was the initial body part affected in 36.7% patients. Tremor (alone or with dystonia) was the most common movement disorder (MD; 44.7%) followed by parkinsonism (17.2%), dystonia (13.8%), dystonia plus (dystonia associated with choreoathetosis: 10.3%), mixed MD (more than one MD: 10.3%), and myoclonus (3.4%). MRI was performed in 23 patients and the rest seven patients underwent CT brain. Normal MRI was observed in one patient with parkinsonism. Isolated, discrete lesions were found in six (27.3%) patients. Basal ganglia was the most common site of involvement (66.7%) followed by thalamus (16.7%) and brainstem (16.7%). Diffuse white matter involvement was the most common radiological lesion in patients with tremor. Conclusions: Our study describes the clinical phenomenology of patients with PTMDs and its radiological correlation. Tremor (alone or in combination with dystonia) was the most common MD observed and diffuse white matter lesions without affection of the basal ganglia was the most common site of lesion.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Encéfalo/patologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Transtornos dos Movimentos/complicações , Transtornos dos Movimentos/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Lesões Encefálicas Traumáticas/patologia , Traumatismos Craniocerebrais/patologia , Feminino , Humanos , Masculino , Transtornos dos Movimentos/patologia , Estudos Prospectivos
15.
Neuropsychology ; 33(8): 1035-1044, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31259562

RESUMO

OBJECTIVE: Head injury during development has been associated with behavioral changes such as impulsivity and antisocial behavior. This study investigates the extent to which behavioral changes associated with childhood head injury are sustained through adolescence and emerging adulthood. METHOD: Survey data was collected at 5 waves spanning 12 years (ages 9-20) from the University of Southern California Risk Factors for Antisocial Behavior twin study. Impulsivity was measured by errors of commission in a Go/NoGo behavioral task, and aggression was measured through youth self-report using the Reactive-Proactive Aggression Questionnaire. Head injury was assessed retrospectively using caregiver questionnaires at twin ages 14-15 years and self-reported at ages 19-20 years. RESULTS: Participants with a head injury in early childhood showed significant delay in the normative developmental decline of impulsivity relative to the noninjured by mid-adolescence (ages 14-15.) Moreover, earlier age at injury was related to a slower decrease in impulsivity and greater increase in reactive aggression scores. Finally, among discordant monozygotic twin pairs, the twin with a head injury experienced significantly less decline in impulsivity by ages 19-20 than the noninjured co-twin. CONCLUSIONS: These findings indicate early childhood head injury may play a significant role in blunting the decline in impulsivity across development, exposing an additional risk factor for antisocial behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Desenvolvimento do Adolescente , Agressão/fisiologia , Traumatismos Craniocerebrais/fisiopatologia , Adolescente , Adulto , Criança , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Estudos Longitudinais , Masculino , Fatores de Risco , Adulto Jovem
16.
BMJ Case Rep ; 12(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31189547

RESUMO

Decompressive craniectomy is a life-saving procedure performed to treat intracranial hypertension caused by a variety of conditions. Subsequent cranioplasty reconstruction is needed for brain protection. Different alloplastic materials with different advantages and disadvantages are available for cranial reconstruction. We present the first case of a deformed titanium cranioplasty mesh in a paediatric patient following head trauma. Children who have undergone cranioplasty reconstruction should be counselled to wear a protective helmet when involved in contact sports or activities that may put their implant at risk of trauma.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Craniectomia Descompressiva/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Fraturas Cranianas/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Criança , Traumatismos Craniocerebrais/complicações , Humanos , Masculino , Falha de Prótese , Fraturas Cranianas/etiologia , Titânio
17.
World Neurosurg ; 129: 9-12, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150845

RESUMO

BACKGROUND: Brain parenchyma herniation through a disrupted inner table into an enlarged diploic cavity with an intact outer table is described as intradiploic encephalocele. Intradiploic encephaloceles share common morphologic characteristics with expanding skull fractures and intradiploic arachnoid cysts. Herein, we describe a case of traumatic occipital intradiploic encephalocele. CASE DESCRIPTION: Cranial computed tomography of an 11-year-old boy revealed erosion of the inner table of the left side of occipital bone and expansion of the cranial diploë by a soft-tissue density with a gyral pattern. His medical history was positive for head trauma at the age of 3 years to the same region. Magnetic resonance imaging showed herniation of left occipital parenchyma with cystic encephalomalacic changes into the diploë. CONCLUSIONS: Intradiploic encephaloceles have different features compared with the classic encephalocele and can be considered as a variant of expanding skull fracture and intradiploic arachnoid cyst.


Assuntos
Traumatismos Craniocerebrais/complicações , Encefalocele/etiologia , Encefalocele/patologia , Criança , Humanos , Masculino
19.
Radiología (Madr., Ed. impr.) ; 61(3): 259-261, mayo-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185298

RESUMO

Se trata de un paciente varón, de 57 años, que acude al servicio de urgencias tras traumatismo facial y craneoencefálico al caerse por las escaleras. El paciente refiere cefalea intensa, motivo por el cual se le solicita una tomografía computarizada craneal donde se objetivan burbujas aéreas en espacio retrofaríngeo. Dado este hallazgo, se decide ampliar el estudio a región cervical y valorar así la posibilidad de perforación faríngea. Las perforaciones faríngeas en el contexto traumático son poco frecuentes, pero más aún lo son las causadas por la calcificación del ligamento longitudinal anterior como en nuestro caso


We report the case of a 57-year-old man who presented at the emergency department with injuries to his face and head after falling down the stairs. A head computed tomography examination done because he complained of an intense headache revealed air bubbles in the retropharyngeal space. Given this finding, a computed tomography of the neck was done to evaluate the possibility of pharyngeal perforation. Traumatic pharyngeal perforations are uncommon, but those caused by the calcification of the anterior longitudinal ligament, as in our case, are even more uncommon


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Faringe/lesões , Traumatismos Faciais/complicações , Traumatismos Craniocerebrais/complicações , Ossificação do Ligamento Longitudinal Posterior/complicações , Diagnóstico por Imagem/métodos , Fatores de Risco
20.
Seizure ; 69: 215-217, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103792

RESUMO

PURPOSE: The aim of this study was to investigate the frequency and characteristics of auras in patients with psychogenic nonepileptic seizures (PNES) and to characterize the patients' historical and clinical risk factors that may be associated with such manifestations. METHODS: In this retrospective database study, all patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 until 2018, were studied. RESULTS: During the study period, 258 patients were investigated. One hundred and seventy-three patients (67.1%) reported having auras. Auras were associated with multiple variables, including sex ratio, history of head injury, ictal injury, and taking antiepileptic drugs, in univariate analyses. We then performed a logistic regression analysis, assessing these four variables. The model that was generated by the regression analysis was significant (p = 0.0001) and could predict the possibility of auras in 72% of the patients. Within the model, sex ratio (OR: 0.498; 95% CI: 0.282-0.878; p = 0.01) and a history of head injury (OR: 0.096; 95% CI: 0.020-0.465; p = 0.004) retained their significance. CONCLUSION: Patients with PNES may frequently report auras including some auras which are often seen in patients with focal epilepsies; as a result, they are at great risk of receiving wrong diagnosis and unnecessary treatments. Health care professionals involved in the management of patients with seizures should be aware of this risk and prescribe an antiepileptic drug only after making a definite diagnosis of epilepsy in a patient with a paroxysmal event.


Assuntos
Epilepsia/etiologia , Transtornos Psicofisiológicos/complicações , Convulsões/etiologia , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/epidemiologia , Tontura/epidemiologia , Tontura/etiologia , Epilepsia/epidemiologia , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Transtornos Psicofisiológicos/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Fatores Sexuais
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