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1.
Am J Surg ; 221(3): 606-608, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33485622

RESUMO

BACKGROUND: Many institutions obtain a delayed head CT in patients presenting after a ground level fall while on anticoagulation. This study evaluates their risk of delayed ICH. METHODS: Retrospective chart review of 635 patients on anticoagulation who sustained a ground level fall with a negative initial head CT and a GCS above eight. Patients underwent a repeat head CT within 48 h. The ISS was calculated for all patients. RESULTS: Five patients had a delayed ICH. All survived and none required neurosurgical intervention. Patient variables did not have any correlation with development of ICH. Patients with a delayed ICH had a significantly higher ISS. CONCLUSION: Patients on anticoagulation presenting to the hospital after a ground level fall, with a GCS above eight and an initial negative head CT, do not need to undergo repeat imaging. ISS could be used to stratify patients who are at higher risk of delayed ICH.


Assuntos
Acidentes por Quedas , Anticoagulantes/uso terapêutico , Traumatismos Craniocerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Idoso , Traumatismos Craniocerebrais/complicações , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452072

RESUMO

Bacterial brain abscesses are typically spread through a haematogenous route. Open head wounds and neurosurgical interventions are uncommon aetiologies. Ectopic tissue found in the cerebral cortex is usually ascribed almost entirely from carcinomas. Here, we describe a 57-year-old gentleman who, 22 years after a fireworks related traumatic injury to the left orbit, presented with headaches and altered behaviour. Imaging revealed an abscess immediately superior to the orbit, whose bacterial aetiology was identified to be Pseudomonas aeruginosa, encapsulated by ciliated respiratory epithelium. This represents a case in which tissue was displaced during the initial trauma or craniofacial reconstructive surgery from the frontal sinus.


Assuntos
Abscesso Encefálico/etiologia , Abscesso Encefálico/patologia , Traumatismos Craniocerebrais/complicações , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Abscesso Encefálico/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/lesões , Pseudomonas aeruginosa , Mucosa Respiratória/patologia
5.
Rozhl Chir ; 99(7): 316-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972150

RESUMO

INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.


Assuntos
Lesões Encefálicas , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Craniectomia Descompressiva/efeitos adversos , Derrame Subdural/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
6.
Plast Reconstr Surg ; 146(2): 381-388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740591

RESUMO

BACKGROUND: Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. METHODS: One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. RESULTS: Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). CONCLUSIONS: This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Traumatismos Craniocerebrais/complicações , Descompressão Cirúrgica/estatística & dados numéricos , Transtornos de Enxaqueca/cirurgia , Lesões do Pescoço/complicações , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
7.
J Pediatr ; 223: 148-155.e2, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32532650

RESUMO

OBJECTIVES: To evaluate the incidence of anemia in patients with abusive head trauma (AHT), noninflicted traumatic brain injury (TBI), and physical abuse without AHT and the effect of anemia on outcome. STUDY DESIGN: In a retrospective, single-center cohort study, we included children under the age of 3 years diagnosed with either AHT (n = 75), noninflicted TBI (n = 77), or physical abuse without AHT (n = 60) between January 1, 2014, and December 31, 2016. Neuroimaging was prospectively analyzed by pediatric neuroradiologists. Primary outcome was anemia at hospital presentation. Secondary outcomes included unfavorable outcome at hospital discharge, defined as a Glasgow Outcome Scale between 1 and 3, and intracranial hemorrhage (ICH) volume. RESULTS: Patients with AHT had a higher rate of anemia on presentation (47.3%) vs noninflicted TBI (15.6%) and physical abuse without AHT (10%) (P < .001). Patients with AHT had larger ICH volumes (33.3 mL [10.1-76.4 mL] vs 1.5 mL [0.6-5.2 mL] ; P < .001) and greater ICH/total brain volume percentages than patients with noninflicted TBI (4.6% [1.4-8.2 %] vs 0.2% [0.1-0.7%]; P < .001). Anemia was associated with AHT (OR, 4.7; 95% CI, 2.2-10.2) and larger ICH/total brain volume percentage (OR, 1.1; 95% CI, 1.1-1.2) in univariate analysis. Unfavorable outcome at hospital discharge was associated with anemia (OR, 4.4; 95% CI, 1.6-12.6) in univariate analysis, but not after controlling for covariates. CONCLUSIONS: Patients with AHT were more likely to present to the hospital with anemia and increased traumatic ICH volume than patients with noninflicted TBI or physical abuse without AHT. Children with anemia and AHT may be at increased risk for an unfavorable outcome.


Assuntos
Anemia/epidemiologia , Traumatismos Craniocerebrais/complicações , Hemorragias Intracranianas/complicações , Abuso Físico , Medição de Risco/métodos , Traumatismos Craniocerebrais/diagnóstico , Feminino , Humanos , Incidência , Lactente , Hemorragias Intracranianas/diagnóstico , Masculino , Pennsylvania/epidemiologia , Estudos Retrospectivos , Fatores de Risco
9.
Lakartidningen ; 1172020 05 29.
Artigo em Sueco | MEDLINE | ID: mdl-32484233

RESUMO

Brain injuries due to abusive head trauma (AHT) in infants are not rare and they are probably under-diagnosed. Retinal hemorrhages (RH) constitute a cardinal symptom of AHT and AHT is the most common cause of RH in infants next to childbirth. Retinoschisis with or without retinal folds is highly suggestive of AHT and never seen secondary to childbirth. Bilateral extensive RH that are too numerous to count, multilayered and extending to the peripheral retina in infants < 3 years of age, in combination with brain injury and in absence of leukemia, ruptured brain aneurysm/AVM, fatal head crush or known severe accidental trauma must be considered to be caused by AHT in the absence of any other compelling factors. The ophthalmologist has an important role and a responsibility in describing the pattern of RH and in evaluating the likelihood of the diagnosis in the medical report and in communication with pediatricians and child protection team.


Assuntos
Lesões Encefálicas , Maus-Tratos Infantis , Traumatismos Craniocerebrais , Hemorragia Retiniana , Retinosquise , Criança , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/etiologia , Humanos , Lactente , Hemorragia Retiniana/etiologia
10.
World Neurosurg ; 140: 258-261, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32445897

RESUMO

BACKGROUND: Post-traumatic diploic leptomeningeal cyst with bilateral posterior cranial fossa epidural hygroma is a rare complication after calvarial fracture. Very few cases have been reported to date; hence, there are no specific guidelines for the management of these cases. CASE DESCRIPTION: A 4-year-old boy was brought to the emergency department after suffering from head trauma caused by a fall from a rooftop where he was treated conservatively at a local hospital. Later, he developed swelling in the occipital region and was brought to the department of neurosurgery where he was operated on. After the first surgery, recurrence of swelling was seen after a postoperative period of 2 months, and computed tomography scan reported persistent epidural hygroma with extension into the subcutaneous space. The second surgery was performed, and 12-month follow-up did not show any recurrence of swelling in the patient. CONCLUSIONS: Post-traumatic leptomeningeal cyst is commonly associated with occipital injury. The causes are as follows: the dura is very loosely attached to the intracranial lamina in young children, injury to the skull results in potential epidural space, and any tear or breach in the meninges leads to accumulation of cerebrospinal fluid in these spaces giving rise to cystic swelling. Watertight duroplasty with trials of duro-periosteal hitching has been described in the management of these cases.


Assuntos
Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Procedimentos Neurocirúrgicos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/etiologia , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X
11.
World Neurosurg ; 140: 193-197, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32360925

RESUMO

BACKGROUND: Traumatic intracranial aneurysms are rare complications after head trauma. This report describes the case of a patient with a traumatic pericallosal aneurysm. CASE DESCRIPTION: A 73-year-old man developed headache and lower limb paresis, and emergency computed tomography scan revealed a hematoma in the corpus callosum. We performed coil embolization for a pericallosal aneurysm, but follow-up angiography showed recurrence of the aneurysm 6 days after the surgery. We diagnosed this as a traumatic aneurysm and subsequently performed parent artery occlusion without any complications. CONCLUSIONS: We performed parent artery occlusion for a traumatic aneurysm of the pericallosal artery without complications. Pericallosal aneurysms are rare, but we must consider them when encountering a delayed hematoma around the corpus callosum.


Assuntos
Artéria Cerebral Anterior/cirurgia , Traumatismos Craniocerebrais/complicações , Embolização Terapêutica , Aneurisma Intracraniano/cirurgia , Idoso , Humanos , Aneurisma Intracraniano/etiologia , Masculino , Resultado do Tratamento
12.
Int J Pediatr Otorhinolaryngol ; 134: 110044, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32320837

RESUMO

OBJECTIVES: Cerebrospinal fluid (CSF) rhinorrhea in children is relatively uncommon. Endoscopic repair techniques in adults have become first line for nasal-based CSF leaks, and this meta-analysis looks at the success rates of CSF leak cessation following endoscopic repair in children. METHODS: Three researchers extracted information involving patient population, surgical technique, outcomes of interest, and study design. A computerized search of MEDLINE, EMBASE and the Cochrane library (January 1990-September 2019) looked for several papers on the subject of CSF leak repair in children using endoscopic technique. RESULTS: A total of 15 studies met inclusion criteria. Endoscopic repair of CSF rhinorrhea in children shows a pooled weighted success rate of 94% after first attempt. The most common etiology was traumatic followed by congenital. Iatrogenic defects secondary to tumor resection are becoming more common. The high success rate was irrespective of the techniques using. CONCLUSION: Endoscopic repair techniques have a highly successful closure rate for children presenting with CSF rhinorrhea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Vazamento de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Encefalocele/complicações , Humanos , Doença Iatrogênica , Lactente , Meningocele/complicações , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
13.
J Trauma Acute Care Surg ; 89(2): 301-310, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32332255

RESUMO

BACKGROUND: The number of trauma patients on prehospital novel oral anticoagulants (NOACs) is increasing. After an initial negative computed tomography of the head (CTH), practice patterns are variable for obtaining repeat CTH to evaluate for delayed intracranial hemorrhage (ICH-d). However, the risks and outcomes of ICH-d for patients on NOACs are unclear. We hypothesized that, for these patients, the incidence of ICH-d is low, similar to that of warfarin, and when it occurs, it does not result in clinically significant worse outcomes. METHODS: Five level 1 trauma centers in Northern California participated in a retrospective review of anticoagulated trauma patients. Patients were included if their initial CTH was negative. Primary outcomes were incidence of ICH-d, neurosurgical intervention, and death. Patient factors associated with the outcome of ICH-d were determined by multivariable regression. RESULTS: From 2016 to 2018, 777 patients met the inclusion criteria (NOAC, n = 346; warfarin, n = 431), 54% of whom received a repeat CTH. Delayed intracranial hemorrhage incidence was 2.3% in the NOAC group and 4% in the warfarin group (p = 0.31). No NOAC patient with ICH-d required neurosurgical intervention or died because of their head injury. Two warfarin patients received neurosurgical intervention, and three died from their head injury. Head Abbreviated Injury Scale ≥3 was associated with increased odds of developing ICH-d (adjusted odds ratio, 32.70; p < 0.01). CONCLUSION: The incidence of ICH-d in patients taking NOAC is low. In this study, patients on NOACs who developed ICH-d after an initial negative CTH did not need neurosurgical intervention or die from their head injury. Repeat CTH in this patient population does not appear necessary. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.Therapeutic, level IV.


Assuntos
Anticoagulantes/uso terapêutico , Traumatismos Craniocerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Administração Oral , Anticoagulantes/efeitos adversos , California/epidemiologia , Traumatismos Craniocerebrais/complicações , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Padrões de Prática Médica , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Procedimentos Desnecessários , Varfarina/efeitos adversos , Varfarina/uso terapêutico
14.
J Clin Neurosci ; 75: 221-223, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32223977

RESUMO

Alexander disease (ALXDRD) is a rare astrocytic leukodystrophy caused by GFAP mutations. The adult-onset (AO) variant is usually characterized by gradual onset of spastic ataxia and bulbar symptoms with slowly progressive course. We report two AO-ALXDRD cases with rapid worsening after minor head trauma. In one of them, the only post-traumatic neuroimaging change was revealed by diffusion tensor imaging study. Our observations support the link between head trauma and ALXDRD progression, and suggest that this progression may be ascribed to microstructural changes. Clinicians should inform ALXDRD patients to minimize the risk of head trauma.


Assuntos
Doença de Alexander/complicações , Doença de Alexander/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Progressão da Doença , Índice de Gravidade de Doença , Doença de Alexander/genética , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mutação/genética
16.
Med. leg. Costa Rica ; 37(1): 39-44, ene.-mar. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1098370

RESUMO

Resumen La intoxicación con alcohol está frecuentemente asociada con trauma craneoencefálico (TCE), pero el impacto del alcohol en la patogénesis y el pronóstico del TCE sigue siendo poco clara. La literatura actual provee evidencia en términos de datos clínicos y experimentales que respaldan los efectos neuroprotectores del alcohol en pacientes con TCE. Para establecer de manera significativa esta relación es necesario el desarrollo de estudios prospectivos observacionales fuertes, con el fin de comprender los efectos del alcohol en los resultados clínicos a largo plazo (incluyendo el resultado neurológico) en pacientes con TCE con una apropiada selección y ajuste del riesgo basal.


Abstract Alcohol intoxication is often associated with traumatic brain injuries (TBIs), but the impact of alcohol on the pathogenesis and prognosis of TBIs remains unclear. Current literature provides evidence in terms of experimental and clinical data supporting alcohol's neuroprotective effects in patients with TBIs. To establish in a significative way this association, there lies a need for strong prospective observational studies, in order to comprehend the effects of alcohol on the long-term outcomes (including the neurological outcome) in patients with TBI with proper selection and baseline risk adjustment.


Assuntos
Apoptose , Intoxicação Alcoólica/complicações , Traumatismos Craniocerebrais/complicações , Indicadores de Morbimortalidade , Etanol/efeitos adversos , Alcoolismo/complicações
17.
World Neurosurg ; 137: 200-205, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058122

RESUMO

BACKGROUND: Although several complications after ventriculoperitoneal shunting (VPS) have been reported, transoral protrusion of a peritoneal catheter is a rare event. In the few reported cases from the literature, it is more common in pediatric patients. This case report describes the first adult in the literature with a transoral VPS protrusion after jejunal perforation. CASE DESCRIPTION: A 58-year-old man with posttraumatic hydrocephalus was noted with the distal tubing of the VPS protruding from his mouth after he vomited. Radiologic imaging showed jejunal perforation of the distal part of the VPS. The VPS was initially externalized, and then removed. The patient remained stable. CONCLUSIONS: We present a rare case of transoral protrusion of a peritoneal catheter 11 months after a VPS procedure and review of the literature through this article.


Assuntos
Tratamento Conservador , Remoção de Dispositivo , Hidrocefalia/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Jejuno , Complicações Pós-Operatórias/diagnóstico por imagem , Falha de Prótese , Derivação Ventriculoperitoneal , Traumatismos Craniocerebrais/complicações , Humanos , Hidrocefalia/etiologia , Perfuração Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Boca , Vômito
20.
World Neurosurg ; 136: 198-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927123

RESUMO

BACKGROUND: Pseudoaneurysms of the middle meningeal artery represent fewer than 1% of all intracranial aneurysms; it can be associated with different patterns of intracranial hemorrhages. A chronic epidural hematoma (CEDH) caused by post-traumatic pseudoaneurysm of the middle meningeal artery (MMA) has not yet been reported. CASE DESCRIPTION: A 17-year-old male patient was referred to our unit after a car accident, with head trauma and presented motor and language deficits. After a brain computed tomography scan that revealed a left temporal epidural hematoma, the patient underwent surgery with complete hematoma drainage and recovery. After 5 months, he developed a chronic epidural hematoma secondary to a pseudoaneurysm of the MMA, as shown by cerebral angiography. We also reviewed the literature to evaluate the state of the art concerning the diagnosis and management of patients affected by CEDH. CONCLUSIONS: Pseudoaneurysms are considered unstable because of the poor support of the aneurysmal wall. They tend to progressively increase in size and ultimately rupture, leading to delayed intracranial bleeding. A univocal definition of the interval of time between the acute head trauma and the diagnosis to classify the CEDH is still debated. To our knowledge, this is the first case described of a CEDH secondary to a pseudoaneurysm of the MMA. In our study we suggest defining CEDHs as extradural hematomas diagnosed and/or treated 21 days or more after a head injury.


Assuntos
Falso Aneurisma/complicações , Traumatismos Craniocerebrais/complicações , Hematoma Epidural Craniano/etiologia , Artérias Meníngeas , Acidentes de Trânsito , Adolescente , Falso Aneurisma/cirurgia , Traumatismos Craniocerebrais/cirurgia , Hematoma Epidural Craniano/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem
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