Can midline brain shift be used as a prognostic factor to predict postoperative restoration of consciousness in patients with chronic subdural hematoma?

BACKGROUND AND PURPOSE: Our aim was to determine if midline brain shift could be used as a prognostic factor to predict postoperative restoration of consciousness in patients with CSDH. In these patients, we evaluated the relation (1) between midline brain shift as measured on CT and alteration of level of consciousness, and (2) between midline brain shift and restoration of consciousness after the operation. METHODS: Prospectively recorded data of 45 patients with CSDH were evaluated. We compared level of consciousness of patients measured by GCS score, brain displacement at PG and SP both in the preoperative and early postoperative period. RESULTS: Preoperatively, PG and SP shifts of the patients who were alert (GCS = 15) were significantly less than those of patients who had diminished consciousness. However, in patients with diminished consciousness (GCS < 15), the amount of lateral brain displacement and the degree of diminution of consciousness did not correlate. Those patients who had a preoperative SP shift of less than 10 mm had a significantly lesser chance to become alert after operation (2 of 5 patients) when compared with those patients who had a preoperative SP shift of 10 mm or more (21 of 23 patients). CONCLUSIONS: We conclude that preoperative SP shift may be used as a factor to predict restoration of consciousness in patients with CSDH; the likelihood of becoming alert after operation is increased if SP shift is 10 mm or greater, and is decreased if SP shift is less than 10 mm.

Depressed fractures over cranial venous sinus.

Seventeen patients with depressed fractures over cranial venous sinus who had undergone operations between 1993 and 1998 were reviewed retrospectively. There were 15 male and two female patients. Their ages ranged from 7 to 48 years. The most frequent causes of trauma were motor vehicle accident (in eight cases) followed by assault (in six cases). In the majority of cases, depressed fractures were localized over the superior sagittal sinus, and half of them were over the medial third of the sinus. In 11 cases, massive blood loss occurred intraoperatively that could be controlled by digital pressure with gelfoam or with a free muscle flap. Postoperative infection developed in one case and was treated successfully with antibiotic medication alone. Two patients died due to associated intracerebral lesions. The remaining 15 patients returned to daily living activity in the follow-up period.

QTc dispersion in children with severe head trauma.

OBJECTIVE: Corrected QT (QTc) interval prolongation has been described after subarachnoid hemorrhage and head injury in adults. Abnormal QTc prolongation is associated with a higher risk of ventricular arrhythmias. The aim of this study was to analyze QTc interval and QTc dispersion in children with severe head trauma. METHODS: Forty-three patients with severe head trauma and 49 children with no or only mild head injury as controls were enrolled in the study. QT interval from standard 12-lead electrocardiogram immediately after admission was calculated. QT interval was corrected by heart rate according to Bazett formula, and then QTc dispersion was calculated. At the same time, levels of serum electrolytes were measured. RESULTS: Although no significant difference in terms of age, sex, and R-R interval was found, QTc interval and QTc dispersion values were significantly increased in the patients with severe head trauma compared with those with no or only mild head injury (QTc, 447 +/- 31 vs. 409 +/- 27 milliseconds; QTc dispersion, 77 +/- 22 vs. 52 +/- 16 milliseconds, respectively). When the patients with severe head trauma were categorized as those with or without intracranial hemorrhage, both QTc interval and QTc dispersion were significantly greater in those with intracranial hemorrhage. These electrocardiographic parameters were inversely associated with Glasgow Coma Scale score, serum calcium levels, and, at a lesser degree, potassium levels. CONCLUSIONS: Children with severe head trauma, especially those with intracranial hemorrhage have longer QTc interval and greater QTc dispersion.