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The usefulness of diffusion tensor imaging in detection of diffuse axonal injury in a patient with head trauma

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Neural Regeneration Research 2012年第6期7卷 475-478页

作者： Hyeok Gyu Kwon Sung Ho Jang Department of Physical Medicine and Rehabilitation College of Medicine Yeungnam University

Diffuse axonal injury is the predominant mechanism of injuries in patients with traumatic brain injury. Neither conventional brain computed tomography nor magnetic resonance imaging has shown sufficient sensitivity in the diagnosis of diffuse axonal injury. In the current study, we attempted to demonstrate the usefulness of diffusion tensor imaging in the detection of lesion sites of diffuse axonal injury in a patient with head trauma who had been misdiagnosed as having a stroke. A 44-year-old man fell from a height of about 2 m. Brain magnetic resonance imaging （32 months after onset） showed leukomalactic lesions in the isthmus of the corpus callosum and the left temporal lobe. He presented with mild quadriparesis, intentional tremor of both hands, and trunkal ataxia. From diffusion tensor imaging results of 33 months after traumatic brain injury onset, we found diffuse axonal injury in the right corticospinal tract （centrum semiovale, pons）, both fomices （columns and crus）, and both inferior cerebellar peduncles （cerebellar portions）. We think that diffusion tensor imaging could be a useful tool in the detection of lesion sites of diffuse axonal injury in patients with head trauma.

关键词： traumatic brain injury diffuse axonal injury diffusion tensor imaging head trauma

Knowledge, Attitude, and Practice of Using Helmets in Children amongst Parents to Prevent head Injuries: A Cross-Sectional Study in Riyadh, Saudi Arabia

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Open Journal of Pediatrics 2024年第2期14卷 255-265页

作者： Turki Salah Aldeen Bukhari Abdullah Yahya Aldhban Anas Abdulrahman Alqasem Dona Jamal Al Hatlani Hareth Aldosaimani Hamad A. Al Madi Khalid Alqahtani Prince Sultan Military Medical City Riyadh Saudi Arabia Emergency Department Disaster Medicine and Emergency Preparedness Prince Sultan Military Medical City Riyadh Saudi Arabia Emergency Department Asir Central Hospital Abha Saudi Arabia

Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-sectional study, done by online survey using a snowball sampling technique, the number of included responses were 386 parents (Male and female) living in Riyadh Aged 21 - 60 years old or above. Results: The study showed that there is a difference in Parents’ belief in the importance of helmet use while riding a Bicycle vs Motorcycle/Quad bike and that was affected by parents’ education level, almost all the people who answered the survey (76.7%) agree that it is important for their children to wear a helmet when riding both a Bicycle and a Motorcycle or Quadbike with a cumulative percentage of (93.8%). And almost all agreed on multiple approaches to help increase helmet use be it by forcing rental shops to give out helmets, forcing sellers to recommend the use of helmets, increasing awareness campaigns, and imposing fines for not wearing helmets. Conclusions: This study is the first to explore Family helmet use while riding Bicycles and Motorcycles/Quad bikes. Although Parent’s belief in the importance of helmet use for their children was high, it is clear that the level of practice is low. With that the risk of head injuries might be high, our findings suggest that safety interventions for increasing pediatric helmet use are needed to increase helmet use and reduce the risk of head injury and hospitalization.

关键词： head trauma head Injury Helmet Bicycle Motorcycle Quad Bike KAP Knowledge Attitude Practice

Anticipation of Dural Tear in Patients with Blunt head trauma

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Open Journal of Modern Neurosurgery 2022年第3期12卷 132-140页

作者： Mohamed M. Elsherbini Ali H. Elmokadem Hatem Badr Amr F. Khalil Neurosurgery Department Mansoura University Mansoura Egypt Radiology Department Mansoura University Mansoura Egypt

Background: Dural tears are considered among the neurosurgical challenges to be dealt with during management of head trauma patients;it’s important to anticipate such pathology pre-operatively;the purpose of this study is to discuss and analyze various predictors of dural tear as a sequala of blunt head trauma. Methods: Patients with blunt head trauma who underwent surgery during the year 2020 were analyzed;operative data were reviewed;only patients with reported dural repair as a step during surgery were included. Patients with penetrating head injury were excluded. Preoperative radiology, epidemiological and clinical details were analyzed to conclude specific criteria for dural tear. Results: Twenty-three patients were involved in the study;male predominance was evident. The most common primary injury was depressed fracture (73.9%), while the most common mode of trauma was domestic injury (43.5%), especially in pediatric group (76.9%). Two cases of growing skull fracture were involved, and both were in pediatric group. CT findings were conclusive for immediate dural tear findings, however, suggestive for patients with growing skull fractures. Mean depth of depression for depressed fracture group was 15.07 mm. Conclusion: Dural tears are not a serious complication of head trauma, however, their sequalae are life-threatening. Anticipation of dural tear is feasible radiologically pre-operatively for immediate dural repair and craniotomy fashioning;for cases of growing skull fractures, it’s difficult to anticipate the course from time of impact till time of presentation.

关键词： Dural Tear Growing Skull Fracture head trauma Depressed Fracture

Massive Epistaxis Revealing a Post-traumatic Aneurysm of the Internal Carotid Artery: A Clinical Case and Review of the Literature

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International Journal of Otolaryngology and head & Neck Surgery 2024年第2期13卷 120-125页

作者： Yannick Mossus Maguy Mbede Roger Meva’a Biouélé Leonel Atanga Adèle-Rose Ngo Nyeki Pierre Ongolo Zogo François Djomou Alexis Ndjolo Department of Ophthalmology ENT and Stomatology Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Medical Imaging Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.

关键词： Aneurysm Internal Carotid Artery head trauma Epistaxis

Unusual head trauma: About Three Observations at the Chu Pr Bocar Sidy Sall (BSS) of Kati

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Open Journal of Medical Imaging 2023年第3期13卷 57-62页

作者： Coulibaly Salia Ilias Guindo Traore Ousmane Diarra Issa Traore Youssouf Sanogo Souleymane Diarra Ouncoumba Diarra Hawa Sidibe Siaka Medical Imaging Department Pr BSS University Hospital of Kati Mali Medical Imaging Department Kati University Hospital Kati Mali Department of traumatology Neurosurgery Unit Pr BSS University Hospital of Kati Mali

Introduction: Penetrating head injuries are often due to human-to-human violence, mainly by firearms, those by stab are rare. CT is the exam of choice in the assessment of emergency lesions. We report three observations, all victims of knife assault during the brawl in order to clarify the contribution of DTM in the care. Observations: 1) Mr. I S, 21-year-old, student, was admitted with the hillside implanted in the skull. There were traces of blood on his face and clothes. There was no neurological deficit on examination. The CT scan performed showed the knife penetrating the vault of the skull at the left parietal level, up to 5 cm in the cerebral parenchyma with a minimal subdural and intracerebral hematoma;2) Mr. S C, 43-year-old, farmer, admitted with a large left fronto-temporo-parietal wound, bleeding and right hemiplegia. The CT scan performed showed a frontal linear fracture (with fronto-ethmoid hemosinus) and left temporoparietal with a parietal intraparenchymal hematoma and homolateral frontoparietal subdural hematoma;3) Mr. S B: 40 years old, driver, admitted with a parietal wound. The CT scan performed objectified a left parietal cortical hematoma in relation to a metallic foreign body (3000 HU) corresponding to the distal end of the knife penetrating the vault of the skull. They all underwent emergency surgery and received antibiotics and preventive serotherapy. The postoperative follow-up was simple, the follow-ups are without neurological sequelae. Conclusion: head trauma by knife is rare, it results from inter-human violence. The lesion diagnosis is computed tomography. The prognosis depends on the severity.

关键词： head trauma Stabbing CT CHU Kati

Delayed neurological deterioration following head trauma

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Neural Regeneration Research 2010年第23期5卷 1829-1831页

作者： Sung Ho Jang Department of Physical Medicine and Rehabilitation College of MedicineYeungnam University

We report a patient who presented with neurological deterioration 26 days after a motor vehicle accident. A 25-year-old man crashed a car onto farmland from a height of approximately 3 meters. Neurological deterioration including ataxia and visual disturbance became apparent 26 days after the accident. Brain magnetic resonance imaging did not reveal any abnormality, but brain single photon emission computed tomography showed mild hypoperfusion in the left frontotemporal lobe. An ophthalmic examination revealed no specific abnormality, but visual-evoked potentials revealed prolonged latencies in both eyes. We propose that this neurological deterioration might have resulted from traumatic axonal injury. As such, future studies should examine preventive strategies against delayed deterioration in patients with head trauma.

关键词： brain injury ataxia axonal injury head trauma

head trauma in Infants: Experience of a High Flow Tertiary Hospital in a Developing Country

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Open Journal of Modern Neurosurgery 2016年第2期6卷 76-81页

作者： Mohamed M. Salama Ahmed El-Fiki Department of Neurosurgery Faculty of Medicine Cairo University Giza Egypt

Background and Objective: head trauma in infants is a common health problem that has not been the focus of many research articles. The aim of study was to describe the epidemiology, etiology, management and clinical outcome of head trauma in infants (head trauma admitted to the neurotrauma unit in Cairo University hospitals during the period between September 2013 and December 2014. The data of these patients including age, sex, mode of trauma, neurological status on admission, CT findings, operative details in surgical cases, clinical outcome, and length of hospital stay were analyzed. Results: The study included 57 boys and 38 girls, with mean age of 13.2 months (range: 3 days - 23 months). The most common mode of trauma was falls (82.1%). Most of the patients had mild head injury (84.2%). Twenty two patients were operated upon, including 9 patients for evacuation of hematomas, 11 patients for elevation of depressed fractures, 1 patient for decompressive craniotomy and 1 patient for growing skull fracture. Good recovery followed in 83 patients. There were 4 deaths. Mean length of stay was 4 days (range: 1 - 31 days). Conclusion: Most of head injuries in infants are mild. The commonest etiology is falls, which is a preventable cause in many circumstances. The majority of these patients do not require surgical intervention. Good recovery is the rule in most of these infants with low mortality rates.

关键词： head trauma Infants traumatic Brain Injury

Shock index and its variants as predictors of mortality in severe traumatic brain injury

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World Journal of Critical Care Medicine 2024年第1期13卷 40-48页

作者： Randhall B Carteri Mateus Padilha Silvaine Sasso de Quadros Eder Kroeff Cardoso Mateus Grellert Department of Nutrition Centro Universitário CESUCAPorto Alegre 94935-630Brazil Department of Analysis and Systems Development Centro Universitário CESUCAPorto Alegre 94935-630Brazil Department of Nutrition Hospital Pronto Socorro de Porto AlegrePorto Alegre 90040-192Rio Grande do SulBrazil Department of Physiotherapy Hospital Pronto Socorro de Porto AlegrePorto Alegre 90040-192Rio Grande do SulBrazil Institute of Informatics Federal University of Rio Grande do Sul(UFRGS)Porto Alegre 91501-970Rio Grande do SulBrazil

BACKGROUND The increase in severe traumatic brain injury(sTBI)incidence is a worldwide phenomenon,resulting in a heavy disease burden in the public health systems,specifically in emerging countries.The shock index(SI)is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock,which is increased in sTBI.Considering the high mortality of sTBI,scrutinizing the predictive potential of SI and its variants is vital.AIM To describe the predictive potential of SI and its variants in sTBI.METHODS This study included 71 patients(61 men and 10 women)divided into two groups:Survival(S;n=49)and Non-survival(NS;n=22).The responses of blood pressure and heart rate(HR)were collected at admission and 48 h after admission.The SI,reverse SI(rSI),rSI multiplied by the Glasgow Coma Score(rSIG),and Age multiplied SI(AgeSI)were calculated.Group comparisons included Shapiro-Wilk tests,and independent samples t-tests.For predictive analysis,logistic regression,receiver operator curves(ROC)curves,and area under the curve(AUC)measurements were performed.RESULTS No significant differences between groups were identified for SI,rSI,or rSIG.The AgeSI was significantly higher in NS patients at 48 h following admission(S:26.32±14.2,and NS:37.27±17.8;P=0.016).Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function,only the AgeSI was a viable outcome-predictive tool in sTBI,warranting future research in different cohorts.

关键词： head trauma Critical patient Neuro-cardio axis Predictive tool Clinical practice

Exceptional Complication of a Benin Cranial trauma in a 3-Year-Old Child

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World Journal of Cardiovascular Diseases 2022年第6期12卷 315-319页

作者： Lahrache Karim Soulaimane M’harzi Ayad Ghanam Aziza Elouali Maria Rkain Noufissa Benajiba Abdeladim Babakhouya Faculty of Medicine and Pharmacy Mohammed I University Oujda Morocco Department of Pediatrics Mohammed VI University Hospital Oujda Morocco

Internal carotid artery (ICA) dissection with associated stroke is rare event in children. The usual mechanism is either direct trauma or sudden neck movements. We describe the case of a 3-year-old patient admitted with right hemiplegia following a stroke. The diagnosis was confirmed by ANGIO-MRI. During treatment with anticoagulants and antiplatelet agents, the patient showed significant improvement in the right-sided hemiplegia. Minor head trauma is a possible pathological mechanism for ICA dissection in children. However, the scenario is extremely rare.

关键词： Child head trauma Internal Carotid Artery Dissection Stroke