Moderate head injuries in children as compared to other age groups, including the cases who had talked and deteriorated

Effect of Iloprost on endothelin-1-induced free radical activation in rabbit brain stem

Iloprost, a stable analogue of prostacyclin, was used to reverse the early period of vasoconstriction provoked by Endothelin-1 by administering into the rabbit basilar artery. We observed if this produced an effect on the central nervous system parenchyma mediated by free radical system. The red neurons were counted in brain stem sections stained with haematoxylin and eosin, while superoxide dismutase and malondialdehyde levels were measured in brain stem tissue samples as a marker of reactive oxygen metabolites; both 30 and 90 min after administration of either Endothelin-1 (0.25 ng) alone or Endothelin-1 followed by Iloprost (0.5 microg/kg) into the basilar artery. Endothelin-1 significantly increased the number of red neurons, while Iloprost significantly reduced them after 30 and 90 min. However, regarding the reactive oxygen metabolites; a similar reversing effect of Iloprost was not observed although superoxide dismutase levels were significantly decreased after Endothelin-1 infusion.

Effects of vasoconstriction on the acute anterior pituitary hormonal response to head injury

Since cerebral vasoconstriction alone may impair the hypothalamic and pituitary circulation, we planned to investigate whether the hormonal response to the vasoconstriction that may be induced by the head injury is a significant component of the general acute hormonal response to head injury. Although diffuse adrenocorticotropic hormone immunohistochemical staining of the adenohypophysis of rabbits was observed in the head trauma administered group, only mild positive staining was present in the Endothelin-1 administered group. However, decreased prolactin staining was found in both of the groups. It is postulated that trauma induced vasoconstriction may not be an important manipulating factor in the corticotrophic hormone response to injury, while it may be responsible for the decreased prolactin response.

Current controversies in the management of minor pediatric head injuries

Each year hundreds of thousands of children receive care in emergency departments after head injury. Minor head injuries account for a majority of these injuries. The prevalence, morbidity, and costs associated with pediatric minor head injuries make it an important topic. We review the management of pediatric minor head injury, emphasizing current areas of controversy, including criteria for neuroimaging, indications for hospitalization, the role of anticonvulsant therapy, and the long-term neurobehavioral sequelae of pediatric minor head injury.

Clinical significance of acute traumatic intracranial pneumocephalus

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury. CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present and whether the air bubbles were single or multiple. Clinical data such as the presence of persistent rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were were also assessed to determine the significance of this rare finding.

Assessment of mortality associated with mild head injury in the pediatric age group

Reducing mortality among accident and trauma patients requires careful attention to monitoring those regarded as being at low risk. We hospitalized almost 1600 head-injured patients in the period between 1979 and 1992 at the Neurosurgery Department of Gazi University Medical School, Ankara, Turkey. These patients were selected from among the numerous patients admitted to our emergency unit and treated with the same protocol in the same department. Among the hospitalized children, there were three patients defined as having a mild head injury on the basis of Glasgow Coma Scale scores of 15 who later had unfavorable outcomes. Clinical signs that might identify potentially endangered patients with mild injury were gathered; these included the presence of post-traumatic amnesia, somnolence, irritability, anisocoria, local evidence of trauma to the head, associated injuries, history of altered consciousness, and skull fracture. The study was designed to identify features by which patients who are in real danger can be distinguished among the many with trivial trauma that we face every day. We did not find any identifying clinical features and concluded that computed tomographic scanning is the only reliable answer. This will reduce avoidable mortality and morbidity by identifying the patients who are at higher risk than is at first evident.