Acute-Phase Intraoperative Findings of Traumatic Spinal Cerebrospinal Fluid Leakage

The Examination of Prognostic Factors and Treatment Strategies for Traumatic Cerebrospinal Fluid Leakage

Introduction This study aimed to determine the optimal timing for surgical intervention and the prognostic factors of cerebrospinal fluid (CSF) leakage. Methods We identified 25 patients with probable CSF leaks from 472 consecutive patients with head trauma. In addition to baseline characteristics and findings on admission, injury severity score (ISS), abbreviated injury score (AIS), and other factors related to CSF leakage were considered. We analyzed the prognostic factors after setting the primary endpoint as the modified Rankin Scale (mRS) at the time of discharge to determine the appropriate timing for surgical intervention. Results Univariate analysis revealed significantly poorer prognoses for elderly patients (p<0.001) and cases with low Glasgow Coma Scale (GCS) levels (p=0.039) and high D-dimer levels (p=0.028), which was consistent with findings from the analyses of all patients with head trauma. We found that multiple traumas (AIS≥3 at two or more sites, p=0.047) and high lactate levels (p=0.043) were poor prognostic factors specific to CSF leakage cases, while a longer time to CSF leakage cessation was also associated with a poorer prognosis (median, six days versus 13 days, p=0.014). An evaluation of the time to closure found that spontaneous cessation occurred within 14 days in most cases. Conclusions Conservative medical treatment is the first choice for most cases of traumatic CSF leakage. Surgical intervention should be considered if leakage does not cease after 14 days post injury. Furthermore, severe multiple injuries and high lactate levels were poor prognostic factors specific to patients with CSF leakage.

The Application Value of MRI in the Training and Physical Rehabilitation of Gastrocnemius with Acute Sports Injury

The purpose of this study was to analyze the magnetic resonance imaging (MRI) signs of acute gastrocnemius injury and to provide the basis for clinical diagnosis. Thirty-two patients with acute gastrocnemius muscle injury (19 males and 13 females, aged 18-63 years, mean 46 years) were recruited, and MRI scans were performed. The results showed that all the lesions of calf gastrocnemius were detected in 32 patients, including first-degree injury in 15 cases, second-degree injury in 15 cases, and third-degree injury in 2 cases. MRI can display the location and pathological changes of acute gastrocnemius injury, providing good imaging data for clinical diagnosis and treatment.