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Li R, Su Z, Li Z, Li D, Luo R, Qiu J, Lan H. Experimental investigation of brain contusion characteristics and dynamic response in low-age children using an animal model. Injury 2024; 55:111589. [PMID: 38704918 DOI: 10.1016/j.injury.2024.111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Brain contusion is a prevalent traumatic brain injury (TBI) in low-age children, bearing the potential for coma and fatality. Hence, it is imperative to undertake comprehensive research in this field. METHODS This study employed 4-week-old piglets as surrogates for children and introduced self-designed devices for both free-fall drop impact tests and drop-hammer impact tests. The study explored the characteristics of brain contusion and dynamic responses of brain under these distinct testing conditions. RESULTS Brain contusions induced by free-fall and drop-hammer conditions both were categorized as the coup injury, except that slight difference in the contusion location was observed, with contusion occurring mainly in the surrounding regions beneath the impact location under free-fall condition and the region just right beneath the impact location under drop-hammer condition. Analysis of impact force and intracranial pressure (ICP) curves indicated similar trends in impact forces under both conditions, yet different trends in ICPs. Further examination of the peak impact forces and ICPs elucidated that, with increasing impact energy, the former followed a combined power and first-order polynomial function, while the latter adhered to a power function. The brain contusion was induced at the height (energy) of 2 m (17.2 J), but not at the heights of 0.4, 0.7, 1, 1.35 and 1.7 m, when the vertex of the piglet head collided with a rigid plate. In the case of a cylindrical rigid hammer (cross-sectional area constituting 40 % of the parietal bone) striking the head, the brain contusion was observed under the energy of 21.9 J, but not under energies of 8.1 J, 12.7 J and 20.3 J. Notably, the incidence of brain contusion was more pronounced under the free-fall condition. CONCLUSIONS These findings not only facilitate a comprehensive understanding of brain contusion dynamics in pediatric TBIs, but also contribute to the validation of theories and finite element models for piglet heads, which are commonly employed as surrogates for children.
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Affiliation(s)
- Rui Li
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing, 100044, PR China
| | - Zhongqing Su
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing, 100044, PR China
| | - Zhigang Li
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, 100083, PR China.
| | - Dapeng Li
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, PR China
| | - Rutao Luo
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, PR China
| | - Jinlong Qiu
- Daping Hospital of Army Medical University, PLA, 400042, PR China
| | - Huiqing Lan
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing, 100044, PR China
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Abstract
Traumatic brain injury is one of the most common causes of morbidity and mortality and significantly impacts the patients' quality of life and socioeconomic status. It can be classified into primary and secondary injuries. Primary injury occurs at the time of the initial head trauma, such as skull fracture, extra-axial hemorrhage, brain contusion, and diffuse axonal injury. Secondary injury develops later as complications such as diffuse cerebral edema, brain herniation, and chronic traumatic encephalopathy. This article describes the indication for imaging, imaging modalities, recommended imaging protocols, and imaging findings of primary and secondary injuries, including pitfalls of each pathology.
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Affiliation(s)
- Aniwat Sriyook
- Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Jewell S, Hobson S, Brewer G, Rogers M, Hartings JA, Foreman B, Lavrador JP, Sole M, Pahl C, Boutelle MG, Strong AJ. Development and Evaluation of a Method for Automated Detection of Spreading Depolarizations in the Injured Human Brain. Neurocrit Care 2021; 35:160-175. [PMID: 34309783 PMCID: PMC8536628 DOI: 10.1007/s12028-021-01228-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spreading depolarizations (SDs) occur in some 60% of patients receiving intensive care following severe traumatic brain injury and often occur at a higher incidence following serious subarachnoid hemorrhage and malignant hemisphere stroke (MHS); they are independently associated with worse clinical outcome. Detection of SDs to guide clinical management, as is now being advocated, currently requires continuous and skilled monitoring of the electrocorticogram (ECoG), frequently extending over many days. METHODS We developed and evaluated in two clinical intensive care units (ICU) a software routine capable of detecting SDs both in real time at the bedside and retrospectively and also capable of displaying patterns of their occurrence with time. We tested this prototype software in 91 data files, each of approximately 24 h, from 18 patients, and the results were compared with those of manual assessment ("ground truth") by an experienced assessor blind to the software outputs. RESULTS The software successfully detected SDs in real time at the bedside, including in patients with clusters of SDs. Counts of SDs by software (dependent variable) were compared with ground truth by the investigator (independent) using linear regression. The slope of the regression was 0.7855 (95% confidence interval 0.7149-0.8561); a slope value of 1.0 lies outside the 95% confidence interval of the slope, representing significant undersensitivity of 79%. R2 was 0.8415. CONCLUSIONS Despite significant undersensitivity, there was no additional loss of sensitivity at high SD counts, thus ensuring that dense clusters of depolarizations of particular pathogenic potential can be detected by software and depicted to clinicians in real time and also be archived.
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Affiliation(s)
- Sharon Jewell
- Department of Bioengineering, Imperial College London, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Academic Neuroscience Centre, King's College London, Room A1.27, De Crespigny Park, Box 41, London, SE5 8AF, UK
| | | | | | - Michelle Rogers
- Department of Bioengineering, Imperial College London, London, UK
| | - Jed A Hartings
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Clemens Pahl
- Department of Intensive Care Medicine, King's College Hospital, London, UK
| | | | - Anthony J Strong
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Academic Neuroscience Centre, King's College London, Room A1.27, De Crespigny Park, Box 41, London, SE5 8AF, UK.
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Lara M, Moll A, Mas A, Picado MJ, Gassent C, Pomar J, Llompart-Pou JA, Brell M, Ibáñez J, Pérez-Bárcena J. Use of diffusion tensor imaging to assess the vasogenic edema in traumatic pericontusional tissue. Neurocirugia (Astur : Engl Ed) 2021; 32:161-9. [PMID: 34218876 DOI: 10.1016/j.neucie.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Cerebral edema is a frequent and serious complication of traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is considered a useful technique to assess white matter integrity after TBI. The objective of this prospective, observational study was to assess the characteristics of the vasogenic edema in the traumatic pericontusional tissue and compare it to the vasogenic edema found in brain tumors. We also included a control group. METHODS Using DTI, the Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) were measured in the area of vasogenic edema in both TBI and tumor patients. The measurements in the control group were done in the gray and white matter. We included 15 TBI patients, 18 tumor patients and 15 controls. RESULTS ADC and FA showed no differences between TBI and tumor patients (p=0.27 for AF; p=0.79 for ADC). Compared to healthy controls, TBI and tumor patients presented higher ADC values and lower FA values. The differences between TBI and controls were statistically significant (p<0.05). CONCLUSIONS In this prospective observational study using DTI-MRI in a selected group of mild and moderate TBI patients with vasogenic pericontusional edema we have shown that there were no significant differences of the ADC and FA values compared to brain tumor patients. Furthermore, healthy controls showed significant lower ADC values and higher FA values compared to TBI and tumor patients. Future studies, using DTI-MRI, should address whether any therapy has a favorable impact on the vasogenic edema of TBI patients with brain contusions.
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Lara M, Moll A, Mas A, Picado MJ, Gassent C, Pomar J, Llompart-Pou JA, Brell M, Ibáñez J, Pérez-Bárcena J. Use of diffusion tensor imaging to assess the vasogenic edema in traumatic pericontusional tissue. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30080-4. [PMID: 32709492 DOI: 10.1016/j.neucir.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Cerebral edema is a frequent and serious complication of traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is considered a useful technique to assess white matter integrity after TBI. The objective of this prospective, observational study was to assess the characteristics of the vasogenic edema in the traumatic pericontusional tissue and compare it to the vasogenic edema found in brain tumors. We also included a control group. METHODS Using DTI, the Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) were measured in the area of vasogenic edema in both TBI and tumor patients. The measurements in the control group were done in the gray and white matter. We included 15 TBI patients, 18 tumor patients and 15 controls. RESULTS ADC and FA showed no differences between TBI and tumor patients (p=0.27 for AF; p=0.79 for ADC). Compared to healthy controls, TBI and tumor patients presented higher ADC values and lower FA values. The differences between TBI and controls were statistically significant (p<0.05). CONCLUSIONS In this prospective observational study using DTI-MRI in a selected group of mild and moderate TBI patients with vasogenic pericontusional edema we have shown that there were no significant differences of the ADC and FA values compared to brain tumor patients. Furthermore, healthy controls showed significant lower ADC values and higher FA values compared to TBI and tumor patients. Future studies, using DTI-MRI, should address whether any therapy has a favorable impact on the vasogenic edema of TBI patients with brain contusions.
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Affiliation(s)
- Mónica Lara
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Apolonia Moll
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Antonio Mas
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - María José Picado
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Carmen Gassent
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Jaume Pomar
- Neuropsychology and Cognition Research Group, Research Institute on Health IDISBA & IUNICS-UIB, Palma de Mallorca, Spain
| | | | - Marta Brell
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Javier Ibáñez
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Jon Pérez-Bárcena
- Intensive Care Department, Son Espases University Hospital, Palma de Mallorca, Spain.
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Eriksen N, Pakkenberg B, Rostrup E, Okonkwo DO, Mathern B, Shutter LA, Strong AJ, Woitzik J, Pahl C, Dreier JP, Martus P, Lauritzen MJ, Fabricius M, Hartings JA. Neurostereologic Lesion Volumes and Spreading Depolarizations in Severe Traumatic Brain Injury Patients: A Pilot Study. Neurocrit Care 2019; 30:557-68. [PMID: 30972614 DOI: 10.1007/s12028-019-00692-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spreading depolarizations (SDs) occur in 50-60% of patients after surgical treatment of severe traumatic brain injury (TBI) and are independently associated with unfavorable outcomes. Here we performed a pilot study to examine the relationship between SDs and various types of intracranial lesions, progression of parenchymal damage, and outcomes. METHODS In a multicenter study, fifty patients (76% male; median age 40) were monitored for SD by continuous electrocorticography (ECoG; median duration 79 h) following surgical treatment of severe TBI. Volumes of hemorrhage and parenchymal damage were estimated using unbiased stereologic assessment of preoperative, postoperative, and post-ECoG serial computed tomography (CT) studies. Neurologic outcomes were assessed at 6 months by the Glasgow Outcome Scale-Extended. RESULTS Preoperative volumes of subdural and subarachnoid hemorrhage, but not parenchymal damage, were significantly associated with the occurrence of SDs (P's < 0.05). Parenchymal damage increased significantly (median 34 ml [Interquartile range (IQR) - 2, 74]) over 7 (5, 8) days from preoperative to post-ECoG CT studies. Patients with and without SDs did not differ in extent of parenchymal damage increase [47 ml (3, 101) vs. 30 ml (- 2, 50), P = 0.27], but those exhibiting the isoelectric subtype of SDs had greater initial parenchymal damage and greater increases than other patients (P's < 0.05). Patients with temporal clusters of SDs (≥ 3 in 2 h; n = 10 patients), which included those with isoelectric SDs, had worse outcomes than those without clusters (P = 0.03), and parenchymal damage expansion also correlated with worse outcomes (P = 0.01). In multivariate regression with imputation, both clusters and lesion expansion were significant outcome predictors. CONCLUSIONS These results suggest that subarachnoid and subdural blood are important primary injury factors in provoking SDs and that clustered SDs and parenchymal lesion expansion contribute independently to worse patient outcomes. These results warrant future prospective studies using detailed quantification of TBI lesion types to better understand the relationship between anatomic and physiologic measures of secondary injury.
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Jan K, Čeněk Š, Tomáš Z, Dušan H, Jan C. The reasons for reoperations after surgery for acute subdural hematoma and the implications of suspected injury mechanisms. Soud Lek 2020; 65:79-83. [PMID: 33736438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
STUDY AIM The primary aim is to analyze the relationship between the reasons for reoperation after surgery for acute subdural hematoma and the injury mechanism and secondarily the relationship between the acute subdural hematoma primarily operated on and the area of reoperation. METHODS Among adult patients operated on for acute subdural hematoma between 2013 and 2017, patients reoperated within 14 days were identified. Injury mechanisms, reasons for reoperation, and reoperated lesion location were studied. RESULTS Of 86 patients operated on for acute subdural hematoma, 24 patients were reoperated (27.9%). The main indications for reoperation after uncomplicated falls as injury cause (12 patients) were recurrent/significant residual subdural hematoma (7 patients) and contralateral subdural hematoma (3 cases). In complicated falls (long staircase, 3 patients), the reasons for reoperation were expansive intraparenchymal hematoma or brain contusion. In traffic accidents (4 patients, 3 pedestrians hit by cars), the reason for reoperations was brain contusion (two cases), contralateral intracerebral and subdural hematoma and postoperative epidural hematoma. Injury mechanism was unknown in 5 patients. In 20.8% of reoperations, the reoperated lesion (mainly subdural hematoma) was contralateral to the primary subdural hematoma. Prognosis was worse in reoperated patients. CONCLUSIONS Recurrent/significant residual subdural hematomas are the most frequent reasons for reoperation after acute subdural hematoma surgery. The reasons for reoperations are related to the mechanism of injury. Simple falls are associated mainly with recurrent/significant residual or contralateral subdural hematomas. In complicated falls or traffic accidents (vigorous injuring force) hemorrhagic injuries of the brain parenchyma prevail.
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Rehman L, Afzal A, Aziz HF, Akbar S, Abbas A, Rizvi R. Radiological Parameters to Predict Hemorrhagic Progression of Traumatic Contusional Brain Injury. J Neurosci Rural Pract 2019; 10:212-217. [PMID: 31001007 PMCID: PMC6454978 DOI: 10.4103/jnrp.jnrp_335_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Traumatic intracerebral contusion is a frequent factor culminating in death and disability, and its progression relates to unfavorable outcome. We evaluated the radiological factors associated with hemorrhagic progression of contusions (HPC). Materials and Methods Two hundred and forty-six patients were enrolled in this prospective cohort over a period of 1 year. Contusion volume was quantified using the "ABC/2" technique, whereas progression was considered as >30% increase in the initial volume. Univariate and multivariate statistics were used to examine the correlation between the risk factors of interest and HPC. Results HPC was seen in 110 (44.7%) patients. Binary logistic regression showed in the final adjusted model that multiplicity (relative risk [RR]: 2.24, 95% confidence limit [CL]: 1.00-5.48), bilateral lesions (RR: 2.99, 95% CL: 1.08-8.25), initial volume of contusion (RR: 4.96, 95% CL: 1.87-13.13), frontal location (RR: 1.42, 95% CL: 1.08-3.56), and presence of concomitant intracranial hematoma (extradural-RR: 3.90, 95% CL: 1.51-10.01, subdural-RR: 2.91, 95% CL: 1.26-6.69, and subarachnoid-RR: 2.27, 95% CL: 1.01-5.80) were significantly associated with HPC. The overall mortality was 18.7% and was almost equal among patients with and without HPC. Mortality was significantly associated with Glasgow Coma Scale on admission (adjusted RR: 12.386, 95% CL: 4.789-32.035) and presence of comorbid conditions (adjusted RR: 0.313, 95% CL: 0.114-0.860). Conclusion Initial computed tomography scan is a good predictor of high-risk group for HPC.
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Affiliation(s)
- Lal Rehman
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Ali Afzal
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Sana Akbar
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Asad Abbas
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Raza Rizvi
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Abstract
Chop or slash wounds are produced by sharp-edged tools such as an axe, or a machete. This paper presents a case of a violent death of a 57 year-old-man. Autopsy revealed deformation of the right side of the head. A total of 23 slash, stab and cut wounds as well as contused lacerations were identified on the scalp as well as the face and the neck. In addition, superficial abrasions and bruises were identified on the skin. The immediate cause of death was due to extensive brain contusion following fragmentation of the neurocranium. The injuries resulting in the death of the victim were sustained during an assault on the head with an axe, which was used both as a slashing tool and a blunt instrument.
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Affiliation(s)
- Petr Handlos
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic.,Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic
| | - Matěj Uvíra
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic
| | - Marek Dokoupil
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic.,Department of Epidemiology and Public Health, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic
| | - Klára Marecová
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic. .,Department of Forensic Medicine and Medical Law, University Hospital Olomouc, CZ-779 00, Olomouc, Czech Republic.
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Hilmer LV, Park KB, Vycheth I, Wirsching M. Cerebral Contusion: An Investigation of Etiology, Risk Factors, Related Diagnoses, and the Surgical Management at a Major Government Hospital in Cambodia. Asian J Neurosurg 2018; 13:23-30. [PMID: 29492116 PMCID: PMC5820890 DOI: 10.4103/ajns.ajns_342_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Cerebral contusions are a common type of injury among the Cambodian population, mostly due to road traffic accidents. This article aims to assess various aspects around brain contusion focusing on the condition at admission, residing province, mechanism and time of injury, age and sex distribution with differing helmet wearing, and alcohol consumption patterns. Hospitalization-related data such as treatment and outcome were analyzed. Methods This was a retrospective analysis of 406 cases who have been admitted during the period between May 2013 and May 2016. Results Two hundred and ninety-five (75.51%) of the patients came from rural areas, 312 (76.84%) were male (mean age 31.17 ± 12.90 years for males and 38.5 ± 16.29 years for females). The average hospital stay amounted to 10.51 ± 6.67 days. One hundred and eight two cases (52.29%) happened between 4.00 and 11.00 p.m. Three hundred and nineteen (79%) of the injured patients were motorcycle drivers and 18% pedestrians. Male patients had an alcohol involvement in 135 (49.45%) (females in 5 [6.25%]) cases and 26 (10%) wore a helmet (females in 5 [6.25%]). Surgery was performed in 82 cases, specifically craniotomy and craniectomy +/- elevation of a depressed skull fracture. Two hundred and ninety-six (73.09%) patients showed related second diagnosis, mostly subdural hematoma in 96 (32.43%) and epidural hematoma in 63 (21.28%) cases. Fifty patients (13.16%) had a Glasgow Coma Scale of 3-8. 92 (24.21%) of 9-12 and 238 (62.63%) of 13-15 on admission. Most of the patients were discharged with an improved status 324 (91.52%) according to the Glasgow Outcome Scale 4 or 5. Conclusion The severity and resulting neurologic impairment of cerebral contusions show the importance of more in-depth research and prevention programs.
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Affiliation(s)
- Louise Vera Hilmer
- Department for Global Health, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Kee Bum Park
- Department of Global Health, Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Iv Vycheth
- Department of Neurosurgery, Cambodia Neurosurgical Support Project, Preah Kossamak Hospital, University of Health Sciences, Phnom Penh 12157, Cambodia
| | - Michael Wirsching
- Department for Global Health, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Muhammad G, Aurangzeb A, Khan SA, Hussain I, Alam S, Khan Afridi EA, Khan B, Bhatti SN. Dural Tears In Patients With Depressed Skull Fractures. J Ayub Med Coll Abbottabad 2017; 29:311-315. [PMID: 28718255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. METHODS This cross-sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma. RESULTS A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients. CONCLUSIONS In depressed skull fractures, there are high chances of associated traumatic dural tears which should be vigilantly managed.
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Affiliation(s)
- Gul Muhammad
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Ahsan Aurangzeb
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Shahbaz Ali Khan
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Iqbal Hussain
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Sudhair Alam
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | | | - Baynazir Khan
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
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