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Kelly JP, Feldman K, Wright J, Ganti S, Metz JB, Weiss A. Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages. Doc Ophthalmol 2020; 141:111-126. [PMID: 32052259 DOI: 10.1007/s10633-020-09756-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). METHODS This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. RESULTS Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. CONCLUSIONS Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, OA.5.342, Seattle, WA, 98105, USA.
- Department of Ophthalmology, University of Washington, Seattle, USA.
| | - Kenneth Feldman
- Seattle Children's Hospital, Children's Protection Program, Seattle, USA
- Division of General Pediatrics, University of Washington, Seattle, USA
| | - Jason Wright
- Division of Radiology, Seattle Children's Hospital, Seattle, USA
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, USA
| | - James B Metz
- Department of Pediatrics, University of Vermont, Burlington, USA
| | - Avery Weiss
- Department of Ophthalmology, University of Washington, Seattle, USA
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Venkatasubba Rao CP, Suarez JI, Martin RH, Bauza C, Georgiadis A, Calvillo E, Hemphill JC, Sung G, Oddo M, Taccone FS, LeRoux PD. Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2. Neurocrit Care 2020; 32:88-103. [PMID: 31486027 DOI: 10.1007/s12028-019-00835-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.
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MESH Headings
- Academic Medical Centers/statistics & numerical data
- Adult
- Aged
- Asia/epidemiology
- Brain Injuries, Traumatic/epidemiology
- Brain Injuries, Traumatic/physiopathology
- Brain Injuries, Traumatic/therapy
- Brain Neoplasms/epidemiology
- Brain Neoplasms/physiopathology
- Brain Neoplasms/therapy
- Cerebral Hemorrhage/epidemiology
- Cerebral Hemorrhage/physiopathology
- Cerebral Hemorrhage/therapy
- Critical Care
- Disease Management
- Emergency Service, Hospital
- Europe/epidemiology
- Female
- Glasgow Coma Scale
- Health Resources
- Heart Arrest/epidemiology
- Heart Arrest/physiopathology
- Heart Arrest/therapy
- Hematoma, Subdural/epidemiology
- Hematoma, Subdural/physiopathology
- Hematoma, Subdural/therapy
- Hemodynamic Monitoring/statistics & numerical data
- Hospital Mortality
- Hospitals, Private/statistics & numerical data
- Hospitals, Public/statistics & numerical data
- Humans
- Intensive Care Units
- Internationality
- Ischemic Stroke/epidemiology
- Ischemic Stroke/physiopathology
- Ischemic Stroke/therapy
- Latin America/epidemiology
- Length of Stay/statistics & numerical data
- Logistic Models
- Male
- Middle Aged
- Middle East/epidemiology
- Multivariate Analysis
- Neurophysiological Monitoring/statistics & numerical data
- North America/epidemiology
- Oceania/epidemiology
- Odds Ratio
- Palliative Care/statistics & numerical data
- Patient Admission/statistics & numerical data
- Patient Comfort
- Patient Transfer/statistics & numerical data
- Referral and Consultation/statistics & numerical data
- Reflex, Pupillary
- Resuscitation Orders
- Risk Factors
- Severity of Illness Index
- Subarachnoid Hemorrhage/epidemiology
- Subarachnoid Hemorrhage/physiopathology
- Subarachnoid Hemorrhage/therapy
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Affiliation(s)
- Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA.
| | - Renee H Martin
- Medical University of South Carolina, Charleston, SC, USA
| | - Colleen Bauza
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Alexandros Georgiadis
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Eusebia Calvillo
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA
| | | | - Gene Sung
- University of Southern California, Los Angeles, CA, USA
| | - Mauro Oddo
- CHUV Lausanne University Hospital, Lausanne, Switzerland
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Lucke-Wold B, Vaziri S, Scott K, Busl K. Urinary dysfunction in acute brain injury: A narrative review. Clin Neurol Neurosurg 2020; 189:105614. [PMID: 31786429 DOI: 10.1016/j.clineuro.2019.105614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023]
Abstract
The frontal lobe urinary control center is an important regulator of urinary function. Neurologic injury often causes damage or temporary dysfunction of this center and other related urinary control pathways. Little has been reported about this topic in the literature although a majority of neurologic injury patients suffer from some type of urinary dysfunction. In this review, we highlight what is known about urinary dysfunction based on injury type (traumatic brain injury, hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage, subdural hematoma, and epilepsy). We discuss both clinical and pre-clinical data and pinpoint areas warranting further investigation. In the final section, we provide proposed practice suggestions for managing these patients clinically with the intended goal for refinement in these approaches following further clinical trials.
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Affiliation(s)
- Brandon Lucke-Wold
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Sasha Vaziri
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Kyle Scott
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Katharina Busl
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States; University of Florida, Department of Neurology, Gainesville, FL, United States.
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Waheed S, Baig MA, Siddiqui E, Jamil D, Bashar M, Feroze A. Prognostic significance of optic nerve sheath diameter on computed tomography scan with severity of blunt traumatic brain injury in the emergency department. J PAK MED ASSOC 2018; 68:268-271. [PMID: 29479105] [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: 06/08/2023]
Abstract
Optic nerve sheath diameter measurement (ONSD) has been associated with identifying the prognosis of traumatic brain injury (TBI) patients. The study was planned to evaluate the prognostic value of ONSD measured on the initial brain computed tomography (CT) scan performed on patients with blunt TBI in the emergency department(ED). This retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of moderate and severe TBI patients from January to December 2014. ONSD for each eye on the initial CT scan and Glasgow Coma Scale (GCS) was measured upon patient presentation. Correlation between presentation GCS and ONSD was done through Pearson's correlation. Receiver operator curve (ROC) analysis was done to measure the predictive values of ONSD for mortality. Of the 276 patients, 211(76%) were males and 65(23%) females. ONSD was measured on 160(58%) patients. The mean ONSD measured on CT scan was 3.8±1. The Pearson's correlation between the severity of brain injury as per GCS at presentation and ONSD was not significant (-0.182). We concluded that ONSD measured on the initial CT brain scan had good association with the severity of blunt TBI in patients presenting to the ED.
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MESH Headings
- Accidents, Traffic
- Brain Injuries, Traumatic/diagnostic imaging
- Brain Injuries, Traumatic/mortality
- Brain Injuries, Traumatic/physiopathology
- Cross-Sectional Studies
- Emergency Service, Hospital
- Female
- Glasgow Coma Scale
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/mortality
- Hematoma, Epidural, Cranial/physiopathology
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/mortality
- Hematoma, Subdural/physiopathology
- Humans
- Intracranial Hemorrhage, Traumatic/diagnostic imaging
- Intracranial Hemorrhage, Traumatic/mortality
- Intracranial Hemorrhage, Traumatic/physiopathology
- Intracranial Hypertension/diagnostic imaging
- Intracranial Pressure
- Male
- Middle Aged
- Myelin Sheath/pathology
- Optic Nerve/diagnostic imaging
- Optic Nerve/pathology
- Organ Size
- Pakistan
- Pedestrians
- Prognosis
- Retrospective Studies
- Severity of Illness Index
- Subarachnoid Hemorrhage, Traumatic/diagnostic imaging
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/diagnostic imaging
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Affiliation(s)
- Shahan Waheed
- Department of Emergency Medicine, Aga Khan University Hospital
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5
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Candefjord S, Winges J, Malik AA, Yu Y, Rylander T, McKelvey T, Fhager A, Elam M, Persson M. Microwave technology for detecting traumatic intracranial bleedings: tests on phantom of subdural hematoma and numerical simulations. Med Biol Eng Comput 2017; 55:1177-1188. [PMID: 27738858 PMCID: PMC5544814 DOI: 10.1007/s11517-016-1578-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 02/15/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury is the leading cause of death and severe disability for young people and a major public health problem for elderly. Many patients with intracranial bleeding are treated too late, because they initially show no symptoms of severe injury and are not transported to a trauma center. There is a need for a method to detect intracranial bleedings in the prehospital setting. In this study, we investigate whether broadband microwave technology (MWT) in conjunction with a diagnostic algorithm can detect subdural hematoma (SDH). A human cranium phantom and numerical simulations of SDH are used. Four phantoms with SDH 0, 40, 70 and 110 mL are measured with a MWT instrument. The simulated dataset consists of 1500 observations. Classification accuracy is assessed using fivefold cross-validation, and a validation dataset never used for training. The total accuracy is 100 and 82-96 % for phantom measurements and simulated data, respectively. Sensitivity and specificity for bleeding detection were 100 and 96 %, respectively, for the simulated data. SDH of different sizes is differentiated. The classifier requires training dataset size in order of 150 observations per class to achieve high accuracy. We conclude that the results indicate that MWT can detect and estimate the size of SDH. This is promising for developing MWT to be used for prehospital diagnosis of intracranial bleedings.
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Affiliation(s)
- Stefan Candefjord
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden.
- SAFER Vehicle and Traffic Safety Centre at Chalmers, Gothenburg, Sweden.
| | - Johan Winges
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Ahzaz Ahmad Malik
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Yinan Yu
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Thomas Rylander
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Tomas McKelvey
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Andreas Fhager
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Mikael Elam
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
- Clinical Neurophysiology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Gothenburg, Sweden
| | - Mikael Persson
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
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Steiner G, Sobottka SB, Koch E, Schackert G, Kirsch M. Intraoperative imaging of cortical cerebral perfusion by time-resolved thermography and multivariate data analysis. J Biomed Opt 2011; 16:016001. [PMID: 21280907 DOI: 10.1117/1.3528011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new approach to cortical perfusion imaging is demonstrated using high-sensitivity thermography in conjunction with multivariate statistical data analysis. Local temperature changes caused by a cold bolus are imaged and transferred to a false color image. A cold bolus of 10 ml saline at ice temperature is injected systemically via a central venous access. During the injection, a sequence of 735 thermographic images are recorded within 2 min. The recorded data cube is subjected to a principal component analysis (PCA) to select slight changes of the cortical temperature caused by the cold bolus. PCA reveals that 11 s after injection the temperature of blood vessels is shortly decreased followed by an increase to the temperature before the cold bolus is injected. We demonstrate the potential of intraoperative thermography in combination with multivariate data analysis to image cortical cerebral perfusion without any markers. We provide the first in vivo application of multivariate thermographic imaging.
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Affiliation(s)
- Gerald Steiner
- Dresden University of Technology, Medical Faculty Carl Gustav Carus, Clinical Sensoring and Monitoring, University Hospital, Department of Neurosurgery, 01307 Dresden, Germany.
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Cantu RC, Gean AD. Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma 2010; 27:1557-64. [PMID: 20536318 PMCID: PMC2956379 DOI: 10.1089/neu.2010.1334] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There have been a handful of previously published cases of athletes who were still symptomatic from a prior head injury, and then suffered a second injury in which a thin, acute subdural hematoma (SDH) with unilateral hemisphere vascular engorgement was demonstrated on CT scan. In those cases, the cause of the brain swelling/dysautoregulation was ascribed to the presence of the acute SDH rather than to the acceleration/deceleration forces that caused the SDH. We believe that the brain swelling is due to "second-impact dysautoregulation," rather than due to the effect of the SDH on the underlying hemisphere. To support our hypothesis, we present 10 additional cases of acute hemispheric swelling in association with small SDHs in athletes who received a second head injury while still symptomatic from a previous head injury. The clinical history and the unique neuroimaging features of this entity on CT are described and illustrated in detail. The CT findings included an engorged cerebral hemisphere with initial preservation of grey-white matter differentiation, and abnormal mass effect and midline shift that appeared disproportionately greater than the size of the SDH. In addition, the imaging similarities between our patients and those with non-accidental head trauma (shaken-baby syndrome) will be discussed.
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Affiliation(s)
- Robert C Cantu
- Department of Neurosurgery, Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Concord, MA 01742, USA.
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8
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Galaznik JG. Head injury risk associated with feet-first free falls in 12-month-old children: a correlation of biomechanical study with human experience. J Trauma 2010; 68:505-506. [PMID: 20154567 DOI: 10.1097/ta.0b013e3181c9f7e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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9
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Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, Yatsushige H, Sugawara T. Development of chronic encapsulated intracerebral hematoma after radiosurgery for a cerebral arteriovenous malformation. Acta Neurochir (Wien) 2009; 151:1513-5. [PMID: 19597762 DOI: 10.1007/s00701-009-0443-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We report a rare case of chronic encapsulated intracerebral hematoma (CEIH) after radiosurgery for a cerebral arteriovenous malformation (AVM). METHODS Seven years after radiosurgery, magnetic resonance imaging revealed a high-intensity mass in the right basal ganglia with a peripheral low signal ring and fluid level on both T1- and T2-weighted images, which was compatible with CEIH. RESULTS Stereotactic evacuation and placement of an Ommaya reservoir were performed. CONCLUSION The concentration of vascular endothelial growth factor was high in the hematoma, suggesting that CEIH may be similar to chronic subdural hematoma.
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Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa-shi, Tokyo 190-0014, Japan.
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Unterhofer C, Chemelli A, Waldenberger P, Bauer R, Ortler M. Traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. Acta Neurochir (Wien) 2009; 151:1301-4. [PMID: 19468680 DOI: 10.1007/s00701-009-0251-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 02/21/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Post-traumatic fistulas between the middle meningeal artery and the cranial venous system are extremely rare. We describe clinical presentation and successful endovascular management of a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. METHODS A 53-year-old man was admitted with multiple brain contusions and a temporoparietal fracture after a head trauma. On day 3 after trauma he developed unilateral signs of a cavernous sinus syndrome. Digital subtraction angiography showed a fistula between the middle meningeal artery and the sphenoparietal sinus. RESULTS The fistula was occluded by endovascular coil embolization, resulting in complete remission of the clinical symptoms. CONCLUSION A high index of suspicion is necessary to detect subtle signs of venous congestion of the cavernous sinus in an intubated patient. Angiography is the diagnostic modality of choice and should include the selective investigation of the external carotid artery vascular territory. Endovascular therapy provides minimal invasive and definitive treatment of this rare condition.
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MESH Headings
- Accidents, Traffic
- Arteriovenous Fistula/diagnostic imaging
- Arteriovenous Fistula/etiology
- Arteriovenous Fistula/pathology
- Bicycling/injuries
- Brain Injuries/complications
- Brain Injuries/diagnostic imaging
- Brain Injuries/pathology
- Cavernous Sinus Thrombosis/etiology
- Cavernous Sinus Thrombosis/physiopathology
- Cavernous Sinus Thrombosis/therapy
- Cerebral Angiography
- Cranial Sinuses/diagnostic imaging
- Cranial Sinuses/injuries
- Cranial Sinuses/pathology
- Embolization, Therapeutic
- Exophthalmos/etiology
- Exophthalmos/pathology
- Exophthalmos/physiopathology
- Facial Bones/injuries
- Head Injuries, Closed/complications
- Head Injuries, Closed/diagnostic imaging
- Head Injuries, Closed/pathology
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/pathology
- Hematoma, Epidural, Cranial/physiopathology
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/pathology
- Hematoma, Subdural/physiopathology
- Humans
- Intracranial Hypertension/diagnostic imaging
- Intracranial Hypertension/etiology
- Intracranial Hypertension/pathology
- Male
- Meningeal Arteries/diagnostic imaging
- Meningeal Arteries/injuries
- Meningeal Arteries/pathology
- Middle Aged
- Parietal Bone/injuries
- Prostheses and Implants
- Skull Fractures/complications
- Skull Fractures/diagnostic imaging
- Skull Fractures/pathology
- Temporal Bone/injuries
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Claudia Unterhofer
- Clinical Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Galaznik JG. Thin-films of subdural hemorrhage in the absence of mechanical trauma: the new challenge of an expanding differential. Pediatr Radiol 2009; 39:882-3. [PMID: 19415259 DOI: 10.1007/s00247-009-1257-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 02/04/2009] [Indexed: 11/26/2022]
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12
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Cohen MC, Scheimberg I. Histology of the dural membrane supports the theoretical considerations of its role in the pathophysiology of subdural collections in nontraumatic circumstances. Pediatr Radiol 2009; 39:880-1. [PMID: 19294373 DOI: 10.1007/s00247-009-1210-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 02/12/2009] [Indexed: 12/01/2022]
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14
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Abstract
In this article we reply to the recent critique by Punt et al. in Pediatric Rehabilitation. Our hypothesis about the pathogenesis of intracranial bleeding in infants has three important implications. First, in the case of an infant with a swollen brain, subdural and retinal haemorrhage but no objective evidence of trauma, the findings by themselves are not certain evidence of abuse; second, violence is not necessary to produce subdural and retinal haemorrhage; and lastly, non-traumatic events producing apnoea with a catastrophic rise in intracranial pressure could produce a clinical picture identical to that seen in trauma.
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16
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17
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Medoev SB, Artarian AA. [Subdural hematomas in infants and children of early age]. Zh Vopr Neirokhir Im N N Burdenko 2008:12-17. [PMID: 19230477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The article focuses on clinical presentation, pathophysiology and course of infantile subdural hematomas. Diagnostic procedures and surgical technique are described. Authors demonstrated results of minimally invasive surgical treatment of infantile subdural hematomas.
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Moon KS, Lee JK, Joo SP, Kim TS, Jung S, Kim JH, Kim SH, Kang SS. Kernohan's notch phenomenon in chronic subdural hematoma: MRI findings. J Clin Neurosci 2007; 14:989-92. [PMID: 17823049 DOI: 10.1016/j.jocn.2006.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 05/15/2006] [Accepted: 05/17/2006] [Indexed: 11/19/2022]
Abstract
We report two cases of Kernohan's notch phenomenon secondary to chronic subdural hematoma detected by MRI. In the first case, the patient was drowsy with an oculomotor palsy and a hemiparesis ipsilateral to the chronic subdural hematoma. MRI in the post-operative period showed no abnormal signal or deformity of the crus cerebri. The neurological signs immediately resolved after trephination. In the second case, the patient was admitted with progressive decrease in their level of consciousness and ipsilateral hemiparesis with the chronic subdural hematoma. MRI on admission revealed an abnormal signal in the contralateral crus cerebri against the chronic subdural hematoma. After surgery, the mental state gradually recovered to normal with some degree of residual hemiparesis. In patients with chronic subdural hematoma, a compressive deformity of the crus cerebri, without abnormal signal on MRI, may predict a better neurological recovery in patients with Kernohan's notch phenomenon.
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Affiliation(s)
- Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 8 Hack-Dong, Dong-Ku, 501-757, Gwangju, Korea
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LeGrand SA, Hindman BJ, Dexter F, Moss LG, Todd MM. Reliability of a telephone-based Glasgow Outcome Scale assessment using a structured interview in a heterogenous population of patients and examiners. J Neurotrauma 2007; 24:1437-46. [PMID: 17892406 DOI: 10.1089/neu.2007.0293] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A reliable telephone-based Glasgow Outcome Scale (GOS) assessment would be advantageous to both patients and investigators. Using a previously published structured GOS interview and scoring system, the aim of this study was to assess the reliability of telephone-based GOS scores compared to those obtained face-to-face in a heterogenous population of patients and examiners. Sixty-six patients hospitalized for a variety of acute neurological injuries underwent two GOS interviews approximately 90 days after injury. From a pool of six examiners, structured interviews were conducted using a standardized data form containing nine yes/no questions. One interview was conducted face-to-face and the other interview was conducted by telephone, the order being randomly selected. A different examiner conducted the second interview, and was unaware of the findings of the first interview. From this data, a separate investigator assigned GOS scores using standardized criteria. Concordant GOS scores were obtained in 71% (47/66) of patients and discordant scores in 29% (19/66); kappa = 0.56 +/- 0.08 (SE) (95% CI kappa = 0.40-0.73). Patient-, examiner-, and interview-related characteristics had no significant associations with GOS concordance, although patient sex had a significant association with discrepant responses to one specific question (work at previous capacity). When used by multiple examiners to assess patients with diverse neurological conditions, use of a structured GOS examination does not guarantee a reliable telephone-based GOS score. Determination of whether patient sex influences the validity of the structured face-to-face GOS interview is worthy of future study.
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Affiliation(s)
- Scott A LeGrand
- Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Cappelletti M, Freeman ED, Cipolotti L. The middle house or the middle floor: bisecting horizontal and vertical mental number lines in neglect. Neuropsychologia 2007; 45:2989-3000. [PMID: 17640687 PMCID: PMC2567815 DOI: 10.1016/j.neuropsychologia.2007.05.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 04/22/2007] [Accepted: 05/29/2007] [Indexed: 12/03/2022]
Abstract
This study explores the processing of mental number lines and physical lines in five patients with left unilateral neglect. Three tasks were used: mental number bisection ('report the middle number between two numbers'), physical line bisection ('mark the middle of a line'), and a landmark task ('is the mark on the line to the left/right or higher/lower than the middle of the line?'). We manipulated the number line orientation purely by task instruction: neglect patients were told that the number-pairs represented either houses on a street (horizontal condition) or floors in a building (vertical condition). We also manipulated physical line orientation for comparison. All five neglect patients showed a rightward bias for horizontally oriented physical and number lines (e.g. saying 'five' is the middle house number between 'two' and 'six'). Only three of these patients also showed an upward bias for vertically oriented number lines. The remaining two patients did not show any bias in processing vertical lines. Our results suggest that: (1) horizontal and vertical neglect can associate or dissociate among different patients; (2) bisecting number lines operates on internal horizontal and vertical representations possibly analogous to horizontal and vertical physical lines; (3) at least partially independent mechanisms may be involved in processing horizontal and vertical number lines.
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Affiliation(s)
- Marinella Cappelletti
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AR, UK
| | - Elliot D. Freeman
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AR, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
- Department of Psychology, University of Palermo, via Delle Scienze 15, Palermo, Italy
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21
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Abstract
Subdural hemorrhage (SDH) and primary subarachnoid hemorrhage (SAH) are two forms of intracranial bleeding that can be encountered in infants. These events can be life threatening to the infant and devastating to his family. Neonatal nurses need to have an understanding of these unfortunate, yet not uncommon, types of intracranial hemorrhage. This article explains the etiology, the diagnosis, and the treatment of SDH and SAH, concluding
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Affiliation(s)
- Stacie Barker
- Boone Hospital Center, ICN, Columbia, MO 65201, USA.
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22
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Abstract
PURPOSE To test the hypothesis that chronic subdural hematoma (CSDH) enlarges by the causative factors, this study has performed. MATERIALS AND METHODS In 10 patients with CSDH, coagulation factors in venous blood taken at the time of surgery and hematomic contents aspirated from the CSDH were studied, using both laboratory assays and microscopy. RESULTS When compared to the range of normal plasma, the hematoma fluids demonstrated a marked reduction in factor II, V, VII, VIII, and X, moderate reduction of factors IX and XI, and slight reduction of factor XII. Activated protein C and antithrombin III levels were decreased. The FDP (Fibrinogen Degradation Product) levels in chronic subdural hematoma were extremely high. The endothelial cells of the macrocapillaries (also called ''sinusoid'') showed numerous gap junctions between adjacent endothelial cells and a thinness or absence of the basement membrane, suggesting that the macrocapillaries are very fragile and susceptible to bleeding. CONCLUSION Excessive coagulation in the hematoma, predominantly via the extrinsic clotting pathway, local hyperfibrinolysis, transmitted pulsations, and characteristics of the macrocapillaries play an important role in the leakage of blood and the enlargement of CSDH.
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Affiliation(s)
- Yu Shik Shim
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Chong Oon Park
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Dong Kun Hyun
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Hyung Chun Park
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
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Di Ieva A, Di Lieva A, Aimar E, Tancioni F, Levi D, Debernardi A, Pisano P, Rahal D, Nozza A, Magagnoli M, Gaetani P. Focal extra-axial hemorrahagic mass with subdural hemorrhage secondare to extramedullary hematopoiesis in idiopathic myelodysplastic sindrome. J Neurosurg Sci 2007; 51:29-32. [PMID: 17369789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Idiopathic myelodysplastic syndrome is a disease characterized by a clonal stem cell disorder in which megacaryocitic and granulocytic lineages are mainly involved; extramedullary myeloid metaplasia is due to abnormal location of myeloid tissue in other organs than bone marrow. Rarely the central nervous system is involved. When it happens, it is typical to find masses around the brain and pachymeningeal thickening, but it is very rare to find it associated with subdural haemorrhage, as in the case we describe in the present article. Considering our case and the literature we can suggest that radiological images associated with the clinical history of the patient suggestive for extramedullary hematopoiesis can be sufficient for a correct diagnosis and for a radiotherapy treatment, demanding surgery in the case of diagnostic doubts, massive hemorrahages or neurological decifits caused by the focal lesions.
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Affiliation(s)
- A Di Ieva
- Department of Neurosurgery, Istituto Clinico HUMANITAS IRCCS, Rozzano (Milan), Italy.
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Ziyal IM, Bilginer B, Celik O, Ozcan OE, Ozgen T. Tentorial meningioma on follow-up presenting with sudden deterioration due to intra- and peritumoral hemorrhage. Acta Neurochir (Wien) 2006; 148:1315-6. [PMID: 17086475 DOI: 10.1007/s00701-006-1045-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 09/15/2006] [Indexed: 11/25/2022]
Abstract
Almost all meningiomas presenting with intracranial hemorrhage in the literature were admitted with symptoms relating to the hemorrhage and there were no prehemorrhage scans which demonstrated the actual size and apperance of the meningioma. This is a very rare report of a case with a tentorial meningioma documented with pre- and posthemorrhage scans.
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Affiliation(s)
- I M Ziyal
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Chong CCW, van Gelder JM. Subdural haematomas complicating insertion of the low-pressure Novus hydrocephalus valve: a simple method for intra-operative testing of the anti-siphon device. J Clin Neurosci 2006; 13:759-62. [PMID: 16904895 DOI: 10.1016/j.jocn.2005.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 10/13/2005] [Indexed: 10/24/2022]
Abstract
We previously reported 52 patients with hydrocephalus who were followed up after insertion of low-pressure Novus valves. These valves have a normally open anti-siphon device (ASD) incorporated. There were no cases of subdural haematomas (SDH). Subsequently, three new patients suffered SDH after insertion of these valves. We investigated a simple method for intra-operative testing of the ASD. These new patients had their valves replaced. In the laboratory, flow rates through five valves were recorded as a function of proximal positive pressure and distal negative pressures (siphoning). The flow rates were influenced by both proximal positive and distal negative pressures. The ASD stopped flow at distal negative pressures between -40 and -60 cm H(2)O. Proximal positive pressures increased this threshold. The flow can be measured by counting drops per minute. Three valves removed from patients were functioning as expected, one had unexpectedly slow flow at very high siphoning pressure and one had unexpectedly slow flow rates. In three patients with SDH complicating low-pressure Novus valves, the valves and anti-siphon devices were functioning adequately. Using a simple device, measuring flow rates in drops per minute was reliable and reproducible.
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Affiliation(s)
- Colin C W Chong
- Department of Neurosurgery, Liverpool Health Service, South Western Sydney Area Health Service, University of New South Wales, Liverpool NSW 2170, Sydney, Australia
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Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, Begtrup K, Steiner T. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006; 66:1175-81. [PMID: 16636233 DOI: 10.1212/01.wnl.0000208408.98482.99] [Citation(s) in RCA: 762] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although volume of intracerebral hemorrhage (ICH) is a predictor of mortality, it is unknown whether subsequent hematoma growth further increases the risk of death or poor functional outcome. METHODS To determine if hematoma growth independently predicts poor outcome, the authors performed an individual meta-analysis of patients with spontaneous ICH who had CT within 3 hours of onset and 24-hour follow-up. Placebo patients were pooled from three trials investigating dosing, safety, and efficacy of rFVIIa (n = 115), and 103 patients from the Cincinnati study (total 218). Other baseline factors included age, gender, blood glucose, blood pressure, Glasgow Coma Score (GCS), intraventricular hemorrhage (IVH), and location. RESULTS Overall, 72.9% of patients exhibited some degree of hematoma growth. Percentage hematoma growth (hazard ratio [HR] 1.05 per 10% increase [95% CI: 1.03, 1.08; p < 0.0001]), initial ICH volume (HR 1.01 per mL [95% CI: 1.00, 1.02; p = 0.003]), GCS (HR 0.88 [95% CI: 0.81, 0.96; p = 0.003]), and IVH (HR 2.23 [95% CI: 1.25, 3.98; p = 0.007]) were all associated with increased mortality. Percentage growth (cumulative OR 0.84 [95% CI: 0.75, 0.92; p < 0.0001]), initial ICH volume (cumulative OR 0.94 [95% CI: 0.91, 0.97; p < 0.0001]), GCS (cumulative OR 1.46 [95% CI: 1.21, 1.82; p < 0.0001]), and age (cumulative OR 0.95 [95% CI: 0.92, 0.98; p = 0.0009]) predicted outcome modified Rankin Scale. Gender, location, blood glucose, and blood pressure did not predict outcomes. CONCLUSIONS Hematoma growth is an independent determinant of both mortality and functional outcome after intracerebral hemorrhage. Attenuation of growth is an important therapeutic strategy.
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Affiliation(s)
- S M Davis
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
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Abstract
OBJECTIVE We aim to identify the incidence and the characteristics of non-accidental subdural haemorrhage in Hong Kong in children under the age of 5 years. METHOD Eighteen children aged below 5 years presented with subdural haemorrhage without a history of significant trauma were studied. Clinical features and the work-up process for probable child abuse were analysed. RESULTS Sixteen combined case conferences were held, and eleven cases were concluded to be genuine child abuse cases of non-accidental head injury (incidence=1.5 per 100,000 children <5 years old per year). Among these cases, the most common presentation in the younger age group (age<1 year) was seizure (5/7), whilst that in the older age group (age 1-4 years) was coma (4/4, two of these patients also had seizure). One patient in the younger age group and three (3/4) of the older age group were found to have multiple unexplained bruises, suggesting that, in older children, direct impact injury played an important role. Five (5/7) children in the younger age group and all four children in the older age group had retinal haemorrhage. Coma on admission was associated with an unfavourable outcome (6/7 vs 0/4, p=0.015). CONCLUSIONS Sixty-one percent of childhood subdural haemorrhage (11/18) without a history of significant trauma were genuine child abuse cases and should all be investigated for probable "non-accidental injury". An organised protocol involving a multi-disciplinary team is mandatory.
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Affiliation(s)
- David T F Sun
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories East, Hong Kong
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28
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Usul H, Karaarslan G, Cakir E, Kuzeyl K, Mungan L, Baykal S. Conservative management of spontaneous posterior fossa subdural hematoma in a neonate. J Clin Neurosci 2006; 12:196-8. [PMID: 15749432 DOI: 10.1016/j.jocn.2004.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2003] [Accepted: 03/25/2004] [Indexed: 10/25/2022]
Abstract
Symptomatic intracranial hemorrhage in term neonates is uncommon, and is usually secondary to trauma, coagulation disorders and/or hypoxia. Posterior fossa hemorrhage in the neonate is a rare neurosurgical emergency and is usually associated with the same etiological factors. Diagnosis is with computed tomography and magnetic resonance imaging. We present a spontaneous posterior fossa subdural hematoma in a term neonate and discuss conservative management.
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Affiliation(s)
- Haydar Usul
- Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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29
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Ahn ES, Smith ER. Acute clival and spinal subdural hematoma with spontaneous resolution: clinical and radiographic correlation in support of a proposed pathophysiological mechanism. Case report. J Neurosurg 2006; 103:175-9. [PMID: 16370287 DOI: 10.3171/ped.2005.103.2.0175] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infratentorial and spinal subdural hematomas (SDHs) from traumatic injury in the pediatric population occur with such rarity that they can present the clinician with a challenge in diagnosis and management. When such hematomas are correctly identified, clinicians must decide whether to evacuate the lesion or manage it expectantly. The authors discuss the case of a 4-year-old child who presented with a clival and spinal SDH after a fall from a fourth-story window. The clinical and radiographic findings support a possible mechanism of evolution of these lesions. There is little evidence to guide management of clival and spinal SDHs. This case supports the evaluation for a spinal SDH when a clival hematoma is diagnosed. In the setting of a good neurological examination, expectant management can be an appropriate method of treatment. Additionally, this case lends insight into the pathophysiology of spinal SDHs. Unlike its intracranial counterpart, the spinal subdural space lacks bridging veins. The mechanism of formation of spinal SDHs after trauma has been heretofore relatively unclear. The images in this case support the hypothesis that redistribution of the clival SDH to dependent areas in the spinal subdural space is a significant mechanism in the evolution of these lesions.
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MESH Headings
- Child, Preschool
- Cranial Fossa, Posterior
- Hematoma, Subdural/complications
- Hematoma, Subdural/diagnosis
- Hematoma, Subdural/physiopathology
- Hematoma, Subdural, Spinal/complications
- Hematoma, Subdural, Spinal/diagnosis
- Hematoma, Subdural, Spinal/physiopathology
- Humans
- Magnetic Resonance Imaging
- Male
- Remission, Spontaneous
- Tomography, X-Ray Computed
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Affiliation(s)
- Edward S Ahn
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, USA
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30
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Abstract
Carotid and vertebral artery dissections from blunt cervical trauma are uncommon injuries that in recent years are becoming increasingly recognized as a result of angiographic screening protocols in trauma patients. Traumatic carotid cavernous fistulas are even less common events, but represent the most common intracranial vascular anomaly after head injury. The present report details the unique case of a woman with no history of collagen vascular disease who developed dissections of both carotid and both vertebral arteries, as well as a direct carotid cavernous fistula, after a motor vehicle collision. Her vascular injuries resolved without need for surgical or endovascular intervention.
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Affiliation(s)
- R L Yong
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
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32
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Abstract
CASE REPORT This is a report of a case of a subdural haematoma in infancy of possible non-accidental aetiology with raised pericerebral pressure, which we postulate has eroded the inner table of the cranial bones and resulted in leakage of marrow precursor cells into the extradural space. RESULT Subdural tapping via the fontanelle has created a channel allowing subsequent ingress of nucleated red cell precursors into the subdural space. This addition to the subdural collection has prolonged its course necessitating subduro-peritoneal shunting.
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Affiliation(s)
- R A Minns
- Department of Paediatric Neuroscience, Royal Hospital for Sick Children, Edinburgh, UK
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34
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Smidt MH, de Bruin HG, van't Veer MB, van den Bent MJ. Intracranial granulocytic sarcoma (chloroma) may mimic a subdural hematoma. J Neurol 2005; 252:498-9. [PMID: 15726254 DOI: 10.1007/s00415-005-0680-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 09/17/2004] [Accepted: 10/04/2004] [Indexed: 10/25/2022]
MESH Headings
- Central Nervous System Neoplasms/pathology
- Central Nervous System Neoplasms/physiopathology
- Central Nervous System Neoplasms/therapy
- Hematoma, Subdural/pathology
- Hematoma, Subdural/physiopathology
- Hematoma, Subdural/therapy
- Humans
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/physiopathology
- Leukemia, Myeloid, Acute/therapy
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Sarcoma, Myeloid/etiology
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
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Abstract
Bilateral convexity and interhemispheric subdural hematomas are common neuroimaging patterns seen in infants who have sustained nonaccidental head injuries (NAHIs). These collections often appear aschronic or acute-on-chronic on computerized tomography (CT) studies. To determine the nature of these extraaxial fluid collections and their relationship to cerebrospinal fluid (CSF) dynamics, the authors studied five infants with suspected NAHI in whom symptomatic bilateral mixed- or low-density subdural collections were revealed on imaging studies; the patients underwent burr hole evacuation of the hematoma and external drainage. Once decompression was achieved, radiotracer was injected into the lumbar subarachnoid space, and the subdural drainage system was monitored for appearance of the isotope. In all five cases, the radiotracer moved rapidly from the lumbar subarachnoid space into the convexity subdural space and then into the external drainage system. This indicated the possibility that some of these mixed-density subdural collections were acute blood mixed with CSF rather than acute-on-chronic collections arising from rebleeding subdural membranes. The authors propose that, during infancy, tears in the loosely adherent arachnoid envelope at the main arachnoid granulation site along the superior sagittal sinus may result in a considerable amount of CSF mixing with acute blood in the subdural space, creating a hematohygroma.
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Affiliation(s)
- Alexander Zouros
- Division of Neurosurgery, Loma Linda University, Loma Linda, California 92354, USA.
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Eijkenboom M, Gerlach I, Barker A, Luiten P, van der Staay FJ. Chronic cognitive effects of bilateral subdural haematomas in the rat. Neuroscience 2004; 124:523-33. [PMID: 14980724 DOI: 10.1016/j.neuroscience.2003.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2003] [Indexed: 11/26/2022]
Abstract
Humans suffering from subdural haematomas often show long-term cognitive dysfunctions. For identifying putative, recovery-enhancing therapeutics, animal models need to be developed in which recovery of function can be measured. For investigating whether and which type of recovery, i.e. spontaneous or training-induced recovery, or continuous partial retardation, is present in the rat model for bilateral subdural haematomas, spatial navigation abilities were assessed in the Morris water escape task in independent groups of rats at 1, 2, 4, 8, or 18 weeks after surgery. Complete spontaneous recovery seemed to occur at 8 weeks after injury. However, at 18 weeks after injury, the subdural haematoma caused a renewed deterioration of water maze performance, which was of a lesser degree than the impairments observed immediately after injury. This second phase performance deterioration was accompanied by an increase in generalised astrocyte reactivity. The rat subdural haematoma model provides an interesting tool for investigating spontaneous recovery processes of spatial navigation (8 weeks after injury), but also for progressive brain dysfunctions, considering the second phase of behavioural impairments seen at 18 weeks after injury.
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Affiliation(s)
- M Eijkenboom
- Central Nervous System Research, Bayer Healthcare, Aprather Weg 18a, 42906 Wuppertal, Germany.
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38
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Nakatani M, Kawaguchi T. [A case of multiple subdural hematoma in the posterior fossa with intracranial hypotension]. No To Shinkei 2003; 55:1060-1. [PMID: 14870578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Sándor J, Szücs M, Kiss I, Ember I, Csepregi G, Futó J, Vimláti L, Pál J, Büki A, Dóczi T. [Risk factors for fatal outcome in subdural hemorrhage]. Ideggyogy Sz 2003; 56:386-95. [PMID: 14743593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Subdural haemorrhage (SDH) is of high public health importance because of its frequency, high case fatality ratio (CFR) and the young age of affected population. Despite the fact that the effectivity of guideline based treatment has been improved in the last decade, the Hungarian praxis shows variable compliance for recommendations. OBJECTIVES The study aimed to describe the heterogeneity of the treatment effectivity (by geographically identifying the populations provided with appropriate or non-optimal level care), to determine the relationship between the institutional proxies quality and the results of treatment for SDH by linking the proxies properties to the patients' records. METHODS The institutions' protocols were assessed by a self-completed questionnaire in 1997. The participating hospitals treated 79% of the Hungarian patients with SDH. The Hungarian hospital discharge data in 1997-1999 were the source of patient specific data. The risk factors of lethal outcome were investigated by logistic regression analysis. RESULTS High proportion of patients had been treated in hospital with low compliance for guidelines. The non-permanent access to neurosurgical service and CT facility, the lack of intracranial pressure monitoring and the respiration support provided out of intensive care units worsened the survival of subjects. It was quantified that the full compliance could have diminished the case fatality ratio by 15-20%. The ratio of extreme county level CFRs exceeded 2.36 and extrapolating the effectivity observed in the county with lowest lethality, the Hungarian CFR would have been reduced by 21% among patients with SDH main diagnosis. (The interpretation of findings is limited by the lack of differentiation between acute and chronic cases and of direct categorisation of severity for subdural haemorrhage in the official hospital discharge records). DISCUSSION The study results urge the increase of compliance for evidence based guidelines, since despite of some validity issues, it was demonstrated that the deviation from recommended practice is reflected in the disadvantageous outcome.
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Affiliation(s)
- János Sándor
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Közegészségtani Intézet, Pécs
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40
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Abstract
BACKGROUND AND PURPOSE Hyperglycemia has a deleterious effect on brain ischemia. However, the effect of hyperglycemia in intracerebral hemorrhage (ICH) is not well known. We investigated the effect of hyperglycemia on the development of brain edema and perihematomal cell death in ICH. METHODS Hyperglycemia was induced by intraperitoneal injection of streptozotocin (60 mg/kg) in adult Sprague-Dawley male rats. ICH was induced by stereotaxic infusion of 0.23 U of collagenase into the left striatum. Seventy-two hours after ICH, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was performed for perihematomal cell death. We also measured brain water content to evaluate edema formation. RESULTS The serum glucose level of the hyperglycemic group was 394.0+/-180.3 mg/dL (n=31), and that of the normoglycemic group was 97.5+/-27.4 mg/dL (n=31). The size of hemorrhage was similar between groups, without any significant difference (n=8 in each group). The brain water content of hyperglycemic rats (n=17) increased in both lesioned (81.0+/-0.5%) and nonlesioned hemispheres (78.7+/-0.6%) compared with the normoglycemic group (n=17; lesioned: 78.9+/-0.8%; nonlesioned: 77.3+/-1.1%). In the hyperglycemic group, more TUNEL-positive cells were found in the perihematomal regions (n=6). CONCLUSIONS Hyperglycemia caused more profound brain edema and perihematomal cell death in experimental ICH.
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Affiliation(s)
- Eun-Chol Song
- Department of Neurology and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Tian H, He W, Yang H. [A simulation study on brain hematoma real time monitoring by use of electrical impedance tomography]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2003; 20:245-8. [PMID: 12856589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
It is significant to develop a new set of medical equipment in which electrical impedance tomography is applied to brain hematoma real time monitor. This paper describes some progress in reconstruction algorithm of EIT. The methods make it possible to improve the precision as well as computation speed dramatically. In addition, intensive simulation describes all the process for real time monitoring of brain hematoma by exploiting EIT.
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Affiliation(s)
- Haiyan Tian
- Key Laboratory of High Voltage and Electrical Theory New Technology, Education Ministry of China, College of Electrical Engineering, Chongqing University, Chongqing 400044
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44
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Piao YX, Chen LG, Wang QH, Wang F, Zeng FJ, Lu M. Traumatic interhemispheric subdural hematoma. Chin J Traumatol 2003; 6:186-9. [PMID: 12749794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yong-xu Piao
- Department of Neurosurgery, Chengdu Military General Hospital, Chengdu 610083, China.
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45
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Lang JM, Beck J, Zimmermann M, Seifert V, Raabe A. Clinical evaluation of intraparenchymal Spiegelberg pressure sensor. Neurosurgery 2003; 52:1455-9; discussion 1459. [PMID: 12762891 DOI: 10.1227/01.neu.0000065136.70455.6f] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2002] [Accepted: 02/10/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Spiegelberg 3-PN intraparenchymal pressure sensor was clinically evaluated. DESCRIPTION OF INSTRUMENTATION The Spiegelberg intraparenchymal pressure sensor is a low-cost device that uniquely performs regular automatic zeroing in situ throughout the measurement period. OPERATIVE TECHNIQUE The Spiegelberg sensor was inserted in 87 patients who required intracranial pressure monitoring as part of their routine management. Complications were assessed by postoperative computed tomographic scanning and clinical investigation. The automated zeroing procedure was assessed after implantation of the sensor and during long-term measurement. In five patients, the "gold standard' of intraventricular pressure was measured simultaneously and compared with the intraparenchymal or subdural Spiegelberg 3-PN pressure. EXPERIENCE AND RESULTS No complications associated with the Spiegelberg sensor were observed. The duration of monitoring ranged from 3 to 28 days (mean, 10 d). In 3 patients, technical problems occurred, and in 84 patients, the pressure measurement was successful, including the automatic zeroing procedures performed by the monitor after insertion and hourly thereafter. The absolute difference between the Spiegelberg reading and the intraventricular pressure was less than +/-3 mm Hg in 99.6% and less than +/-2 mm Hg in 91.3% of readings. An Altman-Bland bias plot revealed good agreement between the two methods, with an average bias of 0.5 mm Hg, but revealed a significant trend toward 10% lower Spiegelberg readings with increasing intracranial pressure of >25 mm Hg. There was no difference between intraparenchymal and subdural locations. CONCLUSION The Spiegelberg 3-PN sensor was reliable and simple to use. It can be recommended for routine intraparenchymal and subdural pressure measurement at a considerably lower price compared with other tip transducers and has the unique advantage of automated zeroing in vivo.
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Affiliation(s)
- Josef-Michael Lang
- Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
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Nordström CH, Reinstrup P, Xu W, Gärdenfors A, Ungerstedt U. Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 2003; 98:809-14. [PMID: 12657839 DOI: 10.1097/00000542-200304000-00004] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients with severe traumatic brain lesions, the lower limit for cerebral perfusion pressure (CPP) is controversial. The aim of this prospective study was to assess this limit from bedside measurements of cerebral energy metabolism and to clarify whether the penumbra zone surrounding a focal lesion is more sensitive to a decrease in CPP than less-injured areas. METHODS Fifty patients with severe head injury were included after evacuation of an intracranial hematoma and/or focal brain contusion. They were treated according to intensive care routine (Lund concept), including continuous monitoring of intracranial pressure. One microdialysis catheter was inserted in less-injured brain tissue ("better" position), and one or two catheters were inserted into the boundary of injured cerebral cortex ("worse" position). Concentrations of glucose, pyruvate, and lactate were analyzed and displayed bedside and were related to CPP (n = 29,495). RESULTS Mean interstitial glucose concentration was unaffected by the level of the CPP within the studied ranges. Increases in lactate concentration (P = 0.0008) and lactate-pyruvate ratio (P = 0.01) were obtained in the "worse" but not in the "better" position at CPP less than 50 mmHg compared with the same positions at CPP greater than 50 mmHg. CONCLUSIONS The study results support the view that CPP may be reduced to 50 mmHg in patients with severe traumatic brain lesions, provided that the physiologic and pharmacologic principles of the Lund concept are recognized. In the individual patient, preservation of normal concentrations of energy metabolites within cerebral areas at risk can be guaranteed by intracerebral microdialysis and bedside biochemical analyses.
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Abstract
The objective of the present study was to analyze the effect of different loading directions following impact, and to evaluate existing global head injury criteria. Detailed and parameterized models of the adult human head were created by using the Finite Element Method (FEM). Loads corresponding to the same impact power were imposed in different directions. Furthermore, the Head Injury Criterion (HIC) and the recently proposed Head Impact Power (HIP) criterion were evaluated with respect to the relative motion between the skull and the brain, as well as the strain in the bridging veins. It was found that the influence of impact direction had a substantial effect on the intracranial response. The largest relative skull-brain motion and strain in the bridging veins occurred with the anterior-posterior (AP) and posterior-anterior (PA) rotational impulses. HIC was unable to predict consequences of a pure rotational impulse while HIP needed individual scaling coefficients for the different terms to account for difference in load direction. When using the proposed scaling procedure, a better prediction of subdural hematoma (SDH) was obtained. It is thus suggested that an evaluation of the synergistic terms is necessary to further improve the injury prediction. These variations should be considered when developing new head injury criteria.
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Affiliation(s)
- Svein Kleiven
- Department of Aeronautics, Royal Institute of Technology, Stockholm, Sweden.
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48
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Abstract
INTRODUCTION Waveform analysis of ICP and mABP provideqs important information about cerebrovascular reactivity and intracranial compliance. Traditionally spectral analysis and correlation statistics have been used despite certain limitations. Approximate entropy (ApEn) is an established measure of system regularity; which can change with pathology. This study defines a novel method for application of ApEn to the ICP/mABP waveform, and reports changing ApEn with pathophysiology in the rodent brain. METHODS Nine Sprague-Dawley rats were anesthetized for mABP, and ICP recording. Rats were exposed to 15 minutes hypotension (45-50 mmHg), followed by resuscitation, equilibration and infusion of a 500 ul subdural hematoma. Raw data, ApEn(RAW), and wave-period, ApEn(PERIOD), were assessed for stochastic fluctuations using ApEn (m = 2, r = 0.2 SD). Results were compared with the established parameters: standard deviation, harmonic transfer function, Pressure Reactivity Index and Correlation Coefficient. RESULTS At baseline, ApEn(ABP-PERIOD) and ApEn(ICP-PERIOD) were 1.464 +/- 0.003, and 0.690 +/- 0.020 respectively, suggesting that random heart rate fluctuations are damped during transfer to the ICP waveform. ApEn(ICP-PERIOD) consistently rose during hypotension (ICP 7 +/- 2: ApEn(ICP-PERIOD) 1.086 +/- 0.074, p < 0.05) and after SDH infusion (ICP 35 +/- 12: ApEn(ICP-PERIOD) 1.24 +/- 0.03, p < 0.01). These values were closer to mABP and suggest enhanced transfer of random fluctuations. Significant changes in ApEn were seen in the absence of significant changes in other parameters. CONCLUSIONS This study defines a system for analyzing the transfer of random fluctuations in mABP waveform to the ICP waveform. ApEn appears to be responsive to changes in intracranial compliance and/or cerebrovascular resistance, therefore more formal studies of the sensitivity and specificity of this novel measure are warranted. These initial findings suggest that ApEn may be a useful adjunct measure of the ICP waveform.
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Affiliation(s)
- A Beaumont
- Department of Physiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
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Sawauchi S, Beaumont A, Signoretti S, Tomita Y, Dunbar J, Marmarou A. Diffuse brain injury complicated by acute subdural hematoma and secondary insults in the rodents: the effect of surgical evacuation. Acta Neurochir Suppl 2003; 81:241-2. [PMID: 12168315 DOI: 10.1007/978-3-7091-6738-0_62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Head Trauma associated with acute sudural hematoma (SDH) and complicated by secondary insult is a grave clinical combination with complex pathophysiology. The aim of this study was to develop a clinically relevant injury model, which can be used to study the interaction between injury mechanisms. We present a novel model of SDH combined with diffuse brain injury (DBI) and a hypoxic secondary insult, and investigate the effects of surgical evacuation. Adult Sprague-Dawley rats were given a 300 microliters SDH and 20 minute-hypoxia following Impact Acceleration DBI. Hematoma was evacuated at one hour post-injury. Physiological parameters were measured for 5 hours, together with assessment of brain water content. Secondary insult after traumatic SDH was associated with significant brain swelling and stimulated refractory rise in ICP. In traumatic SDH complicated by secondary insult, brain swelling is exacerbated by surgical evacuation.
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Affiliation(s)
- S Sawauchi
- Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia, USA
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50
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Abstract
STUDY DESIGN A case report with a literature review is presented. OBJECTIVE To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of traumatic spinal subdural hematoma. SUMMARY OF BACKGROUND DATA Traumatic spinal subdural hematoma is uncommon, and only eight cases have been reported in the literature. Concomitant intracranial and spinal subdural hematoma in the same patient has not been well studied. METHODS A case of concomitant spinal and intracranial subdural hematoma is reported as well as a review of the literature. RESULTS Including our patient, we found that five of the nine patients with traumatic spinal subdural hematoma also had intracranial hematoma. We hypothesize that the mechanism of traumatic spinal subdural hematoma may be associated with intracranial events. Recognition of blood products in magnetic resonance imaging scans is important to distinguish spinal subdural hematoma from other spinal lesions. It is generally agreed that prompt laminectomy with evacuation of hematoma should be performed before irreversible damage to the spinal cord occurs. However, including our patient, three of the nine reported cases with thoracic or lumbar subdural hematoma resolved spontaneously with conservative treatment. CONCLUSIONS This 12-year-old boy illustrated the rapid spontaneous resolution of traumatic subdural hematoma in both left hemisphere and lumbar spine with conservative treatment. This report suggests a possible role of conservative management for traumatic lumbar subdural hematoma, especially when the patients already have neurologic recovery.
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Affiliation(s)
- Kuo-Sheng Hung
- Department of Trauma and Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan
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