1
|
Cook R, Zima L, Khazaal J, Williams J. Low-velocity penetrating brain injury: a review of the literature and illustrative case. Brain Inj 2024; 38:668-674. [PMID: 38555515 DOI: 10.1080/02699052.2024.2336067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied. CASE As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness. DISCUSSION Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course. CONCLUSION In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes.
Collapse
Affiliation(s)
- Richard Cook
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura Zima
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jawad Khazaal
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John Williams
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
2
|
Dietz N, Blank M, Asaka W, Oxford BG, Ding D, Sieg E, Koenig HM. Emergent Management of Severe Hypothermia, Acidemia, and Coagulopathy in Operative Penetrating Ballistic Cranial Trauma. Cureus 2024; 16:e55630. [PMID: 38586715 PMCID: PMC10995893 DOI: 10.7759/cureus.55630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Hypothermia in a trauma patient has been associated with increased morbidity and mortality and is more frequently seen in those sustaining traumatic brain injuries (TBIs). Acidosis is an important consequence of hypothermia that leads to derangements across the spectrum of the coagulation cascade. Here, we present a case of a 31-year-old male presented after suffering a right parietal penetrating ballistic injury with an associated subdural hematoma and 7 mm midline shift requiring decompressive craniectomy and external ventricular drain (EVD) placement in the setting of severe hypothermia (28°C) and acidosis (pH 7.12). With aggressive rewarming intraoperatively, the use of full-body forced-air warming, warmed IV fluids, and increasing the ambient room temperature, the patient's acidosis and hypothermia improved to pH 7.20 and 34°C. Despite these aggressive attempts to rewarm the patient, he developed coagulopathy in the setting of concurrent hypothermia and acidosis. This case highlights the importance of prompt reversal of hypothermia due to its potentially fatal effects, particularly in the setting of severe TBIs. We discuss the critical aspects of surgical management of the injury and anesthetic management of hypothermia, acidosis, and coagulopathy perioperatively.
Collapse
Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Meghan Blank
- Department of Anesthesiology, University of Louisville Hospital, Louisville, USA
| | - William Asaka
- Department of Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Brent G Oxford
- Department of Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Emily Sieg
- Department of Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Heidi M Koenig
- Department of Anesthesiology, University of Louisville Hospital, Louisville, USA
| |
Collapse
|
3
|
Wardhana DPW, Lauren C, Awyono S, Rosyidi RM, Tiffany T, Maliawan S. Particular Surgical Technique for Transorbital-Penetrating Craniocerebral Injury Inflicted by a Screwdriver: Technical Case Report. Korean J Neurotrauma 2023; 19:356-362. [PMID: 37840617 PMCID: PMC10567536 DOI: 10.13004/kjnt.2023.19.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 10/17/2023] Open
Abstract
Surgical techniques for non-missile penetrating brain injuries (PBI) are challenging because they require good preoperative planning. Generally, extraction is performed ipsilaterally at the entry site. In certain cases, the extraction can be performed contralaterally through the inner end of the foreign body; however, this requires special consideration. We present a case report of a patient who had a stab wound on the head via a screwdriver and underwent surgery, during which extraction was performed contralaterally through the inner end of the screwdriver without inducing any neurological deficit. Careful preoperative planning and surgical technique modification are required to minimize morbidity and mortality in patients with PBIs.
Collapse
Affiliation(s)
- Dewa Putu Wisnu Wardhana
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Academic Hospital of Universitas Udayana, Badung, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Steven Awyono
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Rohadi Muhammad Rosyidi
- Department of Neurosurgery, Medical Faculty of Mataram University, West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Tiffany Tiffany
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Sri Maliawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| |
Collapse
|
4
|
Somrani K, Gader G, Badri M, Zammel I, Rkhami M. A Spectacular Penetrating Craniocerebral Trauma From a Rake: A Case Report. Korean J Neurotrauma 2023; 19:109-114. [PMID: 37051032 PMCID: PMC10083454 DOI: 10.13004/kjnt.2023.19.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 03/22/2023] Open
Abstract
Penetrating intracranial foreign bodies are rare and have a high potential for death or serious morbidity. Their surgical management is complicated and challenging. Herein, we present the case of a 30-years-old man who was a victim of aggression from a rake blow to the head. The rake's teeth were embedded in his cranium, crossing the midline. The surgery was delicate and had to be well studied because two of the rake's teeth plunged into the superior sagittal sinus (SSS). The patient recovered a perfect state of consciousness and was discharged with squealer right upper limb monoparesia. Penetrating intracranial foreign bodies are rare. Few studies have reported on the removal of such foreign bodies, particularly in cases where the foreign body is close to or penetrates the SSS. They cause spectacular cranial trauma and a greater volume of the object. The aim of surgery is to remove the object without worsening the parenchymal and vascular cerebral lesions. This maneuver was delicate. A craniectomy is recommended around the penetrating object before it is carefully extracted with or without opening the dura mater.
Collapse
Affiliation(s)
- Kaouther Somrani
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ghassen Gader
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ihsen Zammel
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Rkhami
- Department of Neurosurgery, Trauma and Burn Center of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
5
|
Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis. J Am Coll Surg 2023; 236:81-92. [PMID: 36519911 DOI: 10.1097/xcs.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear. STUDY DESIGN We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders. RESULTS A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients. CONCLUSIONS ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.
Collapse
|
6
|
Aaronson DM, Awad AJ, Hedayat HS. Lead toxicity due to retained intracranial bullet fragments: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE21453. [PMID: 36164673 PMCID: PMC9514260 DOI: 10.3171/case21453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors' knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments. OBSERVATIONS The authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms. LESSONS Although rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.
Collapse
|
7
|
Yousif RS, Omar AM, Ismail M, Hamouda WO, Alkhafaji AO, Hoz SS. Excellent recovery after nonmissile penetrating traumatic brain injury in a child: A case report. Surg Neurol Int 2022; 13:388. [PMID: 36128089 PMCID: PMC9479510 DOI: 10.25259/sni_350_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury. Case Description: We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull base zone. Conclusion: We demonstrated that following standard recommendations in the management of pTBI which include applying the advanced trauma life support protocol in ER, acquiring the needed preoperative neuroimaging studies, avoiding moving the penetrating object till patient shifted to OR, and finally performing a planned stepwise surgical intervention through craniotomy may yield an excellent functional recovery, especially in children despite an otherwise grave initial presentation and apparently profound brain injury.
Collapse
Affiliation(s)
- Reber S. Yousif
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Alend M. Omar
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Mustafa Ismail
- College of Medicine, University of Baghdad, Baghdad, Iraq,
| | - Waeel O. Hamouda
- Department of Neurosurgery, Kasr Alainy School of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt,
- Department of Neurological and Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia,
| | | | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
| |
Collapse
|
8
|
Diyora B, Patel M, Dhall G, Kale P, Kalikar V, Majeed T, Devani K, Purandare A, Patankar R. Life-threatening perforating brain injury by a rusty iron rod - A case report. Surg Neurol Int 2022; 13:207. [PMID: 35673637 PMCID: PMC9168336 DOI: 10.25259/sni_96_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background When an object traverses through the cranium leaving behind both an entry and exit wound, it is called perforating brain injury. Perforating open brain injury is rare. A paucity of published literature on such cases and a lack of a standard management protocol pose significant challenges in managing such cases. Case Description We present a case of a 24-year-old man who worked as a carpenter at the construction site. He slipped while working and fell from a height of 13 feet onto a rusty, vertically placed 3 feet iron rod located on the ground. Iron rod entered his body from the right upper chest, came out from the neck, and again re-entered through the right upper neck medial to the angle of the mandible and finally came out from the posterosuperior surface of the right side of the head. He presented to the emergency department in a conscious state, but his voice was heavy and slow-paced, and he showed signs of lower cranial nerve palsy on the right side. He underwent numerous radiological investigations. The iron rod was removed in the operation theater under strict aseptic precautions. On day 7 after surgery, he developed right lobar pneumonia, and on day 21, he developed an altered sensorium, followed by a loss of consciousness. He did not regain consciousness and, unfortunately, succumbed after 30 days of sustaining the injuries. Conclusion Perforating open brain injuries are rare, especially in civilian society, and are usually associated with significant morbidity and mortality. Due to a lack of standard guidelines for managing such severe injuries and limited knowledge, many patients with these injuries do not survive. Although each case presents differently, certain management principles must be followed.
Collapse
Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, LTMMC and GH, Sion, Mumbai, Maharashtra, India
| | - Mehool Patel
- Department of Neurosurgery, LTMMC and GH, Sion, Mumbai, Maharashtra, India
| | - Gagan Dhall
- Department of Neurosurgery, LTMMC and GH, Sion, Mumbai, Maharashtra, India
| | - Pramod Kale
- Department of Surgery, Zen Hospital and Research Centre, Chembur, Mumbai, Maharashtra, India
| | - Vishakha Kalikar
- Department of Surgery, Zen Hospital and Research Centre, Chembur, Mumbai, Maharashtra, India
| | - Tanveer Majeed
- Department of Surgery, Zen Hospital and Research Centre, Chembur, Mumbai, Maharashtra, India
| | - Kavin Devani
- Department of Neurosurgery, LTMMC and GH, Sion, Mumbai, Maharashtra, India
| | - Anup Purandare
- Department of Neurosurgery, LTMMC and GH, Sion, Mumbai, Maharashtra, India
| | - Roy Patankar
- Department of Surgery, Zen Hospital and Research Centre, Chembur, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Hoey A, Troy C, Bauerle W, Xia A, Hoey B. Delayed-Onset Seizures Following Self-Inflicted Nail Gun Injury to the Head: A Case Report and Literature Review. J Neurol Surg Rep 2022; 83:e54-e62. [PMID: 35756905 PMCID: PMC9232295 DOI: 10.1055/s-0042-1749650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Nail gun use and its associated incidence of injury have continued to increase since it was first introduced in 1959. While most of these injuries involve the extremities, a subset of patients suffer intracranial trauma. The most recent comprehensive review on this particular subject referenced 41 cases and advocated for further discussion regarding proper treatment plans for these individuals. We present the case of a 25-year-old who suffered 35 self-inflicted penetrating head wounds from a nail gun after suffering an amputation injury at his job site. No neurological deficits were present on his arrival to the emergency room. He underwent surgery to treat his arm wound and remove 13 of the 35 nails. The patient was discharged from the hospital on levetiracetam and made a full recovery. Nearly 1 year later, he experienced a seizure at his workplace. However, after resuming his antiepileptic medication, he reports no further complications. This case is distinct for not only being the most nails in a patient's head at presentation, but also following surgery. Utilizing this case, prior review, and 27 subsequent cases, we propose an updated algorithm for diagnosis and treatment of nail-gun-related penetrating head trauma.
Collapse
Affiliation(s)
- Alexander Hoey
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Christopher Troy
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Wayne Bauerle
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Anthony Xia
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Brian Hoey
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| |
Collapse
|
10
|
Aggarwal P, Thapliyal D, Sarkar S. The past and present of Drosophila models of Traumatic Brain Injury. J Neurosci Methods 2022; 371:109533. [DOI: 10.1016/j.jneumeth.2022.109533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
|
11
|
Matsubara M, Sakamoto Y, Takahashi S, Ota Y, Kishi K. Day 14 intervention for penetrating brain injury with a good Glasgow Coma Scale score: A case report. Clin Case Rep 2022; 10:e05257. [PMID: 35035960 PMCID: PMC8752458 DOI: 10.1002/ccr3.5257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
Penetrating brain injury is a rare pathology generally requiring emergency surgical intervention. We discuss a case of penetrating brain injury by the umbrella in which surgical intervention was performed 14 days after the injury, and obtained good clinical results.
Collapse
Affiliation(s)
- Mai Matsubara
- Department of Plastic and Reconstructive SurgeryKeio University School of MedicineTokyoJapan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive SurgeryKeio University School of MedicineTokyoJapan
| | - Satoshi Takahashi
- Department of NeurosurgeryKeio University School of MedicineTokyoJapan
| | - Yu Ota
- Department of OpthalmologyKeio University School of MedicineTokyoJapan
| | - Kazuo Kishi
- Department of NeurosurgeryKeio University School of MedicineTokyoJapan
| |
Collapse
|
12
|
Okura H, Takaki Y, Makino K, Nonaka S, Tsutsumi S, Ishii H. An unprecedented case of penetrating head trauma caused by shoji (a Japanese-style paper sliding door). Trauma Case Rep 2021; 36:100533. [PMID: 34584924 PMCID: PMC8452884 DOI: 10.1016/j.tcr.2021.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Penetrating head trauma (PHT) includes any traumatic injury where an object pierces the skull and breaches the dural membrane surrounding the brain. PHTs are less prevalent than blunt head injuries. However, they often have more complex damage, worse prognosis, and higher rates of morbidity and mortality. An 83-year-old man fell at his home and hit his head on the right side toward a shoji (a Japanese-style paper sliding door). He reported to the emergency room the following day with his family. He had a small wound before the right ear, which was sutured in the emergency room. A CT scan demonstrated tiny pieces of bone fragments inside the brain, as well as right temporal subcortical hemorrhage and pneumocephalus. He was admitted to the hospital and received intensive prophylaxis with antibiotics. He developed life-threatening skin disease and subsequent acute kidney disease requiring hemodialysis. He fully recovered from his life-threatening condition. Here, we report an unprecedented case of a penetrating head injury of an older adult caused by a shoji.
Collapse
Affiliation(s)
- Hidehiro Okura
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| | - Yuki Takaki
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| | - Kensaku Makino
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| | - Senshu Nonaka
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| | - Satoshi Tsutsumi
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| | - Hisato Ishii
- Department of Neurosurgery, Juntendo Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba 279-0021, Japan
| |
Collapse
|
13
|
A Rare Case of Craniocervical Penetrating Injury by a Steel Bar. J Craniofac Surg 2021; 33:e365-e368. [PMID: 34694764 DOI: 10.1097/scs.0000000000008194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Rationale Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery. Chief Complaint The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability. Diagnosis Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue. Intervention We successfully performed the operation and removed the steel bar. Outcomes The patient was followed up for 5 years; muscle strength returned to normal. Lessons Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.
Collapse
|
14
|
Abstract
A 30-year-old man walked into the emergency department after a suicide attempt by firing a nail from a pneumatic nail gun directed at his left temple. He was haemodynamically stable and neurologically intact, able to recall all events and moving all extremities with a Glascow Coma Scale of 15. CT of the brain showed a 6.3 cm nail in the right frontal region without major intracerebral vessel disruption. He was taken to the operating room for left temporal wound washout, debridement of gross contamination and closure with titanium cranial fixation plate. The foreign body was not accessible on initial surgical intervention and was left in place to define anatomy and plan for subsequent removal. Thin slice CT images were used to create 3D reconstructions to facilitate stereotactic navigation and foreign body removal via right craniotomy the following day. The patient tolerated the procedures well and recovered with full neurological function.
Collapse
Affiliation(s)
- Roger Chen Zhu
- Department of Surgery, New York-Presbyterian Queens, Flushing, New York, USA
| | | | - Miroslav Kopp
- Department of Surgery, New York-Presbyterian Queens, Flushing, New York, USA.,Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Ning Lin
- Department of Surgery, New York-Presbyterian Queens, Flushing, New York, USA .,Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
15
|
Sharma G, Shekhawat JS, Sinha VD. A Rare Case of Transorbital Penetrating Intracranial Injury by a Screw. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1718241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Gaurav Sharma
- Department of Neurosurgery, Sawai Man Singh Medical College Jaipur, Rajasthan, India
| | | | - Virendra Deo Sinha
- Department of Neurosurgery, Sawai Man Singh Medical College Jaipur, Rajasthan, India
| |
Collapse
|
16
|
Transorbital-penetrating intracranial injury due to a homemade metal arrow: A case report. Ann Med Surg (Lond) 2020; 57:183-189. [PMID: 32774851 PMCID: PMC7398978 DOI: 10.1016/j.amsu.2020.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 11/21/2022] Open
Abstract
A transorbital-penetrating intracranial injury (TOPI) is an unusual traumatic brain injury. This rare injury has the potential to result in serious and fatal brain damage with a high mortality rate and requires prompt multidisciplinary surgical intervention. Here, we describe an interesting case in which a patient who presented with accidental penetrating injuries of the brain was found to have a transorbital-penetrating intracranial injury (TOPI). We chose an anterior approach to the foreign body above the entrance wound for removal in a retrograde manner with fluoroscopic guidance. The patient remained well with no complications and was discharged on postoperative day 10. Reasonable diagnostic imaging, surgical planning, and careful post-surgery management can increase patients successful outcomes. A transorbital-penetrating intracranial injury (TOPI) is an uncommon traumatic brain injury. TOPIs have the potential to result in serious brain damage with a high mortality rate. An interesting case of accidental TOPI that was treated successfully with fluoroscopic guidance is presented.
Collapse
|
17
|
Pringle C, Bailey M, Bukhari S, El-Sayed A, Hughes S, Josan V, Ramirez R, Kamaly-Asl I. Manchester Arena Attack: management of paediatric penetrating brain injuries. Br J Neurosurg 2020; 35:103-111. [PMID: 32677863 DOI: 10.1080/02688697.2020.1787339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The Manchester Arena bombing on 22 May 2017 resulted in 22 deaths and over 160 casualties requiring medical attention. Given the threat of modern- era terrorist attacks in civilian environments, it is important that we are able to anticipate and appropriately manage neurological injuries associated with these events. This article describes our experience of managing paediatric neurosurgical blast injuries, from initial triage and operative management to longer-term considerations. MATERIALS AND METHODS Case study and literature review. RESULTS Paediatric traumatic and penetrating brain injury patients often make a good neurological recovery despite low GCS at time of injury; this should be accounted for during triage and operative decision making in major trauma, mass casualty events. Conservative management of retained shrapnel is advocated in view of low long-term infection rates with retained shrapnel and worsened neurological outcome with shrapnel retrieval. All penetrating brain injuries should receive a prolonged course of broad-spectrum antibiotics and undergo long term follow-up imaging to monitor for the development of cerebral abscesses. MRI should never be utilised in penetrating brain injury cases, even in the absence of macroscopically visible fragments, due to the effect of MRI ferromagnetic field torque on shrapnel fragments. Anti-epileptic drugs should only be prescribed for the initial seven days after injury, as continuing beyond this does not incur any benefit in the reduction of long term post-traumatic epilepsy. CONCLUSION All receiving neurosurgical units should become familiar with optimum management of these thankfully rare, but complex injuries from their initial presentation to long term follow up considerations. All neurosurgical units should have well-rehearsed local plans to follow in the event of such incidents, ensuring timely deliverance of appropriate neurosurgical care in such extreme settings.
Collapse
Affiliation(s)
- Catherine Pringle
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Matthew Bailey
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Shafqat Bukhari
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Ashraf El-Sayed
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Stephen Hughes
- Department of Microbiology and Immunology, Royal Manchester Children's Hospital, Manchester, UK
| | - Vivek Josan
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Roberto Ramirez
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Ian Kamaly-Asl
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| |
Collapse
|
18
|
Nikova AS, Karakasi MV, Pavlidis P, Birbilis T, Dimitrov I. Does Nationality Matter for the Gunshot Brain Injury? Ten-Year Retrospective Observational Cadaveric Comparative Study for Gunshot TBI between Greece and Bulgaria. Korean J Neurotrauma 2019; 15:95-102. [PMID: 31720262 PMCID: PMC6826088 DOI: 10.13004/kjnt.2019.15.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/09/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. Methods The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. Results The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. Conclusion PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.
Collapse
Affiliation(s)
- Alexandrina S Nikova
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria-Valeria Karakasi
- Department of Forensic Science and Toxicology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Pavlos Pavlidis
- Department of Forensic Science and Toxicology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodossios Birbilis
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ivaylo Dimitrov
- Department of Forensic Science and Toxicology, "Stamen Iliev" Regional Hospital, Montana, Bugaria
| |
Collapse
|
19
|
Abdelhameid AK, Saro A. Non-missile penetrating brain injuries: cases registry in Sohag University Hospital. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
20
|
Mikhael M, Frost E, Cristancho M. Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review. J Neurosurg Anesthesiol 2018; 30:290-298. [DOI: 10.1097/ana.0000000000000441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
21
|
Deng H, Yue JK, Winkler EA, Dhall SS, Manley GT, Tarapore PE. Adult Firearm-Related Traumatic Brain Injury in United States Trauma Centers. J Neurotrauma 2018; 36:322-337. [PMID: 29855212 DOI: 10.1089/neu.2017.5591] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Civilian firearm injury is an important public health concern in the United States. Gunshot wounds to the head (GSWH) remain in need of update and systematic characterization. We identify predictors of prolonged hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), medical complications, mortality, and discharge disposition from a population-based sample using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), years 2003-2012. Statistical significance was assessed at α < 0.001 to correct for multiple comparisons. In total, 8148 adult GSWH patients were included extrapolating to 32,439 national incidents. Age was 36.6 ± 16.4 years and 64.4% were severe traumatic brain injury (TBI; Glasgow Coma Scale [GCS] score 3-8). Assault (49.2%), handgun (50.3%), and residential injury (43.2%) were of highest incidence. HLOS and ICU LOS were 7.7 ± 14.2 and 5.7 ± 13.4 days, respectively. Overall mortality was 54.6%; suicide/self-injury was associated with the highest mortality rate (71.6%). GCS, Injury Severity Score, and hypotension were significant predictors for outcomes overall. Medicare/Medicaid patients had longer HLOS compared to private/commercial insured (mean increase, 4.4 days; 95% confidence interval [2.6-6.3]). Compared to the Midwest, the South had longer HLOS (mean increase, 3.7 days; [2.0-5.4]) and higher odds of complications (odds ratio [OR], 1.7 [1.4-2.0]); the West had lower odds of complications (OR, 0.6; [0.5-0.7]). Versus handgun, shotgun (OR, 0.3; [0.2-0.4]) and hunting rifle (OR, 0.5; [0.4-0.8]) resulted in lower mortality. Patients with government/other insurance had higher odds of discharging home compared to private/commercially insured (OR, 1.7; [1.3-2.3]). In comparison to level I trauma centers, level II trauma centers had lower odds of discharge to home (OR, 0.7; [0.5-0.8]). Our results support hypotension, injury severity, injury intent, firearm type, and U.S. geographical location as important prognostic variables in firearm-related TBI. Improved understanding of civilian GSWH is critical to promoting increased awareness of firearm injuries as a public health concern and reducing its debilitating injury burden to patients, families, and healthcare systems.
Collapse
Affiliation(s)
- Hansen Deng
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John K Yue
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Ethan A Winkler
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S Dhall
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Geoffrey T Manley
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Phiroz E Tarapore
- 1 Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,2 Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| |
Collapse
|
22
|
Bolatkale M, Acara AC. The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury. Am J Emerg Med 2018; 37:433-438. [PMID: 29887193 DOI: 10.1016/j.ajem.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%-93% and 87%-100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. METHODS The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB. RESULTS The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p < .001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with ≤2 (p < .001). A statistically significant negative correlation was determined between GCS and number FB (r = -0.697; p < .001). CONCLUSION When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI.
Collapse
Affiliation(s)
- Mustafa Bolatkale
- Medipol University Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Ahmet Cagdas Acara
- Bozyaka Research and Training Hospital, Department of Emergency Medicine, Izmir, Turkey
| |
Collapse
|
23
|
|
24
|
Diyora B, Kotecha N, Mulla M, Dethe S, Bhende B, Patil S. Perforating head injury with iron rod and its miraculous escape: Case report and review of literature. Trauma Case Rep 2018; 14:11-19. [PMID: 29644302 PMCID: PMC5887117 DOI: 10.1016/j.tcr.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/29/2022] Open
Abstract
Civilian perforating head injury is rare. Because rarity of this injury, there is no standard management protocol. We report a case of perforating head injury with iron rod, review the literature on the subject and discuss the challenges in the management of such case. We have not found similar case in the literature. Civilian perforating head injury is rare. A 25-year-male brought to the emergency department with approximately two feet perforating iron rod in the head, entering via frontal region, left side of midline and coming out of the occipital region. He developed right sided hemiplegia and global aphasia. He underwent series of imaging for the evaluation of the course of the iron rod and injury sustained because of it. Under strict aseptic precaution, iron rod removed in the operation theater. His clinical condition improved over a period of three weeks. At one year follow up- he had almost normal speech and language functions and was able to walk without support. This case illustrates the possibility of bizarre type of such injury in the presence of protective helmet and challenges in the management. Preoperative planning on the basis of images, prophylactic antibiotics and anticonvulsant medications, cleaning of the objects with antiseptic solutions, anterograde extraction after adequate exposure around entry and exit points resulted in good clinical outcome after successful removal of the rod.
Collapse
Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, Second floor, College building, LTMG Hospital, Sion, Mumbai 22, India
| | - Nitin Kotecha
- Department of Neurosurgery, Second floor, College building, LTMG Hospital, Sion, Mumbai 22, India
| | - Mazhar Mulla
- Department of Neurosurgery, Second floor, College building, LTMG Hospital, Sion, Mumbai 22, India
| | - Shailendra Dethe
- Department of Anaesthesia, College building, LTMG Hospital, Sion, Mumbai 22, India
| | - Bhagyashree Bhende
- Department of Neurosurgery, Second floor, College building, LTMG Hospital, Sion, Mumbai 22, India
| | - Swapnil Patil
- Department of Neurosurgery, Second floor, College building, LTMG Hospital, Sion, Mumbai 22, India
| |
Collapse
|
25
|
Definition of Traumatic Brain Injury, Neurosurgery, Trauma Orthopedics, Neuroimaging, Psychology, and Psychiatry in Mild Traumatic Brain Injury. Neuroimaging Clin N Am 2018; 28:1-13. [DOI: 10.1016/j.nic.2017.09.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
26
|
Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol 2017; 24:301-309. [DOI: 10.1007/s10140-016-1477-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/22/2016] [Indexed: 12/24/2022]
|
27
|
Zyck S, Toshkezi G, Krishnamurthy S, Carter DA, Siddiqui A, Hazama A, Jayarao M, Chin L. Treatment of Penetrating Nonmissile Traumatic Brain Injury. Case Series and Review of the Literature. World Neurosurg 2016; 91:297-307. [DOI: 10.1016/j.wneu.2016.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022]
|
28
|
Chen L, Bao Y, Liang Y, Wang Y, Jiang J. Surgical management and outcomes of non-missile open head injury: Report of 44 cases from a single trauma centre. Brain Inj 2016; 30:318-23. [PMID: 26832968 DOI: 10.3109/02699052.2015.1113565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To retrospectively analyse the surgical management and outcomes of non-missile open head injuries (NMOHI). METHODS Forty-four patients who suffered from NMOHI were included. The Glasgow outcome score (GOS), computed tomography (CT), aetiology and outcomes and complications at discharge and during a 6-month follow-up were analysed. All patients underwent debridement. Intracranial haematoma evacuation, decompressive craniectomy (DC) or replacement were performed. RESULTS Motor vehicle accident and struck by/against were the most common causes (43.2% each). At admission, 33 patients had Glasgow coma scores (GCS) > 8 and 27 of them had a GCS score of > 13. Mean follow-up was 8.7 ± 4.3 months. All patients underwent debridement, 20 underwent bone fracture replacement and 27 underwent haematoma evacuation; 11 patients underwent haematoma evacuation and DC and one had bilateral DC. Twenty-seven patients showed good recovery; 11 patients had moderate disability; three patients had severe disability; and three patients died. After 6 months, 32 patients had good recovery and the morbidity of severe disability had decreased to 13.6%. Thirteen patients developed intracranial infection. Post-traumatic epilepsy and hydrocephalus was detected in three patients. Cerebrospinal fluid fistula was found in five patients. Only one patient developed a brain abscess after 6 months. CONCLUSIONS NMOHI yielded satisfactory recovery and achieved good outcomes.
Collapse
Affiliation(s)
- Lei Chen
- a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Yinghui Bao
- a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Yumin Liang
- a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Yong Wang
- a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| | - Jiyao Jiang
- a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , P.R. China
| |
Collapse
|
29
|
Alvis-Miranda HR, Adie Villafañe R, Rojas A, Alcala-Cerra G, Moscote-Salazar LR. Management of Craniocerebral Gunshot Injuries: A Review. Korean J Neurotrauma 2015; 11:35-43. [PMID: 27169063 PMCID: PMC4847495 DOI: 10.13004/kjnt.2015.11.2.35] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 11/15/2022] Open
Abstract
Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.
Collapse
Affiliation(s)
| | | | - Alejandro Rojas
- Department of Neurosurgery, FUSC, Hospital San Jose, Bogota, Colombia
| | | | | |
Collapse
|
30
|
Plantman S. Novel rodent models of penetrating traumatic brain injury. Neural Regen Res 2015; 10:1047-9. [PMID: 26330819 PMCID: PMC4541227 DOI: 10.4103/1673-5374.160074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/12/2022] Open
|
31
|
Ramdurg SR, Hasa C, Maitra J. An Unusual Case of Trans-orbital Penetrating Brain Injury due to Fall on Branch of a Tree. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
32
|
Cernak I, Wing ID, Davidsson J, Plantman S. A novel mouse model of penetrating brain injury. Front Neurol 2014; 5:209. [PMID: 25374559 PMCID: PMC4205813 DOI: 10.3389/fneur.2014.00209] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
Penetrating traumatic brain injury (pTBI) has been difficult to model in small laboratory animals, such as rats or mice. Previously, we have established a non-fatal, rat model for pTBI using a modified air-rifle that accelerates a pellet, which hits a small probe that then penetrates the experimental animal’s brain. Knockout and transgenic strains of mice offer attractive tools to study biological reactions induced by TBI. Hence, in the present study, we adapted and modified our model to be used with mice. The technical characterization of the impact device included depth and speed of impact, as well as dimensions of the temporary cavity formed in a brain surrogate material after impact. Biologically, we have focused on three distinct levels of severity (mild, moderate, and severe), and characterized the acute phase response to injury in terms of tissue destruction, neural degeneration, and gliosis. Functional outcome was assessed by measuring bodyweight and motor performance on rotarod. The results showed that this model is capable of reproducing major morphological and neurological changes of pTBI; as such, we recommend its utilization in research studies aiming to unravel the biological events underlying injury and regeneration after pTBI.
Collapse
Affiliation(s)
- Ibolja Cernak
- Military and Veterans' Clinical Rehabilitation Research, University of Alberta , Edmonton, AB , Canada
| | - Ian D Wing
- Johns Hopkins University Applied Physics Laboratory , Laurel, MD , USA
| | - Johan Davidsson
- Division of Vehicle Safety, Chalmers University of Technology , Göteborg , Sweden
| | - Stefan Plantman
- Department of Neuroscience, Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
33
|
Lê K, Coelho C, Mozeiko J, Krueger F, Grafman J. Does brain volume loss predict cognitive and narrative discourse performance following traumatic brain injury? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:S271-S284. [PMID: 24686463 DOI: 10.1044/2014_ajslp-13-0095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE In this study, the authors investigated the relationship between brain volume loss and performance on cognitive measures, including working memory, immediate memory, executive functions, and intelligence, and a narrative discourse production task. An underlying goal was to examine the prognostic potential of a brain lesion metric for discourse outcomes. It was hypothesized that brain volume loss would correlate with and predict cognitive and narrative discourse measures and have prognostic value for discourse outcomes. METHOD One hundred sixty-seven individuals with penetrating head injury participated. Correlational and regression analyses were performed for the percentages of total brain and hemispheric volume loss and scores on 4 cognitive measures (WMS-III Working Memory and Immediate Memory primary indexes, D-KEFS Sorting Test, and WAIS-III Full Scale IQ) and 7 narrative discourse measures (T-units, grammatical complexity, cohesion, local and global coherence, story completeness, and story grammar). RESULTS The volumetric measures had significant small-to-moderate correlations with all cognitive measures but only one significant correlation with the discourse measures. Findings from regression analyses were analogous but revealed several models that approached significance. CONCLUSION Findings suggest that an overall measure of brain damage may be more predictive of general cognitive status than of narrative discourse ability. Atrophy measures in specific brain regions may be more informative.
Collapse
|
34
|
Papadopoulos IN, Kanakaris NK, Danias N, Sabanis D, Konstantudakis G, Christodoulou S, Bassiakos YC, Leukidis C. A structured autopsy-based audit of 370 firearm fatalities: Contribution to inform policy decisions and the probability of the injured arriving alive at a hospital and receiving definitive care. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:667-677. [PMID: 22809705 DOI: 10.1016/j.aap.2012.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 06/16/2012] [Accepted: 06/18/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED The objectives of this autopsy-based audit of firearm-related fatalities were to acquire data to inform policy decisions and to assess the probability of the injured arriving alive at a hospital and receiving definitive care. EVALUATED VARIABLES Demographics; co-morbidities; location and intention of the injury; toxicology; types of firearms; Abbreviated Injury Scale; Injury Severity Score (ISS); transfer means and time; and location of death. RESULTS Of a total of 370 fatalities, 85.7% were male. The median age was 38 (9-95) years. Suicides (47%) and assaults (45.1%) were the most common underlying intentions. The most seriously injured regions were the head (44.5%), thorax (25.7%), abdomen (10.7%), and spine (5.7%). Of the 370 total subjects, 4.9% had an ISS<16 and 59.5% had an ISS≤74; both groups were classified as potentially preventable deaths. The majority (84%) died at the scene, and only 9.8% left the emergency department alive for further treatment. Multivariate analyses documented that postmortem ISS is an independent factor that predicts the probability of the injured reaching a hospital alive and receiving definitive care. Individuals injured in greater Athens and those most seriously injured in the face, abdomen or spine had significantly greater chances of reaching a hospital alive and receiving definitive care, whereas those injured by a shotgun and the positive toxicology group were significantly less likely to. In conclusion, this study provides data to inform policy decisions, calls for a surveillance network and establishes a baseline for estimating the probability regarding the location of firearm-related deaths.
Collapse
Affiliation(s)
- Iordanis N Papadopoulos
- National & Kapodistrian University of Athens, University General Hospital Attikon, Fourth Surgery Department, 1 Rimini Street, 124 62 Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Changes in apoptotic mechanisms following penetrating ballistic-like brain injury. J Mol Neurosci 2012; 49:301-11. [PMID: 22684621 DOI: 10.1007/s12031-012-9828-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
We investigated apoptotic pathways in a model of severe traumatic brain injury, penetrating ballistic-like brain injury (PBBI). TUNEL staining identified increasing apoptosis within 24 h. From targeted arrays, 11 genes were identified for temporal mRNA evaluation. In addition, mRNA levels and enzyme activity for caspases 3, 8, and 9 were examined. In the death receptor-mediated apoptosis pathway, the relative quantities (RQs) of mRNA for tnfr1, fas, and tnf were upregulated while trail mRNA was downregulated. In the anti-apoptotic TNF-R2 pathway, tnfr2 and flip were upregulated while xiap was downregulated. These findings indicate that increases in tnf levels following injury are not only pro-apoptotic but may also signal competing anti-apoptotic mechanisms. For the mitochondria-mediated apoptosis pathway, RQs of anti-apoptotic factors bcl2a1d and birc3 were upregulated while both bcl2 and bax were downregulated. RQs for casp 3 and casp 8 increased while casp9 decreased. Enzymatic activity increased for caspases 3, 8, and 9. While multiple mechanisms promoting and inhibiting apoptosis are at play during the first week after a PBBI, the cumulative result remains increased apoptosis. The ability to understand and dissect these events will assist in the development and evaluation of treatments targeting apoptosis following severe brain injury.
Collapse
|