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Takao K, Matsuta H, Murata K, Fujiki M. Reversible cerebral vasospasm and cerebral infarction secondary to meningitis following penetrating head trauma with bamboo. BMJ Case Rep 2023; 16:e254676. [PMID: 37553171 PMCID: PMC10414058 DOI: 10.1136/bcr-2023-254676] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
A man in the 70s fell on a bamboo and punctured his left upper eyelid. CT of the head showed fractures of the medial and superior walls of the left orbit, intracranial traumatic subarachnoid haemorrhage, intraventricular haematoma and left frontal cerebral contusion. He was treated conservatively. Despite prophylactic antibiotic therapy, he had prolonged loss of consciousness. A cerebrospinal fluid examination revealed bacterial meningitis. Imaging studies on day 15 showed extensive subacute cerebral infarction in the bilateral parieto-occipital lobes and main trunk artery stenosis. On day 31, MRA showed improvement of the main arteries, and cerebral vasospasm-induced cerebral infarction was diagnosed. He was transferred to rehabilitation with full assistance. The prognosis of bamboo perforation trauma is critical. Thus, preventing and treating central nervous system infection are considered the key to the prognosis. However, given the lack of established treatment for meningitis-associated cerebral vasospasm, case-specific treatment must be considered.
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Affiliation(s)
- Kunpei Takao
- Department of Neurosurgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroyuki Matsuta
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Kumi Murata
- Department of Forensic Medicine, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
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Affiliation(s)
- Karthik Vadamalai
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Mohammad I Hirzallah
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sherry Hsiang-Yi Chou
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
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Maksoud S, Lawson McLean A, Bauer J, Schwarz F, Waschke A. Penetrating traumatic brain injury resulting from a cockerel attack: case report and literature review. Childs Nerv Syst 2020; 36:1067-1070. [PMID: 31784819 DOI: 10.1007/s00381-019-04441-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/08/2019] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury is common in children and can lead to death or considerable, long-lasting morbidity. We present the case of a 10-month-old female child who presented after being attacked by a cockerel in a chicken coop. Following a seizure, an MRI scan revealed an intracerebral haemorrhage underlying a stab-type wound inflicted by the bird. Animal bite injuries are common worldwide but they rarely cause intracranial injuries. Domestic hens are rarely dangerous but can become defensive or aggressive during breeding periods or when protecting their territory. To date, only a handful of articles have reported on wounds inflicted by chicken beaks. Those reported were largely facial or ocular injuries. Infectious complications have also been encountered post-injury. This is to our knowledge the first report of a bird attack resulting in significant penetrating traumatic brain injury. Children should be cautioned by guardians to avoid unsupervised contact with chickens, particularly during breeding. Attacks to the neurocranium when they occur must be taken seriously and not treated as humorous or insignificant. Imaging appropriate to the child's clinical condition should be pursued and appropriate intervention and antibiotic treatment should be implemented.
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Affiliation(s)
- Salah Maksoud
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Johannes Bauer
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Albrecht Waschke
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
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Hu Z, Gajavelli S, Spurlock MS, Mahavadi A, Quesada LS, Gajavelli GR, Andreoni CB, Di L, Janecki J, Lee SW, Rivera KN, Shear DA, Bullock RM. Human neural stem cell transplant location-dependent neuroprotection and motor deficit amelioration in rats with penetrating traumatic brain injury. J Trauma Acute Care Surg 2020; 88:477-485. [PMID: 31626023 PMCID: PMC7098436 DOI: 10.1097/ta.0000000000002510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/04/2019] [Revised: 08/30/2019] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penetrating traumatic brain injury induces chronic inflammation that drives persistent tissue loss long after injury. Absence of endogenous reparative neurogenesis and effective neuroprotective therapies render injury-induced disability an unmet need. Cell replacement via neural stem cell transplantation could potentially rebuild the tissue and alleviate penetrating traumatic brain injury disability. The optimal transplant location remains to be determined. METHODS To test if subacute human neural stem cell (hNSC) transplant location influences engraftment, lesion expansion, and motor deficits, rats (n = 10/group) were randomized to the following four groups (uninjured and three injured): group 1 (Gr1), uninjured with cell transplants (sham+hNSCs), 1-week postunilateral penetrating traumatic brain injury, after establishing motor deficit; group 2 (Gr2), treated with vehicle (media, no cells); group 3 (Gr3), hNSCs transplanted into lesion core (intra); and group 4 (Gr4), hNSCs transplanted into tissue surrounding the lesion (peri). All animals were immunosuppressed for 12 weeks and euthanized following motor assessment. RESULTS In Gr2, penetrating traumatic brain injury effect manifests as porencephalic cyst, 22.53 ± 2.87 (% of intact hemisphere), with p value of <0.0001 compared with uninjured Gr1. Group 3 lesion volume at 17.44 ± 2.11 did not differ significantly from Gr2 (p = 0.36), while Gr4 value, 9.17 ± 1.53, differed significantly (p = 0.0001). Engraftment and neuronal differentiation were significantly lower in the uninjured Gr1 (p < 0.05), compared with injured groups. However, there were no differences between Gr3 and Gr4. Significant increase in cortical tissue sparing (p = 0.03), including motor cortex (p = 0.005) was observed in Gr4 but not Gr3. Presence of transplant within lesion or in penumbra attenuated motor deficit development (p < 0.05) compared with Gr2. CONCLUSION In aggregate, injury milieu supports transplanted cell proliferation and differentiation independent of location. Unexpectedly, cortical sparing is transplant location dependent. Thus, apart from cell replacement and transplant mediated deficit amelioration, transplant location-dependent neuroprotection may be key to delaying onset or preventing development of injury-induced disability. LEVEL OF EVIDENCE Preclinical study evaluation of therapeutic intervention, level VI.
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Affiliation(s)
- Zhen Hu
- From the Department of Neurosurgery (Z.H.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Miami Project to Cure Paralysis (Z.H., S.G., M.S.S., A.M., L.S.Q., G.R.G., C.B.A., L.D., J.J., S.W.L., K.N.R., R.M.D.), University of Miami, Miami, Florida; and Branch of Brain Trauma Neuroprotection and Neurorestoration (D.A.S.), Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Nakayama DK. Vesalius: Surgeon to Monarchs. Am Surg 2020; 86:173-175. [PMID: 32223793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Bailey DJ, Bunker L, Mauszycki S, Wambaugh JL. Reliability and stability of the metrical stress effect on segmental production accuracy in persons with apraxia of speech. Int J Lang Commun Disord 2019; 54:902-913. [PMID: 31338954 DOI: 10.1111/1460-6984.12493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acquired apraxia of speech (AOS) involves speech-production deficits on both the segmental and suprasegmental levels. Recent research has identified a non-linear interaction between the metrical structure of bisyllabic words and word-production accuracy in German speakers with AOS, with trochaic words (strong-weak stress) being resistant to errors compared with iambic words (weak-strong). AIMS To replicate previous findings in English speakers with AOS, to measure the test-retest reliability of the effect, and to examine the potential impact of different methods of word scoring. METHODS & PROCEDURES Speech samples were collected from 27 speakers with AOS and aphasia. Participants were at least 12 months post-stroke or penetrating brain injury, and represented a large range of AOS and aphasia severities. Productions were elicited via verbal model. Sampling was conducted on three separate occasions: the initial data-collection session and then repeated samplings at 1- and 4-week intervals. Bisyllabic words with a CVCVC segmental structure were selected. The list was divided into sublists representing differing lexical stress patterns: A list of 42 trochees, and one of 37 iambs. All speech samples were phonetically transcribed and then aligned with canonical transcriptions via an edit distance algorithm that followed transcription alignment principles. Phonetic-level errors (distortions) were penalized less severely than phonemic-level errors. Per cent consonants correct and whole-word accuracy were also examined. Trochee and iamb lists were analysed separately. OUTCOMES & RESULTS Paired samples t-tests indicated that the modified edit distance was significantly lower for the trochee lists than for the iamb lists. There was a lack of a significant effect of time on the absolute difference between modified edit distance for both lists. Intraclass coefficients suggested the list and procedures used are appropriate as an outcome measure for group research. CONCLUSIONS & IMPLICATIONS The results suggest that in English, as in German, the trochaic structure is more resistant to segmental errors in persons with AOS and aphasia, providing replication of the findings of Aichert et al. in 2016. Further, this effect is stable over repeated sampling occasions. Implications for clinical management of AOS include possible ways to scaffold item difficulty and potentially improve stimulus generalization.
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Affiliation(s)
- Dallin J Bailey
- Department of Communication Disorders, Auburn University, Auburn, AL, USA
| | - Lisa Bunker
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Shannon Mauszycki
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Julie L Wambaugh
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
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Lu XCM, Browning J, Liao Z, Cao Y, Yang W, Shear DA. Post-Traumatic Epilepsy and Seizure Susceptibility in Rat Models of Penetrating and Closed-Head Brain Injury. J Neurotrauma 2019; 37:236-247. [PMID: 31530242 DOI: 10.1089/neu.2019.6573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) carries a risk of developing post-traumatic epilepsy (PTE). Currently, animal models that replicate clinical PTE (delayed spontaneous and recurrent seizures) are limited, which hinders pre-clinical research. In this study, we used two rat models of penetrating ballistic-like brain injury (PBBI) and closed-head injury (CHI) to induce spontaneous seizures and also measure changes in seizure susceptibility. In the PBBI model, two trajectories (frontal and lateral) and two injury severities for each trajectory, were evaluated. In the CHI model, a single projectile impact to the dorsal/lateral region of the head was tested. Continuous video-electroencephalographic (EEG) recordings were collected for 10 days at 1 or 6 month(s) post-injury. After EEG recording, all rats were given a sub-convulsant dose of pentylenetetrazole (PTZ) to challenge the seizure susceptibility. The video-EEG recording did not detect PTE following the PBBI. Only one CHI rat demonstrated persistent and recurrent non-convulsive seizures detected at 6 months post-injury. However, after PTZ challenge, 50-100% of the animals across different TBI groups experienced seizures. Seizure susceptibility increased over time from 1 to 6 months post-injury across the majority of TBI groups. Injury severity effects were not apparent within the PBBI model, but were evident between PBBI and CHI models. These results demonstrated the difficulties in detecting delayed spontaneous post-traumatic seizures even in a high-risk model of penetrating brain injury. The PTZ-induced increase in seizure susceptibility indicated the existence of vulnerable risk of epileptogenesis following TBI, which may be considered as an alternative research tool for pre-clinical studies of PTE.
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Affiliation(s)
- Xi-Chun M Lu
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jenny Browning
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Zhilin Liao
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Ying Cao
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Weihong Yang
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Deborah A Shear
- Branch of Brain Trauma Neuroprotection, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Harmon LA, Haase DJ, Kufera JA, Adnan S, Cabral D, Lottenberg L, Cunningham KW, Bonne S, Burgess J, Etheridge J, Rehbein JL, Semon G, Noorbakhsh MR, Cragun BN, Agrawal V, Truitt M, Marcotte J, Goldenberg A, Behbahaninia M, Keric N, Hammer PM, Nahmias J, Grigorian A, Turay D, Chakravarthy V, Lalchandani P, Kim D, Chapin T, Dunn J, Portillo V, Schroeppel T, Stein DM. Infection after penetrating brain injury-An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. J Trauma Acute Care Surg 2019; 87:61-67. [PMID: 31033883 DOI: 10.1097/ta.0000000000002327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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 Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Laura A Harmon
- From the Department of Surgery, University of Colorado Anschutz Medical Center (L.A.H.), Aurora, Colorado; Department of Surgery, Trauma, R Adams Cowley Shock Trauma Center (D.J.H., J.A.K., D.M.S.), University of Maryland (S.A.), School of Medicine, Baltimore MD; St Mary's Medical Center, Florida Atlantic University, Charles E. Schmidt School of Medicine (D.C., L.L.), Boca Raton, Florida; Department of Surgery, Carolinas Medical Center (K.W.C.), Charlotte, North Carolina; Department of Surgery, Division of Trauma, Rutgers, The State University of New Jersey (S.B.), Newark New Jersey; Department of Surgery, Division of Trauma, Eastern Virginia Medical School (J.B., J.E., J.L.R.), Norforlk, Virginia; Department of Surgery, Wright State Boonshoft School of Medicine, (G.S.), Beavercreek, Ohio; Department of Surgery, Division of Trauma, Allegheny General Hospital (M.R.N., B.N.C.), Pittsburgh, Pennsylvania; Department of Surgery, Division of Trauma, Methodist Hospital (V.A., M.T.), Dallas, Texas; Department of Surgery, Division of Trauma, Cooper Health (J.M., A.G.), Camden, New Jersey; Banner Health System (M.B., N.K.), Phoenix, Arizona; Department of Surgery, Division of Trauma, Indiana University School of Medicine (P.M.H.), Indianapolis, Indiana; Department of Surgery, Division of Trauma, University of California Irvine (J.N., A.G.), Orange County; Department of Surgery, Division of Trauma, Loma Linda Medical Center (D.T., V.C.), Loma Linda; Department of Surgery, Division of Trauma, LA County Harbor-UCLA Medical Center (P.L., D.K.), Los Angeles, California; Department of Surgery, Division of Trauma, UC Health Northern Colorado (T.C., J.D.), Loveland, Colorado; Medical City Plano Hospital (V.P.), Plano, Texas; and Department of Surgery, Division of Trauma, University of Colorado Health (T.S.), Colorado Springs, Colorado
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Hobson H, Hogeveen J, Brewer R, Catmur C, Gordon B, Krueger F, Chau A, Bird G, Grafman J. Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia. Neuropsychologia 2018; 111:229-240. [PMID: 29360519 PMCID: PMC8478116 DOI: 10.1016/j.neuropsychologia.2017.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 11/08/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work and Counselling, University of Greenwich, Avery Hill Road, Eltham, London SE9 2UG, UK
| | - Jeremy Hogeveen
- University of California Davis, M.I.N.D. Institute, 2825 50th St, Sacramento, CA 95817, USA
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham TW20 0EX, UK
| | - Caroline Catmur
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cognitive Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, VA, USA
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Aileen Chau
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK
- Department of Experimental Psychology, University of Oxford, 5 Parks Rd, Oxford OX1 3PH, UK
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Hoshide R, Steinberg J, Wali A, Ko A, Pannell JS, Chen CC. Management of Through-and-Through Penetrating Skull Injury: A Railroad Spike That Transgressed the Anterior Skull Base. World Neurosurg 2017; 110:65-70. [PMID: 29038084 DOI: 10.1016/j.wneu.2017.09.152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Penetrating injuries involving foreign objects that transgress the entirety of the human skull present challenges in the management of vascular injuries, infectious risk, cerebrospinal fluid leak, and cosmetic repair. Ultimately, effective management of these injuries requires a multidisciplinary team and judicious surgical planning. CASE DESCRIPTION Here we present the treatment of a patient who experienced a penetrating injury from a railroad spike, with entry and exit points involving the left and right anterior aspects of the temporal fossa, respectively. CONCLUSIONS The rationale for management decisions is reviewed in the context of the published literature.
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Affiliation(s)
- Reid Hoshide
- Department of Surgery, Division of Neurosurgery, University of California - San Diego, San Diego, California, USA
| | - Jeffrey Steinberg
- Department of Surgery, Division of Neurosurgery, University of California - San Diego, San Diego, California, USA
| | - Arvin Wali
- Department of Surgery, Division of Neurosurgery, University of California - San Diego, San Diego, California, USA
| | - Audrey Ko
- Department of Ophthalmology, University of California - San Diego, San Diego, California, USA
| | - J Scott Pannell
- Department of Surgery, Division of Neurosurgery, University of California - San Diego, San Diego, California, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Caudle KL, Lu XCM, Mountney A, Shear DA, Tortella FC. Neuroprotection and anti-seizure effects of levetiracetam in a rat model of penetrating ballistic-like brain injury. Restor Neurol Neurosci 2016; 34:257-70. [PMID: 26890099 DOI: 10.3233/rnn-150580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE We assessed the therapeutic efficacy of FDA-approved anti-epileptic drug Levetiracetam (LEV) to reduce post-traumatic nonconvulsive seizure (NCS) activity and promote neurobehavioral recovery following 10% frontal penetrating ballistic-like brain injury (PBBI) in male Sprague-Dawley rats. METHODS Experiment 1 anti-seizure study: 50 mg/kg LEV (25 mg/kg maintenance doses) was given twice daily for 3 days (LEV3D) following PBBI; outcome measures included seizures incidence, frequency, duration, and onset. Experiment 2 neuroprotection studies: 50 mg/kg LEV was given twice daily for either 3 (LEV3D) or 10 days (LEV10D) post-injury; outcome measures include motor (rotarod) and cognitive (water maze) functions. RESULTS LEV3D treatment attenuated seizure activity with significant reductions in NCS incidence (54%), frequency, duration, and delayed latency to seizure onset compared to vehicle treatment. LEV3D treatment failed to improve cognitive or motor performance; however extending the dosing regimen through 10 days post-injury afforded significant neuroprotective benefit. Animals treated with the extended LEV10D dosing regimen showed a twofold improvement in rotarod task latency to fall as well as significantly improved spatial learning performance (24%) in the MWM task. CONCLUSIONS These findings support the dual anti- seizure and neuroprotective role of LEV, but more importantly identify the importance of an extended dosing protocol which was specific to the therapeutic targets studied.
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Abstract
OBJECTIVES To share results and recommendations for management of penetrating cochlear injury. METHODS A patient underwent repair of a penetrating cochlear injury after a projectile led to a traumatic cochleostomy with a narrow miss of the facial nerve and intracranial carotid artery. RESULTS Postoperatively, the patient's audiogram demonstrated a pure tone average of 47.5 dB for air conduction and 35 dB for bone conduction, worse in the high frequencies, with a Word Recognition Score of 76%. CONCLUSIONS Hearing loss from a penetrating cochlear injury can be mitigated with early repair, minimizing inner ear trauma, and steroid use to treat posttraumatic labyrinthitis.
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Affiliation(s)
- George S Tarasidis
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Richard H Wiggins
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
- 2 Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Richard K Gurgel
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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Mielniczek P, Zieliński G, Koziarski A. [Treatment methods of atypical gunshot wounds to the head--case reports]. Pol Merkur Lekarski 2016; 40:318-324. [PMID: 27234864] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Due to a high mortality rate, headshot injuries pose serious diagnostic and clinical problems. In this work, we wanted to describe four atypical headshot injuries. The first patient with a headshot injury using a nail gun mishap; the second one after a headshot injury, as a result of attempted murder (the bullet came to a parasagittal halt in the left parietal area); the third victim, after a suicide attempt (the bullet was removed from clivus area, below the pituitary gland); in the case of the fourth patient, after shooting himself with a self-constructed weapon in the chin, the metal body was surgically removed - a bearing pellet from the corpus callosum. Males dominate among victims of headshot injuries. Alcohol is one of the elements that facilitate suicidal behaviour. Anti-spasm, antibacterial, anti-tetanus prophylaxes are incredibly important. In some cases, the metallic body does not have to be removed from the brain. Pulmonary embolism can be a cause of death after 7 days from injury.
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Affiliation(s)
- Paweł Mielniczek
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
| | - Andrzej Koziarski
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
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14
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Migliaro M, Segura M, Gurrieri Y, Azor M. [Post traumatic pneumoencephalus]. Medicina (B Aires) 2016; 76:192. [PMID: 27295712] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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15
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Xu M, Wen J, Zhu X, Chen P, Wang C. A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder. Acta Neurol Belg 2015; 115:767-9. [PMID: 25739361 DOI: 10.1007/s13760-015-0439-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Min Xu
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Jinkun Wen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Xun Zhu
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Pin Chen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Cunzu Wang
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
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16
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Bandak FA, Ling G, Bandak A, De Lanerolle NC. Injury biomechanics, neuropathology, and simplified physics of explosive blast and impact mild traumatic brain injury. Handb Clin Neurol 2015; 127:89-104. [PMID: 25702211 DOI: 10.1016/b978-0-444-52892-6.00006-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Explosive blast shock waves and blunt impact to the head are two types of loading shown to result in mild traumatic brain injury (mTBI). While mTBI from these two causes shares some common features behaviorally, there are distinct differences in the pathophysiology of the underlying injury mechanisms. Various elucidations have been offered in the literature to explain the organic damage associated with mTBI resulting from both types of loading. The current state of understanding in this field is somewhat limited by the degree of appreciation of the physics and biomechanics governing the effects of explosive blast shock waves and blunt impact on the head, which has resulted in the various approaches to the investigation of the operative brain injury "wounding mechanisms". In this chapter we provide a simplified description of terminology associated with forces on the head from explosive blast shock waves and blunt impact, to assist readers in the field in evaluating interpretations of brain injury "wounding" processes. Remarkably, mTBI from either loading is shown generally to result in only a small loss of neurons, with hippocampal neurons appearing to be particularly vulnerable to explosive blast shock waves. Explosive blast studies in large animal models show a unique pattern of periventricular injury, which is different from the classic diffuse axonal injury. Both astrocyte and microglial activation are also seen in explosive blast as well as impact trauma, but this may be a general secondary brain injury response, nonspecific to explosive blast or blunt trauma. Additionally, while moderate to severe impact closed head injuries sometimes result in petechial hemorrhages or hematomas, they do not appear to be associated with explosive blast mTBI even with repeated exposure to blasts.
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Affiliation(s)
- F A Bandak
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Integrated Services Group Inc., Potomac, MD, USA.
| | - G Ling
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - A Bandak
- Integrated Services Group Inc., Potomac, MD, USA
| | - N C De Lanerolle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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17
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Vitanovics D, Major O, Lovas L, Banczerowski P. [Tailored cranioplasty using CAD-CAM technology]. Ideggyogy Sz 2014; 67:390-396. [PMID: 25720241] [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: 06/04/2023]
Abstract
OBJECTIVE The majority of cranial defects are results of surgical intervention. The defect must be covered within resonable period of time usually after 4-6 week given the fact that the replacement of bone improve the brain circulation. Number of surgical techniques and materials are available to perform cranioplasty. Due to favorable properties we chosed ultra high molecular weight polyethylene as material. In this paper the authors show a procedure which allows tailored artificial bone replacement using state of art medical and engineering techniques. METHODS between 2004 and 2012, 19 patients were operated on cranial bone defect and a total of 22 3D custom-designed implants were implanted. The average age of patients was 35.4 years. In 12 patients we performed primary cranioplasty, while seven patients had the replacement at least once. Later the implants had to be removed due to infection or other causes (bone necrosis, fracture). All patients had native and bone-windowed 1 mm resolution CT. The 3D design was made using the original CT images and with design program. Computer controlled lathe was used to prepare a precise-fitting model. During surgery, the defect was exposed and the implant was fixed to normal bone using mini titanium plates and screws. All of our patients had control CT at 3, 6 and 12 months after surgery and at the same time neurological examination. RESULTS Twenty-one polyethylene and one titanium implants were inserted. The average follow-up of the patients was 21.5 months, ranged from two to 96 months. We follow 12 patients (63.15%) more than one year. No intraoperative implant modifications had to be made. Each of the 22 implant exactly matched the bone defect proved by CT scan. No one of our patients reported aesthetic problems and we did not notice any kind of aesthetic complication. We had short term complication in three cases due to cranioplasty, subdural, epidural haemorrhage and skin defect. CONCLUSION Polyethylene is in all respects suitable for primary and secondary cranioplasty. Combined with 3D CAD- CAM method excellent aesthetic and functional result was achieved. In our study no case of infection occured. Proper preoperative preparation is important.
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18
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Brown SJ, George S, Braithwaite K. A puzzling case of cryptococcal meningitis. S Afr Med J 2014; 104:720. [PMID: 25909102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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19
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Solov'ev AE, Kornienko GV, Kartyshova MA. [Observation of tetanus in a teenager]. Klin Khir 2014:71-72. [PMID: 25252421] [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: 06/03/2023]
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20
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Rheinboldt M, Francis K, Parrish D, Harper D, Blase J. Terson syndrome in conjunction with ruptured intracranial aneurysm and penetrating intracranial injury: a review of two cases. Emerg Radiol 2013; 21:215-8. [PMID: 24174125 DOI: 10.1007/s10140-013-1172-2] [Citation(s) in RCA: 3] [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] [Received: 09/16/2013] [Accepted: 10/17/2013] [Indexed: 11/30/2022]
Abstract
Terson syndrome, the presence of intraocular hemorrhage in the setting of acutely elevated intracranial pressure, was historically described in conjunction with acute subarachnoid hemorrhage; however, more recently, it has been associated with a gamut of intracranial pathophysiology ranging from blunt or penetrating injury to neurosurgical procedures. We describe two cases of profound intracranial injury, secondary to ballistic injury, and a ruptured intracranial aneurysm, in which posterior chamber ocular hemorrhage was noted on CT imaging. Though the outcome in such cases, as with ours, is often poor, the findings are germane to clinical care as the presence of Terson syndrome has been noted to be a negative prognostic factor in multiple clinical reviews. Additionally, clinical recovery can be impacted adversely by lasting visual deficits or retinal degradation in the absence of timely ophthalmologic intervention.
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Affiliation(s)
- Matt Rheinboldt
- Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA,
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21
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Coelho C, Lê K, Mozeiko J, Hamilton M, Tyler E, Krueger F, Grafman J. Characterizing discourse deficits following penetrating head injury: a preliminary model. Am J Speech Lang Pathol 2013; 22:S438-48. [PMID: 23695915 PMCID: PMC7684633 DOI: 10.1044/1058-0360(2013/12-0076)] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Discourse analyses have demonstrated utility for delineating subtle communication deficits following closed head injuries (CHIs). The present investigation examined the discourse performance of a large group of individuals with penetrating head injury (PHI). Performance was also compared across 6 subgroups of PHI based on lesion locale. A preliminary model of discourse production following PHI was proposed and tested. METHOD Story narratives were elicited from 2 groups of participants, 167 with PHI and 46 non brain-injured (NBI). Micro- and macrostructural components of each story were analyzed. Measures of memory, executive functions, and intelligence were also administered. All measures were compared across groups and PHI subgroups. The proposed model of discourse production was tested with a structural equation modeling procedure. RESULTS No differences for the discourse measures were noted across the six PHI subgroups. Three measures distinguished the PHI and NBI groups: narrative length, story grammar, and completeness. The proposed model of discourse production had an adequate-to-good fit with the cognitive and discourse data. CONCLUSION In spite of differing mechanisms of injury, the PHI group's discourse performance was consistent with what has been reported for individuals with CHI. The model tested represents a preliminary step toward understanding discourse production following traumatic brain injury.
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22
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Lough EG, Glover B, Brown AL. An unusual case of air rifle pellet migration from the brain to the thoracic spine. Am Surg 2013; 79:E33-E34. [PMID: 23317600] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Erik G Lough
- Charleston Area Medical Center, Charleston, West Virginia 25301, USA.
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23
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Seleye-Fubara D, Etebu EN. Pathology of cause of death from penetrating weapons in the Niger Delta region of Nigeria: an autopsy study of 254 cases. Niger Postgrad Med J 2012; 19:107-110. [PMID: 22728977] [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: 06/01/2023]
Abstract
AIMS AND OBJECTIVES To study the pattern of death caused by penetrating weapons. This is a prospective autopsy study of 254 cases over 8 years (1995 - 2002) SUBJECTS AND METHODS A retrospective analysis of all the medico-legal autopsies performed by the authors on bodies in which the circumstances of death suggested the use of penetrating weapons over a period of 8 years was carried out by the authors. RESULTS A total of 254 bodies that died during close combat, communal clashes, militant attacks and armed banditry of penetrating weapons were recorded. The youngest was 2 years old male while the oldest was 75 years old male. The highest death toll occurred between the ages of 20-49 years 197(77.6% cases) with a peak at the age group 20 - 29 years 75(29.5%) cases. There were 218(85.8%) males and 36 (14.2%) females giving a male to female ratio of 6:1. The most common cause of penetrating death was gunshot missiles 136(53.5%), while the most common anatomic site of the wound was the chest wall 85(33.5%). Instant death occurred in 179(70.5%) cases and haemorrhagic shock caused the death of 229(90.2%) cases, while the brain was the most common organ lacerated 61(24.0%). CONCLUSION Penetrating wounds were commonly sustained in close combats, during communal clashes, militant and armed robbery attacks, and youth restiveness in the Niger Delta region of Nigeria. Guns which are prohibited by law and other sharp and pointed instruments were freely used. The condition is preventable by enforcing stringent laws, but it resulted into a lot of mortalities.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Autopsy
- Cause of Death
- Child
- Child, Preschool
- Female
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/mortality
- Head Injuries, Penetrating/pathology
- Homicide/statistics & numerical data
- Humans
- Male
- Middle Aged
- Nigeria/epidemiology
- Prospective Studies
- Retrospective Studies
- Sex Distribution
- Shock, Hemorrhagic/etiology
- Shock, Hemorrhagic/mortality
- Thoracic Wall/injuries
- Violence/statistics & numerical data
- Wounds, Gunshot/complications
- Wounds, Gunshot/mortality
- Wounds, Gunshot/pathology
- Wounds, Stab/complications
- Wounds, Stab/mortality
- Wounds, Stab/pathology
- Young Adult
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Affiliation(s)
- D Seleye-Fubara
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital PMB 6173, Port Harcourt, Nigeria.
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Rostami E, Krueger F, Zoubak S, Dal Monte O, Raymont V, Pardini M, Hodgkinson CA, Goldman D, Risling M, Grafman J. BDNF polymorphism predicts general intelligence after penetrating traumatic brain injury. PLoS One 2011; 6:e27389. [PMID: 22087305 PMCID: PMC3210804 DOI: 10.1371/journal.pone.0027389] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/15/2011] [Indexed: 12/26/2022] Open
Abstract
Neuronal plasticity is a fundamental factor in cognitive outcome following traumatic brain injury. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophin family, plays an important role in this process. While there are many ways to measure cognitive outcome, general cognitive intelligence is a strong predictor of everyday decision-making, occupational attainment, social mobility and job performance. Thus it is an excellent measure of cognitive outcome following traumatic brain injury (TBI). Although the importance of the single-nucleotide polymorphisms polymorphism on cognitive function has been previously addressed, its role in recovery of general intelligence following TBI is unknown. We genotyped male Caucasian Vietnam combat veterans with focal penetrating TBI (pTBI) (n = 109) and non-head injured controls (n = 38) for 7 BDNF single-nucleotide polymorphisms. Subjects were administrated the Armed Forces Qualification Test (AFQT) at three different time periods: pre-injury on induction into the military, Phase II (10-15 years post-injury, and Phase III (30-35 years post-injury). Two single-nucleotide polymorphisms, rs7124442 and rs1519480, were significantly associated with post-injury recovery of general cognitive intelligence with the most pronounced effect at the Phase II time point, indicating lesion-induced plasticity. The genotypes accounted for 5% of the variance of the AFQT scores, independently of other significant predictors such as pre-injury intelligence and percentage of brain volume loss. These data indicate that genetic variations in BDNF play a significant role in lesion-induced recovery following pTBI. Identifying the underlying mechanism of this brain-derived neurotrophic factor effect could provide insight into an important aspect of post-traumatic cognitive recovery.
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Affiliation(s)
- Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frank Krueger
- Department of Molecular Neuroscience, George Mason University, Fairfax, Virginia, United States of America
- Department of Psychology, George Mason University, Fairfax, Virginia, United States of America
| | - Serguei Zoubak
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Henry Jackson Foundation for Advancement in Military Medicine, Rockville, Maryland, United States of America
| | - Olga Dal Monte
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Vanessa Raymont
- Johns Hopkins University, Department of Radiology, Baltimore, Maryland, United States of America
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Medicine, Imperial College, London, United Kingdom
| | - Matteo Pardini
- Department of Neuroscience, Ophtalmology and Genetics, University of Genoa, Genoa, Italy
- Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
| | - Colin A. Hodgkinson
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Goldman
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mårten Risling
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jordan Grafman
- Traumatic Brain Injury Research Laboratory, Kessler Foundation Research Center, West Orange, New Jersey, United States of America
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Serramito-García R, Arcos-Algaba A, Santín-Amo JM, García-Allut A, Bandín-Diéguez FJ, Gelabert-González M. [Epidural haematoma due to an headrest in an adult]. Neurocirugia (Astur) 2009; 20:567-570. [PMID: 19967324] [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: 05/28/2023]
Abstract
A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropriate management, it may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.
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Affiliation(s)
- R Serramito-García
- Servicio de Neurocirugía, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Cirugía, Universidad de Santiago de Compostela.
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Napon C, Dravé A, Kaboré J. [Epilepsy by bovine (zebu) goring: a case report in Burkina Faso]. Bull Soc Pathol Exot 2009; 102:217-218. [PMID: 19950536] [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: 05/28/2023]
Abstract
The post-traumatic epilepsy is responsible for 20% of the symptomatic epilepsies. Accidents on public highway constitute more than 70% of the causes. We report a singular case of fronto-polar post-traumatic epilepsy by zebu goring which appeared two years after the traumatism. The neurological examination of the patient was normal apart from a inconspicuous expansiveness of humor underlined by an excess of familiarity and hypersyntony. The cerebral scanner revealed a left fronto-basal cortico-under-cortical low density up to the homolateral fronto-polar area. The electroencephalogram (EEG) showed some left fronto-polar bursts of spike and wave on a normal bottom line. This clinical observation draws our attention on the fact that in Sahelian tropical environment where bovine breeding holds a major place, the cranio-encephalic traumatism by goring is not rare and can be responsible for epilepsy in the same way as accidents on public highway, or ballistic traumatism.
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Affiliation(s)
- C Napon
- Service de neurologie du CHU Yalgado-Ouedraogo, BP 7022 Ouagadougou 03, Burkina Faso.
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Affiliation(s)
- Babak Mokhlesi
- Sleep Disorders Centre and Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Affiliation(s)
- N U Barua
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
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30
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Ivanova MS, Barinov EK, Romodanovskiĭ PO. [Long-time presence of foreign substance in cranial cavity]. Sud Med Ekspert 2008; 51:29-30. [PMID: 18589672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Gonzalez-Cruz J, Cardenas R, Nanda A. Penetrating orbitocranial injury to the sella: case report and review of the literature. J La State Med Soc 2007; 159:310-314. [PMID: 18390268] [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: 05/26/2023]
Abstract
UNLABELLED A 39-year-old woman sustained a self-inflicted transorbital penetrating injury that resulted in direct pituitary injury with hypopituitarism and decreased vision in the opposite eye. Several hormone deficiencies were detected. Even though this patient did not develop any other complications from her injury (abscess, cerebrospinal fluid fistula or pseudoaneurysm), after two years of follow-up no recovery of pituitary or visual function has occurred. CONCLUSION From our experience in this case, we propose a conservative multidisciplinary approach when dealing with this type of lesion. Broad spectrum antibiotic coverage and early detection and replacement of any hormone deficiency should be instituted.
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Affiliation(s)
- Jorge Gonzalez-Cruz
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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32
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Affiliation(s)
- Nirav A Vora
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Selvanathan S, Goldschlager T, McMillen J, Campbell S. Penetrating craniocerebral injuries from nail-gun use. J Clin Neurosci 2007; 14:678-83. [PMID: 17452105 DOI: 10.1016/j.jocn.2006.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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: 12/17/2005] [Revised: 02/05/2006] [Accepted: 02/07/2006] [Indexed: 11/23/2022]
Abstract
Three patients with penetrating craniocerebral nail-gun injuries are described. In the first patient the nail was impinging on the internal carotid artery (ICA) in the carotid canal. On removal of the nail, the patient developed a false aneurysm at the site. To our knowledge, this is the first reported case of nail-gun injury affecting the ICA and also the first case of penetrating head injury affecting the ICA in the carotid canal. The second patient had seven intracranial nails in the frontal area. Three nails penetrated the left orbit, one of which perforated the globe. One nail damaged the optic nerve resulting in optic neuropathy. In the third patient the nail extended through the squamous temporal bone into the temporal lobe. All three were managed successfully via closed gentle traction without craniotomy and/or endovascular intervention. The literature is reviewed and management options for penetrating head injuries are discussed.
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Affiliation(s)
- S Selvanathan
- Kenneth G. Jamieson Department of Neurosurgery, Level 7, Ned Hanlon Building, Royal Brisbane Hospital, Herston QLD 4029, Australia
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Maras D, Lioupis C, Magoufis G, Tsamopoulos N, Moulakakis K, Andrikopoulos V. Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review. Cardiovasc Intervent Radiol 2007; 29:958-68. [PMID: 16897263 DOI: 10.1007/s00270-005-0367-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. METHOD We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. RESULTS We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. CONCLUSION Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.
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MESH Headings
- Adult
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Anticoagulants/therapeutic use
- Blood Vessel Prosthesis Implantation
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/surgery
- Coated Materials, Biocompatible/therapeutic use
- Combined Modality Therapy
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/surgery
- Humans
- Male
- Polytetrafluoroethylene/therapeutic use
- Radiography
- Skull Fracture, Basilar/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/surgery
- Stents
- Vascular Patency
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Affiliation(s)
- Dimitrios Maras
- Department of Vascular Surgery, The Red Cross Hospital of Athens, Athens, Greece
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Onyekwe LO, Ohaegbulam SC. Penetrating orbito-cranial and ocular cow-horn injuries. Niger J Clin Pract 2007; 10:177-9. [PMID: 17902515] [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: 05/17/2023]
Abstract
Cow horn eye injuries are not common but are devastating causes of uniocular blindness amongst young active population. Early and appropriate intervention can save the life of the patient depending on the severity of the injury. This uncommon cause of unilateral visual loss can be prevented if slaughtering of cows are done by trained and appropriately equipped personnel.
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Affiliation(s)
- L O Onyekwe
- Guinness Eye Center, Nnamdi Azikiwe University Teaching Hospital, Onitsha
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36
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Abstract
The evaluation of superficial penetrating injuries to the face and scalp is common in the emergency department. We present a patient who presented with a ball bullet pellet to the forehead with an initially negative computerized tomographic (CT) scan of the head, who represented 18 hours later with nausea, vomiting, and mental status changes. A repeat CT scan of the head revealed intraparenchymal hemorrhage immediately posterior to the site of pellet entry. Upon review, the initial CT scan was limited by scatter artifact. In this case report, we discuss the potential for significant injury with compressed air-driven arms, the limitation of CT in the presence of metallic foreign bodies, and the significant risks associated with pediatric radiation exposure.
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Affiliation(s)
- Eric J Nilles
- Department of Emergency Medicine, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA.
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37
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Hiraishi T, Tomikawa M, Kobayashi T, Kawaguchi T. [Delayed brain abscess after penetrating transorbital injury]. No Shinkei Geka 2007; 35:481-6. [PMID: 17491344] [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: 05/15/2023]
Abstract
We report a case of brain abscess caused by a penetrating head injury that occurred 9 years earlier. A 14-year-old girl presenting with fever, headache, and stiff neck was admitted to our hospital. She was diagnosed with aseptic meningitis and treated conservatively. Seven days after admission she became stuporous and showed left hemiparesis. Computed tomography (CT) revealed two ring-enhancing masses with perifocal edema in the right frontal lobe. We diagnosed brain abscess and performed right fronto-temporal decompressive craniectomy and stereotactic aspiration, followed by systemic antibiotic therapy. Post-surgery bone window CT revealed a well-defined, low-density foreign body passing from the left orbita to the right frontal lobe through the ethmoid sinus. We learned that the patient had been struck with a plastic chopstick in the left medial eyelid at the age of 5 years. No particular symptoms developed during the following 9 years. After the cerebral edema had diminished over the next 10 days, a second surgery was performed to remove the residual chopstick, repair the fistula at the base of the skull, and perform cranioplasty. The patient was discharged with only slight hyposmia after a 4-week course of antibiotics. This case showed that it is necessary to remove a residual foreign body and to close the dural fistula if there is a possibility of recurrent central nervous system infection. When a child presents with brain abscess, previous penetrating head injury should be considered.
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Affiliation(s)
- Tetsuya Hiraishi
- Department of Neurosurgery, Nagaoka Red Cross Hospital, Nagaoka-city, Niigata, Japan
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38
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Bilotta F, Rosa G, Delfini R, Pinto R, Fiorani B. Unrecognized periorbital penetrating nail in the brain: case report. Am J Emerg Med 2007; 25:198-9. [PMID: 17276812 DOI: 10.1016/j.ajem.2006.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 05/17/2006] [Indexed: 10/23/2022] Open
Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, 00199 Rome, Italy.
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39
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Abstract
Patients who have penetrating head injury all too often present with some of the most devastating and challenging intracranial injuries. The mechanisms of injury and associated neuropathology affect every body system and require a multidisciplinary approach. Evidence-based guidelines have been developed to offer some direction to clinicians involved in their care. Much remains scientifically unsubstantiated, however. Optimal management of critically ill patients who have penetrating head injury requires clinical expertise and care of the highest quality.
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Affiliation(s)
- Patricia A Blissitt
- Neuroscience Intensive Care Unit, Duke University Hospital, Durham, NC, USA.
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Abstract
Post-traumatic epilepsy is reported after 2-5% of closed head injuries but up to 50% or more following penetrating head injury. Despite several studies, no drug strategy has been able, to date, to quench the biochemical events leading to epileptogenesis. One possibility is that treatment with available antiepileptic drugs has been implemented too late, and thus, ultra-early treatment might still be able to stop the neurochemical epileptogenic cascade dead in its tracks. However, currently drug therapy should be instituted only after the first late unprovoked seizure.
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41
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Chibbaro S, Tacconi L. Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients. Acta Neurochir (Wien) 2006; 148:937-41; discussion 941-2. [PMID: 16763734 DOI: 10.1007/s00701-006-0794-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 11/24/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature. METHOD We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours. FINDINGS Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4. CONCLUSION The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Brain Abscess/etiology
- Brain Abscess/surgery
- Brain Injuries/diagnosis
- Brain Injuries/etiology
- Brain Injuries/physiopathology
- Cerebral Hemorrhage, Traumatic/etiology
- Cerebral Hemorrhage, Traumatic/surgery
- Cranial Fossa, Anterior/diagnostic imaging
- Cranial Fossa, Anterior/injuries
- Cranial Fossa, Anterior/pathology
- Diagnosis, Differential
- Early Diagnosis
- Eye Infections/etiology
- Eye Infections/prevention & control
- Female
- Foreign Bodies/complications
- Foreign Bodies/diagnosis
- Foreign Bodies/physiopathology
- Frontal Bone/diagnostic imaging
- Frontal Bone/injuries
- Frontal Bone/pathology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnosis
- Head Injuries, Penetrating/physiopathology
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neurosurgical Procedures/methods
- Neurosurgical Procedures/standards
- Orbital Fractures/complications
- Orbital Fractures/diagnosis
- Orbital Fractures/physiopathology
- Predictive Value of Tests
- Retrospective Studies
- Tomography, X-Ray Computed
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Trieste University Hospital, Trieste, Italy.
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42
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Lawson-Smith MJ, Smith SJ, Leach JCD, Cadoux-Hudson T. Lateral medullary syndrome caused by penetrating head injury. J Clin Neurosci 2006; 13:792-4. [PMID: 16914313 DOI: 10.1016/j.jocn.2005.09.016] [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] [Received: 08/08/2005] [Accepted: 09/23/2005] [Indexed: 11/18/2022]
Abstract
Herein, we report a rare case of a patient surviving penetrating trauma to the brainstem. Low velocity penetrating head injuries may be occult and are associated with a high incidence of vascular injury.
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Affiliation(s)
- M J Lawson-Smith
- Department of Neurosurgery, Radcliffe Infirmary, Oxford, OX2 6HE, UK
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43
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Grunsfeld AA, Login IS. Abulia following penetrating brain injury during endoscopic sinus surgery with disruption of the anterior cingulate circuit: case report. BMC Neurol 2006; 6:4. [PMID: 16430769 PMCID: PMC1373643 DOI: 10.1186/1471-2377-6-4] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 01/23/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is common knowledge that the frontal lobes mediate complex human behavior and that damage to these regions can cause executive dysfunction, apathy, disinhibition and personality changes. However, it is less well known that subcortical structures such as the caudate and thalamus are part of functionally segregated fronto-subcortical circuits, that can also alter behavior after injury. CASE PRESENTATION We present a 57 year old woman who suffered penetrating brain injury during endoscopic sinus surgery causing right basal ganglia injury which resulted in an abulic syndrome. CONCLUSION Abulia does not result solely from cortical injury but can occur after disruption anywhere in the anterior cingulate circuit--in the case of our patient, most prominently at the right caudate.
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Affiliation(s)
- Alexander A Grunsfeld
- Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, 22908, USA
| | - Ivan S Login
- Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, 22908, USA
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Abstract
A 28-year-old man was admitted following a massive caffeine overdose and a self inflicted gunshot wound in an apparent suicide attempt. Although initially stable on admission, he subsequently suffered multiple cardiac arrests and generalised seizures within 23 h of admission; over the next 48 h, he developed rhabdomyolysis. The importance of early management in caffeine overdose is highlighted.
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Affiliation(s)
- O Emohare
- Department of Surgery, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge CB2 2QQ, UK
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45
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Wójcik K, Dalecka-Sztwiertnia E, Piekarska A, Zboińska J, Wrodycki W, Kuydowicz J. [Brain abscess: analysis of prevalence and clinical course]. Przegl Epidemiol 2006; 60:265-71. [PMID: 16964678] [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: 05/11/2023]
Abstract
The aim of the study was the analysis of the patients with bacterial meningitis and brain abscess who were treated in the Department of Infection Disease and Hepatology of Medical University in Lodz in years 1996-2005. We reviewed their clinical presentation, bacteriology treatment and outcome retrospectively. Among 135 patients who were confirmed cases of bacterial meningitis 16 identified as having brain abscesses. The prevalence rate of brain abscesses significantly increased in years: 2004-2005. The common predisposing factors were otic and teeth infections, sinusitis, penetrating head trauma, and bacterial endocarditis. Solitary abscess was found in 56% of the cases while in 44% of the cases multiple abscess were found. The most common presentation: headache, fever and neurological deficit were present in 37% of the cases. 75% of patients were disqualified from early neurosurgical intervention and antibiotic therapy were recommended. The antibiotic therapy was effective only in 1 patient. The mortality rate was 38% and 56% of the survivors had late neurological defects. The prevalence rate of brain abscesses significantly increased in years 2004-2005. Over all mortality was very high and antibiotic therapy hasn't been effective treatment in brain abscess at the late stage of its evolution. The early neurosurgical intervention is recommended. Late neurosurgical intervention strongly influences poor outcome in patients with brain abscess.
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46
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Sanaei-Zadeh H, Aghakhani K, Saidi H. Orbito-cerebral penetrating knife-wound. ACTA ACUST UNITED AC 2005; 13:146-7. [PMID: 16386448 DOI: 10.1016/j.jcfm.2005.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 09/02/2005] [Revised: 10/21/2005] [Accepted: 10/29/2005] [Indexed: 11/19/2022]
Abstract
An orbit-cerebral knife wound is described. Reasons for variation in outcome art discussed.
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MESH Headings
- Adolescent
- Coma, Post-Head Injury/etiology
- Diagnosis, Differential
- Eye Injuries, Penetrating/complications
- Eye Injuries, Penetrating/diagnosis
- Eye Injuries, Penetrating/diagnostic imaging
- Eye Injuries, Penetrating/pathology
- Fatal Outcome
- Forensic Pathology
- Glasgow Coma Scale
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnosis
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/pathology
- Humans
- Male
- Radiography
- Telencephalon/injuries
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Affiliation(s)
- Hossein Sanaei-Zadeh
- Faculty of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran.
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47
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Affiliation(s)
- D J Verret
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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48
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Kim KA, Wang MY, McNatt SA, Pinsky G, Liu CY, Giannotta SL, Apuzzo MLJ. Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome. Neurosurgery 2005; 57:737-47; discussion 737-47. [PMID: 16239886] [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: 05/04/2023] Open
Abstract
OBJECTIVE We identify radiographic imaging similarities found on head computed tomographic (CT) scans of patients with through-and-through gunshot wounds to the head with fatal outcomes. METHODS A retrospective analysis was conducted over an 18-month period from June 2001 through December 2002. Two hundred seventeen gunshot wound patients were evaluated. Exclusion criteria included any patient with cardiopulmonary injury and instability, airway compromise, or extracranial injuries affecting prognosis. Thirty-seven patients with isolated gunshot wounds to the head were included, 10 of which were fatal. Vital signs, examination results, Glasgow coma scale (GCS) score, intracranial pressure monitoring, surgical data, days in the intensive care unit, and CT scan appearance were collected. A Cartesian xyz coordinate system was created centered on the dorsum sella. Bullet pathways on CT scans were plotted and graphed onto a standardized magnetic resonance imaging scan. RESULTS Ten patients progressed to brain death. GCS score and pupil irregularity were associated with fatal outcome (P < 0.0001). CT scans showed that brain shift was more common in survivors. Seventy percent of nonsurvivors had minimal brain shift. A tram-track sign on CT scans correlated with fatal outcome (P = 0.005). Vector analysis of nonsurvivors showed an area of the brain approximately 4 cm above the dorsum sella that, when penetrated through the midline, led to brain death (P = 0.0006). This zone was coined the zona fatalis. CONCLUSION We confirm that GCS score and diabetes insipidus correlated with fatal outcome. In the setting of low-velocity gunshot wounds, fatal outcome and low GCS score were associated with a tram-track sign on CT scans. Bullet passage through a particular supra-dorsum sellar transventricular zone was associated with fatal outcome.
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Affiliation(s)
- K Anthony Kim
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles County General Hospital, Los Angeles, California, USA.
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49
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Coşar A, Gönül E, Kurt E, Gönül M, Taşar M, Yetişer S. Craniocerebral gunshot wounds: results of less aggressive surgery and complications. ACTA ACUST UNITED AC 2005; 48:113-8. [PMID: 15906207 DOI: 10.1055/s-2004-830222] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. In 130 of 400 patients, bone and metal fragments were determined on control CT scans. Most of the deaths in this group of patients were attributed to the influence of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scans. Surgery was not performed until the infection developed. Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.
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Affiliation(s)
- A Coşar
- Department of Anaesthesiology, GATA Medical School, Etlik-Ankara, Turkey
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50
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Affiliation(s)
- A J Green
- Department of Neurology, University of California San Francisco, CA 94143-0114, USA.
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