Study of Head Trauma through Computed Tomography

Objective

Primary brain injuries, which are the result of severe head trauma and cannot be prevented, are always catastrophic and fatal. Yet, if diagnostic and therapeutic steps are taken promptly after a craniocerebral injury, further brain insults may be prevented and the victim's death can be avoided within 24 hours.

Materials and Methods

Source of data, sample size, inclusion criteria, exclusion criteria, statistical methods.

Results

One hundred individuals with confirmed cumputer tomography (CT) scan results of severe head trauma participated in this analysis. Seventy men and thirty women accounted for the total number of patients. The research included 70% men and 30% women. The M/F ratio is 2.3:1. Males between the ages of 21 and 30 (a total of 21 patients) had the highest rate of head injury in our analysis. Males had a lower incidence overall, with nine cases in the 0-10 age range, 11 cases in the 11-20 age range, five cases in the 41-50 age range, three cases in the 51-60 age range, and four cases in patients older than 61. Similarly, eight of the female patients were in the 21-30 age range. There were also four patients between the ages of 0 and 10, four between the ages of 11 and 20, two between the ages of 41 and 50, five between the ages of 51 and 60, and three among those older than 61.

Summary and Conclusion

Men were more likely than women to sustain a head injury. The majority of the study population consisted of patients between the ages of 21 and 30 and 31 and 40. Injuries were found to most often occur in car crashes.

Trampoline-Associated Cranial and Spinal Injuries: A 10-Year Study in a Pediatric Neurosurgery Center

OBJECTIVE

 There has been an increasing use of trampolines for recreation by children in recent years. Many studies have explored the different types of injuries sustained due to falls from trampolines, but so far none have focused specifically on cranial and spinal injuries. In this study, we describe the pattern of cranial and spinal injuries sustained by pediatric patients that were associated with the use of trampolines and their management in a tertiary pediatric neurosurgery unit over a period of 10 years.

METHODS

 This is a retrospective study of all children less than 16 years of age with suspected or confirmed trampoline-associated cranial or spinal injuries, managed by a tertiary pediatric neurosurgery unit from 2010 to 2020. Data collected included the patient's age at the time of injury, gender, neurological deficits, radiological findings, management, and clinical outcome. The data were analyzed to highlight any trends in the pattern of injuries.

RESULTS

 A total of 44 patients with a mean age of 8 years (ranging from one year and five months to 15 years and five months) were identified. 52% patients were male. 10 patients (23%) had a reduced Glasgow Coma Scale (GCS) score. In terms of imaging findings, 19 patients (43%) had a radiologically positive head injury, nine (20%) had a craniovertebral junction (CVJ) injury, including the first (C1) and second (C2) cervical vertebrae, and six (14%) had an injury involving other parts of the spine. No patient sustained concurrent head and spinal injuries. Eight (18%) patients had normal radiological findings. Two (5%) had incidental findings on radiology that required subsequent surgery. A total of 31 patients (70%) were managed conservatively. 11 patients (25%) underwent surgery for their trauma, of which seven were cranial. Two further patients underwent surgery for their incidental intracranial diagnoses. One child died from an acute subdural hemorrhage.

CONCLUSIONS

 This study is the first to focus on trampoline-associated neurosurgical trauma and report the pattern and severity of cranial and spinal injuries. Younger children (less than five years of age) are more likely to develop a head injury, whereas older children (more than 11 years of age) are more likely to develop a spinal injury following the use of a trampoline. Although uncommon, some injuries are severe and require surgical intervention. Therefore, trampolines should be used prudently with the appropriate safety precautions and measures.

[Improvement of the early diagnostic system and complex treatment elderly aged victims with severe traumatic brain injury of postoperative infectious - inflammatory complications.]

Improve the system of early diagnostic and complex treatment of postoperative infectious - inflammatory complications in victims of elderly ages with severe cranial injury. Medical institutions of Saint-Petersburg provided examination and treatment to 94 victims of elderly ages who were operated due to severe cranial injury. Examinations to identify inflammatory complications were provided from the body temperature rising and included laboratory tests, ultrasonography, X-Rays, Computer Tomography. The complex measures taken allowed to reduce severity and duration of postoperative inflammatory complications, cut the average bed-day hospital treatment from 42±6 days to 33±5 days in victims located in the neurosurgery department. Probability of infectious - inflammatory pulmonary complications development increases regardless of age. At the same time inflammatory urine tract complications most often occur among elderly age men who suffer from prostate hyperplasia and malfunction of the urination process after a long time of using intraurethral catheters. Early complex diagnostic examination allows the timely diagnosis of postoperative complications, and to begin the adequate treatment of victims.

Violence in the first millennium BCE Eurasian steppe: Cranial trauma in three Turpan Basin populations from Xinjiang, China

OBJECTIVES

Violence affected daily life in prehistoric societies, especially at conflict zones where different peoples fought over resources and for other reasons. In this study, cranial trauma was analyzed to discuss the pattern of violence experienced by three Bronze to early Iron Age populations (1,000-100 BCE) that belonged to the Subeixi culture. These populations lived in the Turpan Basin, a conflict zone in the middle of the Eurasian Steppe.

METHODS

The injuries on 129 complete crania unearthed from the Subeixi cemeteries were examined for crude prevalence rate (CPR), trauma type, time of occurrence, possible weapon, and direction of the blow. Thirty-three injuries identified from poorly preserved crania were also included in the analyses except for the CPR. Data was also compared between the samples and with four other populations that had violence-related backgrounds.

RESULTS

Overall, 16.3% (21/129) of the individuals showed violence-induced traumatic lesions. Results also indicated that most of the injuries were perimortem (81.6%), and that women and children were more involved in conflict than the other comparative populations. Wounds from weapons accounted for 42.1% of the identified cranial injuries. Distribution analysis suggested no dominant handedness of the attackers, and that blows came from all directions including the top (17.1%). Wounds caused by arrowheads and a special type of battle-ax popular in middle and eastern Eurasian Steppe were also recognized.

DISCUSSION

A comprehensive analysis of the skeletal evidence, historical records, and archeological background would suggest that the raiding to be the most possible conflict pattern reflected by the samples. The attackers were likely to have been nomadic invaders from the steppe (such as the Xiongnu from historical records), who attacked the residents in the basin more likely for their resources rather than territory or labor force.

Calcified cephalohematoma as an unusual cause of EEG anomalies: case report

Cephalohematoma, one of the most common neonatal head injuries, generally undergoes spontaneous resorption. When calcified, it may cause cranial vault distortion and depression of the inner skull layer, although it remains asymptomatic. Surgery, indeed, is usually performed for cosmetic purposes. For these reasons, the long-term effects of calcified cephalohematoma (CC) are widely unknown. The authors report the case of an 11-year-old girl with a persistent calcified CC causing skull deformity and delayed electroencephalography (EEG) anomalies. These anomalies were detected during routine control EEG and were not clinically evident. The young girl underwent surgical removal of the CC for cosmetic purpose. The EEG abnormalities disappeared after surgery, thus reinforcing the hypothesis of a correlation with the brain "compression" resulting from the CC. To the best of the authors' knowledge this is the first time that CC-associated EEG anomalies have been described: even though these anomalies cannot be considered an indication for surgery, they merit late follow-up in case of skull deformity.

Evaluating simulant materials for understanding cranial backspatter from a ballistic projectile

In cranial wounds resulting from a gunshot, the study of backspatter patterns can provide information about the actual incidents by linking material to surrounding objects. This study investigates the physics of backspatter from a high-speed projectile impact and evaluates a range of simulant materials using impact tests. Next, we evaluate a mesh-free method called smoothed particle hydrodynamics (SPH) to model the splashing mechanism during backspatter. The study has shown that a projectile impact causes fragmentation at the impact site, while transferring momentum to fragmented particles. The particles travel along the path of least resistance, leading to partial material movement in the reverse direction of the projectile motion causing backspatter. Medium-density fiberboard is a better simulant for a human skull than polycarbonate, and lorica leather is a better simulant for a human skin than natural rubber. SPH is an effective numerical method for modeling the high-speed impact fracture and fragmentations.

Penetrating Orbital-Cranial Injuries Management in a Limited Resource Hospital in Latin America

Penetrating orbital-cranial injuries (POCIs) are difficult cases especially in hospitals in low-middle-income countries (LMIC) where resources are limited. We present a case series of POCI managed in a university hospital in such scenario. A retrospective case series was conducted including patients with POCI in 2011. Mechanism of injury, Glasgow Coma Scale score, imaging, medical and surgical management, complications, and Glasgow Outcome Scale (GOS) score were analyzed. A total of 30 patients with penetrating orbital injuries were admitted from March 2011 to December 2011. Of this group, only four patients were diagnosed with cranial penetration. Computed tomography (CT) angiography revealed orbital fractures and injury to frontal, temporal, or occipital lobes. Urgent craniotomy with isolation of ipsilateral carotid artery was performed. GOS score at discharge was 5 in three patients and 4 in one patient. POCIs are not uncommon in hospitals of LMIC. In such scenarios, a standard approach with CT angiography and early neurosurgical intervention results in good outcome.