scholarly journals Preoperative brain shift is a prognostic factor for survival in certain neurosurgical diseases other than severe head injury: a case series and literature review

2021 ◽  
Author(s):  
Paolo Missori ◽  
Giuseppe La Torre ◽  
Susanna Lazzari ◽  
Sergio Paolini ◽  
Simone Peschillo ◽  
...  
Keyword(s):  
Head Injury ◽  
Prognostic Factor ◽  
Severe Head Injury ◽  
Univariate Analysis ◽  
Case Series ◽  
Acute Subdural Hematoma ◽  
Anatomical Landmarks ◽  
Brain Shift ◽  
Neurosurgical Treatment ◽  
Intracranial Lesions

AbstractPreoperative brain shift after severe brain injury is a prognostic factor for survival. The aim of this study was to determine whether preoperative brain shift in conditions other than severe head injury has significant prognostic value. We analyzed a radiological database of 800 consecutive patients, who underwent neurosurgical treatment. Brain shift was measured at two anatomical landmarks: Monro’s foramina (MF) and the corpus callosum (CC). Four hundred seventy-three patients were included. The disease exerting the highest mean brain shift was acute subdural hematoma (MF 11.6 mm, CC 12.4 mm), followed by intraparenchymal hematoma (MF 10.2 mm, CC 10.3 mm) and malignant ischemia (MF 10.4 mm, CC 10.5 mm). On univariate analysis, brain shift was a significant negative factor for survival in all diseases (p < 0.001). Analyzed individually by group, brain shift at both anatomical landmarks had a statistically significant effect on survival in malignant ischemia and at one anatomical landmark in chronic subdural and intraparenchymal hematomas. Multivariate analysis demonstrated that the only independent factor negatively impacting survival was brain shift at MF (OR = 0.89; 95% CI: 0.84–0.95) and CC (OR = 0.90; 95% CI: 0.85–0.96). Brain shift is a prognostic factor for survival in patients with expansive intracranial lesions in certain neurosurgical diseases. MF and CC are reliable anatomical landmarks and should be quoted routinely in radiological reports as well as in neurosurgical practice.

Mortality Outcome of Emergency Decompressive Craniectomy and Craniotomy in the Management of Acute Subdural Hematoma: A National Data Analysis

2020 ◽  
pp. 000313482095146
Author(s):  
Nasim Ahmed ◽  
Patricia Greenberg ◽  
SeungHoon Shin
Keyword(s):  
Head Injury ◽  
Hospital Mortality ◽  
Decompressive Craniectomy ◽  
Subdural Hematoma ◽  
Severe Head Injury ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Univariate Analysis ◽  
Acute Subdural Hematoma ◽  
Significant Difference

Background The purpose of the study is to evaluate the in-hospital mortality of patients who presented with acute subdural hematoma (SDH) and underwent emergency decompressive craniectomy (DC) or craniotomy (CO) within 4 hours of hospital arrival. Method The National Trauma Data Bank (NTDB) dataset of the calendar year of 2007 through 2010 was accessed for the study. All blunt severe head injury patients who presented with acute SDH were included in the study. Severe head injury is defined as a head Abbreviated Injury Scale (AIS) score ≥3 and a Glasgow Coma Scale (GCS) score ≤8. Univariate followed by propensity-matched analyses were performed to compare the two procedure groups: DC and CO. Results Out of 2370 patients, 518, (21.9%) patients underwent DC. There were significant differences found in the univariate analysis between the DC and CO groups for median age (38 (IQR: 22.0, 55.0) vs 49 (IQR: 27, 67), P < .001), mechanism of injury (fall: 33.2% vs 50.7%; motor vehicle crashes: 58.3% vs 40.9%, P < .001), and median injury severity score (ISS: 26.0 (IQR: 25, 38) vs 26 (IQR: 25.0, 33.0), P < .001). After propensity score matching and pair-matched analysis, no differences were found with any of the above characteristics. The pair-matched analysis also showed no significant difference in in-hospital mortality (42.7% vs 37.5%, P = .10) between the DC vs CO groups. Conclusion The overall in-hospital mortality for emergency CO or DC for the evacuation of SDH remains high. The preference of one operative procedure over the other did not impact overall mortality.

scholarly journals Decompressive craniotomy: prognostic factors and complications in 89 patients

2008 ◽  
Vol 66 (2b) ◽  
pp. 369-373 ◽  
Author(s):  
Rodrigo Moreira Faleiro ◽  
Luiz Carlos Mendes Faleiro ◽  
Elisa Caetano ◽  
Isabella Gomide ◽  
Cristina Pita ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Acute Subdural Hematoma ◽  
Brain Swelling ◽  
Decompressive Craniotomy ◽  
Independent Test ◽  
Post Traumatic ◽  
Subdural Effusions

Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH). The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submited to unilateral DC were retrospectively analyzed over a period of 30 months. Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%). Traffic accidents had occurred in 47% of the cases. 64% of the patients had suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome ( p=0.0309).

Severe head injury among children: computed tomography evaluation as a prognostic factor

2007 ◽  
Vol 42 (11) ◽  
pp. 1903-1906 ◽  
Author(s):  
Gemma Claret Teruel ◽  
Antonio Palomeque Rico ◽  
Francisco José Cambra Lasaosa ◽  
Albert Català Temprano ◽  
Antoni Noguera Julian ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Prognostic Factor ◽  
Severe Head Injury

Head Injury and Posttraumatic Movement Disorders

Neurosurgery ◽  
2002 ◽  
Vol 50 (5) ◽  
pp. 927-940 ◽  
Author(s):  
Joachim K. Krauss ◽  
Joseph Jankovic
Keyword(s):  
Head Injury ◽  
Movement Disorder ◽  
Movement Disorders ◽  
Severe Head Injury ◽  
Treatment Options ◽  
Diffuse Axonal Injury ◽  
Craniocerebral Trauma ◽  
Causative Factor ◽  
Stereotactic Surgery ◽  
Neurosurgical Treatment

Abstract WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.

Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon

2002 ◽  
Vol 97 (3) ◽  
pp. 542-548 ◽  
Author(s):  
Hiroshi Nakaguchi ◽  
Kazuo Tsutsumi
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Sports Injuries ◽  
Head Injuries ◽  
Acute Subdural Hematoma ◽  
Opposite Edge ◽  
Winter Sports ◽  
Content Type ◽  
Shear Injury ◽  
Fine Print

Object. To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms. Methods. The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries. The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441). Conclusions. The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding.

scholarly journals BRAIN DERIVED NEUROTROPHIC FACTOR (BDNF) PASCACEDERA KEPALA BERAT SEBAGAI FAKTOR PERAMALAN PERJALANAN PENYAKIT {(Brain Derived Neurotrophic Factor (BDNF) as a Prognostic Factor in Severe Head Injury)}

2018 ◽  
Vol 21 (1) ◽  
pp. 61
Author(s):  
Ridha Dharmajaya
Keyword(s):  
Head Injury ◽  
Prognostic Factor ◽  
Brain Damage ◽  
Neurotrophic Factor ◽  
Severe Head Injury ◽  
Time Lapse ◽  
Brain Derived Neurotrophic Factor ◽  
Enzyme Linked Immunosorbent Assay ◽  
Secondary Brain Damage ◽  
Significant Difference

Severe head Injury result in primary and secondary brain damage. The secondary brain damage produces a more worse effect thanthe primary one. Therefore, the process of the secondary brain damage should be prevented in order to obtain a maximum result ofpatient management. The difficulty is to make sure, whether the secondary brain damage is already very bad or, on the other hand, isstill in a positive condition, causing patient management to have a good result. The prognostic decision, is the most important thing inpatient management. The objective of this research was to find an accurate prognostic factor which is simple and non invasive for severehead injury for each time lapse, 24, 48, 72 and 120 hours after the brain damage which had caused the head injury. The installation ofan intracranial pressure (ICP) monitor for the first 24 hours, after the head injury, followed by taking a cerebrospinal fluid sample forBDNF examination at the first 24 hours, 48 hours, 72 hours and 120 hours as well. Enzyme Linked Immunosorbent Assay was used todetermine BDNF. Each subject was assessed by Glasgow Outcome Scale classification, three months after the injury. The result of thisresearch was that BDNF at 48 hours after head injury showed a significant difference (p < 0.05) between good and bad Glasgow OutcomeScale classification. Thus, it can be concluded that patients with an increase in BDNF (>6.16 pg/mL) 48 hours after head injury, mayhave a good prognosis.

scholarly journals Karakteristik Hasil CT-Scan Kepala pada Penderita Cedera Kepala di Rumah Sakit Dr.H.Abdul Moeloek periode Januari – Desember Tahun 2018

2020 ◽  
Vol 1 (3) ◽  
pp. 177-183
Author(s):  
Muhamad Yunus ◽  
Alfi Wahyudi ◽  
Arti Febriyani H ◽  
Rona Asla Romiza
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Head Injury ◽  
Ct Scan ◽  
Head Injuries ◽  
Univariate Analysis ◽  
Descriptive Study ◽  
Male Gender ◽  
Sampling Techniques ◽  
Mild Head Injury ◽  
Intracranial Lesions

Computerized Tomography (CT) -Scans  examination are the main choice modalities in patients with acute head injuries because they are able to view the entire brain tissues and accurately distinguish the nature and presence of intracranial lesions and Extracranial. This study aim to determine the characteristics of results CT-Scan head on the patient's head injury at Dr.H.Abdul Moeloek Hospital January to December Period 2018. The research is a descriptive study with a crosssectional approach. The samples in this study were all records of medical head injury patients at Dr.H.Abdul Moeloek Hospital in January – December 2018 based on the formula Slovin as many as 182 respondents. The sampling techniques in the study used purposive sampling techniques. Data analysis using univariate analysis. From 182 respondents known prevalence of the age of the patient's head injury is 16-25 years as many as 82 respondents (45.1%), male gender 119 respondents (65.4%), a mild head injury of 105 respondents (57.7%). A normal CT-Scan overview of 99 respondents (54.4%) With a valid description (subarachnoid hemorrhage) as much as 25 respondents (13.7%). Characteristics of results CT-Scan head at the head injury sufferer of most ages 16-25 years, most male gender, most dominant mild head injuries and CT-Scan results most commonly present normal results with description SAH (subarachnoid hemorrhage).

Influence of the type of intracranial lesion on outcome from severe head injury

1982 ◽  
Vol 56 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Thomas A. Gennarelli ◽  
Gerri M. Spielman ◽  
Thomas W. Langfitt ◽  
Philip L. Gildenberg ◽  
Timothy Harrington ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Acute Subdural Hematoma ◽  
Good Recovery ◽  
Content Type ◽  
Injury Group ◽  
Lesion Type ◽  
Severity Of Injury ◽  
Gcs Score ◽  
Injured Patients

✓ Recent studies attempting to define the outcome from severe head injury have implied, directly or indirectly, that the severity of injury (as determined by the Glasgow Coma Scale (GSC)) is the sole determinant of outcome. Little attention has been focused on the type of lesion that causes the low GCS score, and there exists an unstated hypothesis that the lesion type is not an important determinant of outcome. No attempt has been made to determine whether patients who have the same GCS score caused by different lesions have the same or different outcomes. Since this is impossible to test without a large number of cases, data were obtained from seven head-injury centers on patients who fulfilled the Glasgow criteria for severe head injury (GCS ≤ 8 for at least 6 hours). Patients were categorized according to a simple classification system comprising seven lesion types, each of which was further subdivided into two GCS score ranges (3 to 5 and 6 to 8). Of 1107 patients, the overall mortality was 41%, but ranged from 9% to 74% among the different lesion categories. Conversely, 26% had good recovery (at 3 months), but among the different lesion groups the range was 6% to 68%. Acute subdural hematoma with GCS scores of 3 to 5 was uniformly the worst problem (74% mortality and 8% good recovery), whereas diffuse injury coma of 6 to 24 hours with GCS scores of 6 to 8 had 9% mortality and 68% incidence of good recovery. Results of this study demonstrate marked heterogeneity within this severe head-injury group and point out that patients with the same GCS score have markedly different outcomes, depending on the causative lesion. The type of lesion is thus as important a factor in determining outcome as is the GCS score, and both must be considered when describing severely head-injured patients.

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