scholarly journals Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Hazim Hakmi ◽  
D’Andrea K Joseph ◽  
Amir Sohail ◽  
Lee Tessler ◽  
Gerard Baltazar ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Patient ◽  
Atmospheric Pressure ◽  
Skin Flap ◽  
Neurological Status ◽  
Definitive Treatment ◽  
Trauma Patients ◽  
Increased Intracranial Pressure ◽  
Fluid Infusion ◽  
Supportive Management

Abstract Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.

scholarly journals Manajemen Anestesi untuk Seksio Sesarea pada Pasien Eklampsia dengan Perdarahan Intrakranial

2021 ◽  
Vol 10 (2) ◽  
pp. 119-126
Author(s):  
Chrismas Gideon Bangun ◽  
◽  
Sudadi Sudadi ◽  
Siti Chasnak Saleh ◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Intracranial Hemorrhage ◽  
Rapid Sequence Induction ◽  
Fetal Distress ◽  
Definitive Treatment ◽  
Increased Intracranial Pressure ◽  
Post Surgery

Intracranial haemorrhage in pregnancy is the leading cause of death in eclampsia patients. Hypertension, which is associated with both ischemic and hemorrhagic strokes, is the main feature. Definitive treatment is termination of pregnancy with cesarean section. However, it is not appropriate to start labor in an unstable mother, despite fetal distress. Once seizures can be controlled, severe hypertension is treated and hypoxia is corrected, labor may begin. The first anesthesia management goals are seizure control, blood pressure control, and prevention of increased intracranial pressure. General anesthesia is an option in the unconscious patient, or decreased consciousness with signs of increased intracranial pressure. Anesthesia is achieved with inhalation, opioids, relaxation and hyperventilation techniques carefully. In this case a 31-year-old mother, 55 kg, 36-37 weeks' gestation comes to the hospital with a decrease in consciousness and a history of seizures. Found sensorium E2M5V2, blood pressure 180/100mmHg and proteinuria 3+. Immediately, a cesarean section with general anesthesia and rapid sequence induction with fentanyl 50 mcg, propofol 100 mg and rocuronium 50 mg intravenously were performed. Post surgery the patient was treated in the ICU, head CT-Scan was performed and intracranial hemorrhage in the right temporoparietal was encountered. Management of intracranial hemorrhage was decided conservatively. The 3rd day postoperative the patient was extubated and on the 5th day the patient was transferred with E3M5V2 sensorium.

Acute Paradoxical Herniation: A Case Report

2021 ◽  
Author(s):  
Vanessa Denny ◽  
Davina Shalev ◽  
Jahannaz Dastgir ◽  
Erin Johnson ◽  
Maria Escobar ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Medical Therapy ◽  
Decompressive Craniectomy ◽  
Atmospheric Pressure ◽  
Rare Complication ◽  
Neurological Deficits ◽  
Increased Intracranial Pressure

AbstractDecompressive craniectomy is used to relieve acute increased intracranial pressure (ICP) when medical therapy has failed. Paradoxical herniation is a rare complication that occurs when the pressure of the intracranial contents falls abnormally below the atmospheric pressure. Symptoms often include neurological deficits, the etiology of which is often mistaken for elevated ICP. This diagnosis requires quick recognition, and treatment requires a change from ICP reduction therapies to those that increase the ICP, and ultimately cranioplasty.

scholarly journals Posture-dependent aphasia: Focal cortical dysfunction in the sinking scalp flap syndrome

2015 ◽  
Vol 6 (02) ◽  
pp. 225-227 ◽  
Author(s):  
Prasad Krishnan ◽  
Siddhartha Roy Chowdhury
Keyword(s):  
Intracranial Pressure ◽  
Atmospheric Pressure ◽  
Neurological Status ◽  
Acute Subdural Hematoma ◽  
Unusual Complication ◽  
Raised Intracranial Pressure ◽  
Decompressive Craniotomy ◽  
Scalp Flap ◽  
Initial Improvement ◽  
Cortical Dysfunction

ABSTRACTDecompressive craniotomies are being increasingly used in the treatment of raised intracranial pressure due to a variety of reasons like large infarcts, hypertensive hemorrhages and contusions. Though effective in decreasing raised intracranial pressure, they have certain complications like the sinking scalp flap syndrome that is caused by cortical dysfunction of the area below the craniotomy which is exposed to the effects of atmospheric pressure. We describe a 60-year-old patient who underwent decompressive craniotomy for acute subdural hematoma and after an initial uneventful postoperative period developed incontinence, irrelevant verbalization and ataxia. He was found to have hydrocephalus and underwent a ventriculo-peritoneal shunt with resolution of his symptoms. Three weeks later his flap had sunk in deeply and the skin was non-pinchable and he was noted to have headaches, vomiting and retching when he sat up. In addition he became aphasic when seated and the symptoms subsided on lying down. A diagnosis of focal cortical dysfunction due to sinking scalp flap syndrome was made. We highlight the incidence and pathophysiology of this unusual complication of decompressive craniotomy and stress the need to be aware of this entity particularly in patients who do not show an initial improvement after decompressive craniotomy as the cause of their poor neurological status may not be explained by any other mechanism.

An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set

2021 ◽  
pp. 000313482110110
Author(s):  
Adel Elkbuli ◽  
Scott Rowe ◽  
Shahm Raslan ◽  
Aleeza Ali ◽  
Brad Boserup ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Patient Outcomes ◽  
Motor Vehicle ◽  
Trauma Patients ◽  
Data Set ◽  
Program Participant ◽  
Quality Program ◽  
Field Triage ◽  
American College Of Surgeons ◽  
Mode Of Transportation

Background Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. Methods A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. Results Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. Conclusion DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.

scholarly journals Evaluation of cerebrovascular hemodynamics in patients with idiopathic intracranial hypertension using transcranial Doppler

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Mahmoud M. Allam ◽  
Hatem A. Almasry ◽  
Sandra M. Ahmed ◽  
Youssuf G. Taha ◽  
Mohammed I. Oraby
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Transcranial Doppler ◽  
Idiopathic Intracranial Hypertension ◽  
Pulsatility Index ◽  
Research Work ◽  
Increased Intracranial Pressure ◽  
Significant Relation ◽  
Before And After

Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure without a clear cause and can have serious visual effects. Previous research work suggests that transcranial Doppler measurements of pulsatility index correlate accurately with elevated intracranial pressure. Objective To assess the cerebrovascular hemodynamic changes in patients with IIH using transcranial Doppler before and after lumbar puncture and CSF withdrawal. Methods An interventional study conducted on 40 patients (31 females and 9 males) fulfilling the modified Dandy criteria for diagnosis of idiopathic intracranial hypertension, MRI brain, and MRV was done to the patients. Lumbar puncture was done for all included patients to measure intracranial pressure and CSF withdrawal. Transcranial Doppler was performed for all included before and after lumbar puncture and CSF withdrawal and the following parameters were measured: peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI). Results Significant relation was found between grades of papilledema and PSV, RI, and PI (p value 0.012, 0.025, 0.016) but no significant relation was found between grades of papilledema and EDV (0.102). Significant changes occurred in parameters of TCD pre- and post-CSF withdrawal including PSV, EDV, and PI (p value 0.001, 0.015, 0.019) denoting a significant change in cerebral hemodynamics after CSF withdrawal which denotes a decrease in intracranial pressure. Conclusion Increased intracranial pressure significantly affects cerebral blood flow. A normalization of transcranial Doppler parameters occurs following lowering of intracranial pressure through lumbar puncture and CSF withdrawal.

Sign in / Sign up

Export Citation Format

Share Document