Cranial Trauma and ICU Management

2020 ◽  
pp. 83-102
Author(s):  
Gary Simonds
Keyword(s):  
Critical Care ◽  
Gunshot Wound ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Physical Symptoms ◽  
Raised Intracranial Pressure ◽  
Diagnostic Problem ◽  
Cranial Trauma ◽  
Icu Management

Head trauma is a commonly encountered diagnostic problem in neurosurgery and is thought by some to be relatively limited in its technical challenges, and, as such, it gives the examinee an opportunity to excel in this area. Six cases are presented and include the history and physical symptoms, imaging studies, analyses, and plan of each case. Cases include closed head injury with raised intracranial pressure, a gunshot wound to the head, an epidural hematoma, trauma with intracerebral hemorrhage, and a depressed skull fracture. Sample questions and reasonable answers are also provided. For those choosing Trauma/Critical Care for the focused component of their exam, there are more in-depth questions oriented particularly to critical care. These are marked with asterisks.

Cranial Trauma and ICU Management

2016 ◽  
pp. 61-74
Author(s):  
Gary Simonds
Keyword(s):  
Gunshot Wound ◽  
Epidural Hematoma ◽  
Sinus Thrombosis ◽  
Treatment Plan ◽  
Treatment Options ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Cranial Trauma ◽  
Wide Range ◽  
Icu Management

Head trauma is a commonly encountered diagnostic problem in neurosurgery and is thought by some to be relatively limited in its technical challenges—as such, it gives the examinee an opportunity to excel in this area. Six cases are presented, and each case includes the history and physical examination, imaging studies, analysis of case and treatment plan, and complications.. Cases include closed head injury with raised intracranial pressure, gunshot wound to the head, epidural hematoma, subdural hematoma, trauma with intracerebral hemorrhage, sinus thrombosis, and a depressed skull fracture. Sample questions and reasonable answers are also provided, with discussion that covers a wide range of treatment options.

scholarly journals Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

2021 ◽  
Author(s):  
Lamkordor Tyngkan ◽  
Nazia Mahfouz ◽  
Sobia Bilal ◽  
Bazla Fatima ◽  
Nayil Malik
Keyword(s):  
Intracranial Pressure ◽  
Epidural Hematoma ◽  
Rare Complication ◽  
Rare Entity ◽  
Raised Intracranial Pressure ◽  
Extradural Hematoma ◽  
Transtentorial Herniation ◽  
Hematoma Evacuation ◽  
Brainstem Injury ◽  
Acute Epidural Hematoma

AbstractTraumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

scholarly journals Osteogenesis Imperfecta and Extra-/Intradural Hematomas: A Case Report and Review of the Literature

2018 ◽  
Vol 07 (04) ◽  
pp. 185-190
Author(s):  
Emrah Celtikci ◽  
Onur Ozgural ◽  
Umit Eroglu ◽  
Yusuf Caglar ◽  
Fatih Yakar
Keyword(s):  
Osteogenesis Imperfecta ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Bleeding Diathesis ◽  
Review Of The Literature ◽  
Life Threatening ◽  
Brittle Bone Disease ◽  
Platelet Defects ◽  
Threatening Situation ◽  
Management Challenge

AbstractOsteogenesis imperfecta, also named as brittle bone disease, is characterized by fragile bones and short stature caused by mutations in the collagen gene. Subdural and intraparenchymal hematomas are defined and associated with trauma, vascular causes, and systemic bleeding diathesis. Skull fragility may lead to epidural hematoma, which is a life-threatening situation. Vascular fragility and intrinsic platelet defects are the causes of bleeding in patients with osteogenesis imperfecta, which is a major management challenge for neurosurgeons. Here, we reported on a 5-year-old boy with osteogenesis imperfecta with epidural hematoma and skull fracture following a trivial trauma, and made a literature review of 28 cases with extra-/intradural hematoma.

scholarly journals Self-Reported Knowledge Levels of Critical Care Nurses in Managing Neuroemergencies: A Survey Based Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Karan Amlani ◽  
Sonia Nelson ◽  
Elka Riley ◽  
Zachary L Hickman ◽  
Christopher P Kellner ◽  
...  
Keyword(s):  
Critical Care ◽  
Intracranial Pressure ◽  
Work Experience ◽  
Neurocritical Care ◽  
Spine Injury ◽  
Postanesthesia Care Unit ◽  
Raised Intracranial Pressure ◽  
Neurological Emergencies ◽  
Level Of Training ◽  
Comprehensive Stroke Center

Abstract INTRODUCTION Neurocritical care has become increasingly subspecialized. However, due to a lack of bed availability in neurocritical care units (NCCUs), sometimes patients may need to be boarded in other intensive care units (ICUs). Several academic centers do not have access to dedicated NCCUs. We hypothesized that general ICU and postanesthesia care unit (PACU) nurses may not feel as comfortable managing neurocritical care patients. In this survey-based quality improvement (QI) study, we explored the self-reported knowledge of ICU and PACU nurses at a comprehensive stroke center in recognizing and managing some common neurological emergencies such as stroke, status epilepticus, and raised intracranial pressure. METHODS We engaged the nursing managers of 8 units in this QI project, which included medical, surgical, neurocritical care, cardiac and cardiothoracic units as well as PACU and interventional radiology units. Using institutional RedCap, anonymized surveys were sent to the nurses in January 2019. We collected information on demographic and critical care work experience. All participants answered questions on a Likert-type scale based on their knowledge of several common neurological emergencies. RESULTS A total of 240 nurses (199 females, 41 males) participated in the survey. Out of which, 112 (58%) had been working in an ICU for 3 yr or longer. Their self-reported level of knowledge in managing neurological emergencies have been summarized below. More than half the participants did not feel comfortable managing patients with EVDs, ICH, SAH, raised intracranial pressure, and TBI and traumatic spine injury patients. More than 70% of nurses were not satisfied with their current level of training to deal with neuroemergency and supported the need for dedicated training/study time. CONCLUSION ICU and PACU nurses report gaps in knowledge in recognizing and managing common neuroemergencies. With an increasing cohorting of patients in subspecialized units, it is important to provide ongoing education to ICU and PACU nurses to help them maintain fundamental neurocritical knowledge.

The management of “asymptomatic” epidural hematomas

1989 ◽  
Vol 70 (3) ◽  
pp. 392-396 ◽  
Author(s):  
Neville W. Knuckey ◽  
Steven Gelbard ◽  
Mel H. Epstein
Keyword(s):  
Risk Factors ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Management Protocol ◽  
Major Vessel ◽  
Low Incidence ◽  
A Prospective Study ◽  
Fine Print

✓ Standard neurosurgical management mandates prompt evacuation of all epidural hematomas to obtain a low incidence of mortality and morbidity. This dogma has recently been challenged. A number of authors have suggested that in selected cases small and moderate epidural hematomas may be managed conservatively with a normal outcome and without risk to the patient. The goal of this study was to define the clinical parameters that may aide in the management of patients with small epidural hematomas who were clinically asymptomatic at initial presentation because there was no clinical evidence of raised intracranial pressure or focal compression. A prospective study was conducted of 22 patients (17 males and five females) aged from 1 to 71 years, who had a small epidural hematoma diagnosed within 24 hours of trauma and were managed expectantly. Of these, 32% subsequently required evacuation of the epidural hematoma 1 to 10 days after the initial trauma. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score, and initial size of the hematoma are not risk factors for deterioration. However, deterioration was seen in 55% of patients with a skull fracture transversing a meningeal artery, vein, or major sinus, and in 43% of those undergoing computerized tomography (CT) within 6 hours of trauma. In contrast, only 13% of patients in whom the diagnosis of a small epidural hematoma was delayed over 6 hours subsequently required evacuation of the epidural collection. Of patients with both risk factors, 71% required evacuation of the epidural hematoma. None of the patients suffered neurological sequelae attributable to this management protocol. It was concluded that patients with a small epidural hematoma, a fracture overlaying a major vessel or major sinus, and/or who are diagnosed less than 6 hours after trauma are at risk of subsequent deterioration and may require evacuation. Conversely, patients without these risk factors may be managed conservatively with repeat CT and careful neurological observation, because of the low risk of delayed deterioration.

Rapid resolution of acute epidural hematoma

1988 ◽  
Vol 68 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Epidural Hematoma ◽  
Clinical Course ◽  
Skull Fracture ◽  
Fracture Line ◽  
Concomitant Increase ◽  
Content Type ◽  
Rapid Resolution ◽  
Acute Epidural Hematoma ◽  
Fine Print

✓ Two cases of acute epidural hematoma with rapid resolution followed by a benign clinical course are reported. Because of the concomitant increase in the epicranial hematoma over a linear skull fracture in each case, the acute epidural hematoma was presumed to have been decompressed into the epicranial region through the fracture line.

Air in acute epidural hematomas

1986 ◽  
Vol 65 (4) ◽  
pp. 555-556 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Temporal Bone ◽  
Clinical Significance ◽  
Epidural Hematoma ◽  
Pediatric Patients ◽  
Skull Fracture ◽  
Air Bubbles ◽  
Content Type ◽  
Air Bubble ◽  
Acute Epidural Hematoma ◽  
Fine Print

✓ Two pediatric patients with acute epidural hematomas containing air bubble(s) are reported. A skull fracture was observed extending to the mastoid cells of the temporal bone in both patients. In one patient the hematoma and air bubbles subsequently increased in volume, requiring a craniotomy. The clinical significance of air in an acute epidural hematoma is discussed.

scholarly journals Endovascular Treatment of Traumatic Intracranial Aneurysm in an Infant

2003 ◽  
Vol 9 (2) ◽  
pp. 199-204 ◽  
Author(s):  
B. Kim ◽  
S.-K. Lee ◽  
K.G. terBrugge
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Anterior Communicating Artery ◽  
Delayed Presentation ◽  
Minor Head Trauma ◽  
Traumatic Aneurysm

Traumatic intracranial aneurysms in children are rare and mostly related to skull fracture or rapid decelerating closed head injury. We report the case of an infant who developed intracranial aneurysm after minor head trauma and managed by endovascular treatment. A seven-month-old infant presented with delayed intracranial hemorrhage following minor head trauma. Cerebral angiography disclosed a multilobulated fusiform aneurysm involving the right anterior cerebral artery (ACA) distal to the anterior communicating artery. Endovascular treatment of the aneurysm was performed and the infant made an excellent recovery during six months clinical and radiological follow-up. Delayed presentation of intracranial hemorrhage with acute deterioration in the infant after head trauma warrants angiography for proper diagnosis and management of the traumatic aneurysm, which has a high mortality rate after rupture and rebleeding. Endovascular treatment of traumatic aneurysm is feasible in infants, and occlusion of distal intracranial arterial aneurysms can be safely and precisely achieved using current coil technology.

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