scholarly journals Bilateral acetabular fractures induced by an epileptic seizure in a paediatric patient: a unique case and its management

2019 ◽  
Vol 12 (8) ◽  
pp. e230143 ◽  
Author(s):  
Nusrat Mohamed ◽  
Stanislau Makaranka ◽  
Kamalpreet Cheema ◽  
Paul Harnett
Keyword(s):  
Damage Control ◽  
Epileptic Seizures ◽  
Open Reduction Internal Fixation ◽  
Acetabular Fractures ◽  
Free Fluid ◽  
Skeletal Traction ◽  
Pfannenstiel Incision ◽  
Pelvic Injuries ◽  
Control Intervention ◽  
Clonic Seizures

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

890 Bilateral Acetabular Fractures Induced by An Epilepticseizure In a Paediatric Patient: A Unique Case Andits Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Mohamed ◽  
S Makaranka ◽  
K Cheema ◽  
P Harnett
Keyword(s):  
Damage Control ◽  
Epileptic Seizures ◽  
Open Reduction Internal Fixation ◽  
Acetabular Fractures ◽  
Free Fluid ◽  
Skeletal Traction ◽  
Pfannenstiel Incision ◽  
Pelvic Injuries ◽  
Control Intervention ◽  
Clonic Seizures

Abstract Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Does preoperative skeletal traction still have a role in acetabular fractures?

2019 ◽  
Vol 70 (3) ◽  
Author(s):  
Alessandro Aprato ◽  
Luca Tolosano ◽  
Marco Favuto ◽  
Kristijan Zoccola ◽  
Gabriele Cominetti ◽  
...  
Keyword(s):  
Acetabular Fractures ◽  
Skeletal Traction

scholarly journals Assessing efficacy and safety of rectally vs. intravenously administered Sibazon in treatment of generalized epileptic seizures in children

2021 ◽  
Vol 13 (3) ◽  
pp. 200-210
Author(s):  
A. G. Prityko ◽  
K. V. Osipova ◽  
P. L. Sokolov ◽  
E. A. Ezhova ◽  
I. G. Kotel’nikova ◽  
...  
Keyword(s):  
Drug Administration ◽  
Epileptic Seizures ◽  
Blood Analysis ◽  
Intramuscular Administration ◽  
Final Visit ◽  
Fisher Exact Test ◽  
Efficacy And Safety ◽  
Clonic Seizures ◽  
Group 2 ◽  
Group 1

Objective: to prove the therapeutic equivalence and similar safety profile of “Sibazon, rectal solution” (international nonproprietary name: diazepam) and “Sibazon, solution for intravenous and intramuscular administration” in children with primary generalized and bilateral tonic, clonic and tonic-clonic seizures.Material and methods. An open-label, randomized clinical trial on efficacy and safety was conducted in 20 patients suffering from epilepsy with generalized seizures aged 1 to 17 years. Clinical blood and urine tests, biochemical blood analysis were used for diagnostics (glucose, total protein, albumin, total bilirubin, cholesterol, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, alkaline phosphatase, creatinine, urea, creatinine clearance), as well as data on electrocardiographic (ECG) and electroencephalographic (EEG) studies. The patients were divided into two groups: in Group 1 (n=8), a rectal solution was used, in Group 2 (n=12) – a solution for intravenous and intramuscular administration.Results. The number of cases in which seizures were completed within 10 minutes after using the drug without resuming within subsequent 60 minutes, in Group 1 was 7 (87.5%), and in Group 2 – 9 (75.0%) (Fisher exact test (FET): p=0.617). Repeated primary generalized or bilateral tonic/clonic/tonic-clonic seizures within 24 hours after drug administration, in Group 1 were absent in 5 (62.5%) patients, in Group 2 – in 6 (50%) (FET: p=0.670); within 48 hours after drug administration – in 5 (62.5%) and 7 (58.3%) children, respectively (FET: p=1.00). Physical examination revealed no pathology in all patients at the final visit. While comparing ECG and EEG data at the final visit, no inter-group differences were found by the number of children with deviations from the norm. The results of laboratory studies confirmed that using the studied drugs had no negative effect on the main indicators of clinical and biochemical blood tests as well as clinical urine analysis.Conclusion. The effectiveness of the rectal form of Sibazon in relieving pediatric generalized epileptic seizures is comparable to that of Sibazon for intramuscular administration. The drug rectal form, due to easy-to-use administration, is preferable for outpatient practice. “Sibazon, rectal solution” is safe and has good tolerability.

scholarly journals Juvenile myoclonic epilepsy: current state of the problem

2021 ◽  
Vol 1 (2) ◽  
pp. 2-20
Author(s):  
N. A. Shnayder ◽  
K. V. Petrov
Keyword(s):  
Primary Care Physicians ◽  
Epileptic Seizures ◽  
Juvenile Myoclonic Epilepsy ◽  
Historical Significance ◽  
Current State ◽  
High Prevalence ◽  
Clonic Seizures ◽  
Generalized Epilepsy ◽  
Genetically Determined ◽  
Selection Of

Due to the high prevalence of the disease, its genetic and clinical heterogeneity, the need for lifelong therapy and the emergence of new views on the pathogenesis and course of JME, it is necessary to provide primary care physicians (general practitioners, district therapists, neurologists) with up-to-date systematized information about the most common form of genetic generalized epilepsy (Herpin-Janz syndrome). JME is a genetically determined disease of the brain, accompanied by a triad of seizures (absences, myoclonia, generalized tonic-clonic seizures), and developing mainly in adolescence and young age. In recent years, monogenic and multifactorial forms of JME have been identified, but questions about the genetics of JME are far from being resolved. JME is characterized by the preservation of intelligence, life expectancy with adequate therapy does not differ from the average population, but the frequency of failures of pharmaco-induced remission is high when taking anticonvulsants is canceled. This explains the need for lifelong pharmacotherapy, individual selection of anticonvulsants. About 30% of patients with JME have non-psychotic mental disorders, disorders of the sleep and wake cycle, which in turn leads to an aggravation of epileptic seizures mainly in the first half of the day. This review presents an analysis of full-text publications in Russian and English over the past five years in the databases eLibrary, PubMed, Web of Science, OxfordPress, Springer, and Clinicalkeys. In addition, the review includes earlier publications of historical significance.

Disulfiram-induced epileptic seizures

2021 ◽  
Vol 14 (3) ◽  
pp. e236296
Author(s):  
Violeta Nogueira ◽  
Mafalda Azevedo Mendes ◽  
Inês Pereira ◽  
Joana Teixeira
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Alcohol Consumption ◽  
Alcohol Dependence ◽  
Male Patient ◽  
Epileptic Seizure ◽  
Therapeutic Agent ◽  
Epileptic Seizures ◽  
Clinical Complications ◽  
Clonic Seizures

Disulfiram has been widely used for over six decades in the treatment of alcohol dependence, as an aversive therapeutic agent. Despite having very few side effects when taken without concurrent alcohol consumption, some of these may underlie serious clinical complications. Epileptic seizure induction is a rare adverse effect of disulfiram and its aetiological mechanism is unknown. We present a hospitalised 47-year-old male patient with two episodes of generalised tonic-clonic seizures during treatment with disulfiram while abstinent from alcohol.

Intraoperative Imaging in Pelvic Surgery

2018 ◽  
Vol 157 (04) ◽  
pp. 367-377 ◽  
Author(s):  
Holger Keil ◽  
Sara Aytac ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Intraoperative Imaging ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
Posterior Pelvic Ring ◽  
Data Set ◽  
Intraoperative 3D Imaging ◽  
Pelvic Injuries ◽  
Preoperative Ct

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

scholarly journals Brain lesion locations associated with secondary seizure generalization

2021 ◽  
Author(s):  
Janne Nordberg ◽  
Frederic LWVJ Schaper ◽  
Marco Bucci ◽  
Lauri Nummenmaa ◽  
Juho Joutsa
Keyword(s):  
Right Hemisphere ◽  
Brain Lesion ◽  
Epileptic Seizures ◽  
University Hospital ◽  
Brain Atlas ◽  
Patient Specific ◽  
Seizure Type ◽  
Adult Onset ◽  
Lesion Location ◽  
Clonic Seizures

Background: Structural brain lesions are the most common cause of adult-onset epilepsy. The lesion location may contribute to the risk for epileptogenesis, but whether specific lesion locations are associated with a risk for secondary seizure generalization from focal to bilateral tonic-clonic seizures, is unknown. Methods: We identified patients with a diagnosis of adult-onset epilepsy caused by an ischemic stroke or a tumor diagnosed at the Turku University Hospital in 2004-2017. Lesion locations were segmented on patient-specific MR imaging and transformed to a common brain atlas (MNI space). Both region-of-interest analyses (intersection with the cortex, hemisphere, and lobes) and voxel-wise analyses were conducted to identify the lesion locations associated with focal to bilateral tonic-clonic compared to focal seizures. Results: We included 170 patients with lesion-induced epilepsy (94 tumors, 76 strokes). Lesions predominantly localized in the cerebral cortex (OR 2.50, 95% C.I. 1.21-5.15, p = 0.01) and right hemisphere (OR 2.22, 95% C.I. 1.17-4.20, p = 0.01) were independently associated with focal to bilateral tonic-clonic seizures. At the lobar-level, focal to bilateral tonic-clonic seizures were associated with lesions in the right frontal cortex (OR 4.41, 95% C.I. 1.44-13.5, p = 0.009). No single voxels were significantly associated with seizure type. These effects were independent of lesion etiology. Conclusions: Our results demonstrate that lesion location is associated with the risk for secondary generalization of epileptic seizures independent of lesion etiology. These findings may contribute to identifying patients at risk for focal to bilateral tonic-clonic seizures.

scholarly journals Diagnostic and treatment features of concomitant injuries of pelvis and abdomen in the emergency traumatology

2016 ◽  
Vol 97 (6) ◽  
pp. 837-841
Author(s):  
V F Chikaev ◽  
R I Zakirov ◽  
D G Zaydullin ◽  
R O Il’in ◽  
G M Fayzrakhmanova
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
External Fixation ◽  
Damage Control ◽  
Pelvic Injury ◽  
Minimally Invasive Osteosynthesis ◽  
Concomitant Injuries ◽  
Pelvic Injuries ◽  
Fixation Devices ◽  
Full Body

Aim. Analysis of experience of treatment of patients with concomitant injuries of pelvis and abdomen in the emergency traumatology.Methods. Analysis of features of diagnosis and treatment of 77 patients with concomitant pelvic injuries admitted to Kazan City Clinical Hospital №7 was conducted.Results. The structure of concomitant pelvic injuries is characterized by a variety of injuries, often accompanied by severe shock. Concomitant pelvic injury in 74% of patients was accompanied by shock, and in 80% of cases it was II-III grade shock. To reduce the patient’s displacement in the admission ward full body CT scan was performed, and for clarifying the scope of injuries and tactics of management CT scan of injured organs was administered. During the first hour after admission to prevent dislocation of fractures and to stop intrapelvic bleeding external fixation devices in different modifications were used depending on the injury; that allowed stabilizing hemodynamics and condition of the victims. In the second step after stabilization of the patient’s state and hemodynamics and correction of homeostasis minimally invasive surgical interventions are recommended on day 5 to 7. If abdominal injury is identified, the optimal way of external fixation of fractures is C-type fixation frame, which allows adequate access for laparotomy.Conclusion. A patient with severe concomitant trauma needs urgent full body scan with subsequent X-ray CT, staging treatment based on the principal «Damage control», early fixation of pelvic fractures with the use of external fixation devices and subsequent minimally invasive osteosynthesis, and optimal external fixation device which allows adequate access in case of surgery.

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