Penetrating knife injury to the skull: A case report in pediatric neurosurgical care

Trauma ◽  
2016 ◽  
Vol 19 (4) ◽  
pp. 302-307
Author(s):  
Tene A Cage ◽  
Nader Sanai ◽  
Michael T Lawton ◽  
Kurtis I Auguste
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Interdisciplinary Team ◽  
Brain Parenchyma ◽  
Cerebral Vasculature ◽  
Local Trauma ◽  
Tertiary Care Centers ◽  
Knife Injury ◽  
Neurologically Intact ◽  
The Brain

Isolated penetrating head injury in children is rare and is usually accidental. Each case is unique since the penetrating object and the trajectory through the brain parenchyma vary greatly among patients. We present a three-year-old girl who presented with a kitchen utility knife penetrating her left midface, skull, and brain abutting the anterior cerebral vasculature. Though the patient initially presented to a local trauma center, there were no pediatric nor vascular neurosurgeons on staff. Thus, she was transferred to our tertiary facility for definitive surgical management. A pediatric and vascular neurosurgeon worked together to remove the knife safely and the underlying vasculature remained intact. Postoperatively, the patient did well and was neurologically intact. Though penetrating cranial injury is rare in the pediatric population, such complex cases of brain injury can be properly managed with good outcome by an interdisciplinary team of specialists in tertiary care centers and can result in an excellent surgical and functional outcome for the patient.

scholarly journals Differential Diagnosis of the Dementias of Unknown Origin: A Clinician's View

1986 ◽  
Vol 13 (S4) ◽  
pp. 381-382 ◽  
Author(s):  
V.A. Kral
Keyword(s):  
Rural Areas ◽  
Unknown Origin ◽  
Brain Parenchyma ◽  
Laboratory Research ◽  
Cerebral Vasculature ◽  
Pathogenetic Mechanism ◽  
Number Of Patients ◽  
Life Threatening ◽  
Close Cooperation ◽  
The Brain

Abstract:The close cooperation of clinical and laboratory research has helped to clarify the etiology of some of the dementing processes of the senium. However, the necessary investigations are complicated, laborious, expensive and can be carried out only in well equipped centres in larger cities. This restricts the number of patients who eventually may benefit from these investigations to a small number. What is needed for the psychogeriatric practice particularly in rural areas and smaller cities are simple diagnostic guidelines for the psychiatrist to answer the question whether the patient suffers from a dementia and if so whether the dementia is in all probability due to a primary degenerative process of the brain parenchyma or of the cerebral vasculature or is it due to another cause.If degeneration of the brain parenchyma seems the prevalent pathogenetic mechanism one would like to establish in a given case which of the known degenerative processes is most probably present in order to avoid mistakes in clinical judgement with their often life threatening consequences.

scholarly journals The role of intraoperative videoangiography in aneurysm surgery—a comparative study from a tertiary care hospital

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
K. Kaiser ◽  
M. Nayil ◽  
A. Ramzan ◽  
S. Sarbjit ◽  
W. Abrar ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cerebral Vasculature ◽  
Aneurysm Surgery ◽  
Real Time Visualization ◽  
The Brain

Abstract Background Indocyanine green (ICG) is a near-infrared (NIR) fluorescent dye. After intravenous injection, it reaches the vessels of the brain within 30 s. A real-time visualization of the cerebral vasculature is possible. Results The infarction rate and the postoperative rebleed rate in the pre-ICG era group were higher than in the ICG era. Conclusion Intraoperative ICGVA is a safe and effective method to confirm the exclusion of the clipped aneurysm from the circulation. It also helps to assess the patency of the surrounding vessels.

scholarly journals Overestimation of the prevalence of eosinophilic colitis with reliance on a single billing code

2018 ◽  
Author(s):  
AB Muir ◽  
ET Jensen ◽  
JB Wechsler ◽  
P Menard-Katcher ◽  
GW Falk ◽  
...  
Keyword(s):  
Chart Review ◽  
Gastrointestinal Disease ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Bloody Stool ◽  
Eosinophilic Colitis ◽  
Billing Code ◽  
Icd Codes ◽  
Tertiary Care Centers ◽  
Multi Center Study

AbstractEosinophilic colitis (EC) is a rare disorder characterized by eosinophilic inflammation of the colon causing diarrhea, bloody stool, nausea, constipation and abdominal pain. The Consortium for Eosinophilic Gastrointestinal Disease Research sought to undertake the first multi-center study of the EC population, but faced challenges with meeting enrollment goals that were based on initial estimates. To understand the reason for this, we performed chart review of patients with ICD codes for EC at 8 tertiary care centers. Chart review revealed that the isolated use of ICD codes overestimated EC rates in the pediatric population.

Changes in Coagulation following Brain Injury

2020 ◽  
Vol 46 (02) ◽  
pp. 155-166
Author(s):  
Marc Maegele ◽  
John Aversa ◽  
Mathew K. Marsee ◽  
Ross McCauley ◽  
Swetha Hanuma Chitta ◽  
...  
Keyword(s):  
Brain Injury ◽  
Point Of Care ◽  
Activated Protein C ◽  
Brain Parenchyma ◽  
Health Concern ◽  
Cerebral Vasculature ◽  
Clinical Presentations ◽  
Initial Injury ◽  
The Brain ◽  
Supporting Structures

AbstractTraumatic brain injury (TBI) is a worldwide public health concern due to increasing mortality, affecting around 10 million patients per year. A wide variety of clinical presentations are a function of the magnitude of injury and the anatomical perturbation of the brain parenchyma, supporting structures, and cerebral vasculature, with subsequent alteration of the blood–brain barrier. These disturbances correspond with the evolution of intracerebral hemorrhage and clinical outcomes. The associated hemostatic alterations associated with TBI are caused by the disruption of the delicate balance between bleeding and thrombosis formation, which can exacerbate initial injury. TBI-associated coagulopathy is a function of a cross-talk between coagulation and inflammation, with varying influences on the immunomodulation and regulation of coagulation that occur on platelets and the endothelium of injured TBI patients. In addition to the severity of initial injury, the following factors modulate the hemocoagulative response to TBI: time from the onset of injury to treatment, age, gender, catecholamine secretion, platelet dysfunction, endotheliopathy, premorbid anticoagulation, fibrinolysis, tissue factor, and activated protein C contribution. All these entities are intertwined and influence the pathologic evolution of TBI. These factors have implications for therapeutic options such as the choice of blood components for transfusion and hemostatic agents such as tranexamic acid. Monitoring hemostatic changes of TBI patients requires an understanding of these interactions between immunology and coagulation, which can be discerned by point-of-care viscoelastic testing with specific limitations. This review considers the implications of these interrelated influences on the evaluation of coagulopathy in TBI.

scholarly journals EUS in Pediatrics: A Multicenter Experience and Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Travis L. Piester ◽  
Quin Y. Liu
Keyword(s):  
Literature Review ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Technical Success ◽  
Pancreatic Fluid ◽  
Therapeutic Uses ◽  
Wide Range ◽  
Fluid Collections ◽  
Tertiary Care Centers

Background/Aim: Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. We also discuss the current and developing diagnostic and therapeutic uses for EUS in pediatrics such as in pancreaticobiliary disease, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.Methods: This is a retrospective review of EUS performed by two pediatric gastroenterologists trained as endosonographers between April 2017 and November 2020. Patient demographics, procedure indication, procedure characteristics, technical success, and complications were collected. Literature review was performed to describe current and future uses of EUS in pediatrics.Results: Ninety-eight EUS were performed with 15 (15.3%) including fine needle aspiration/biopsy and 9 (9.2%) cases being therapeutic. Most common indications include choledocholithiasis (n = 31, 31.6%), pancreatic fluid collections (n = 18, 18.4%), chronic and acute recurrent pancreatitis (n = 14, 14.3%), and acute pancreatitis characterization (n = 13, 13.3%). Notable indications of pancreatic mass (n = 6, 6.1%) and luminal lesions/strictures (n = 6, 6.1%) were less common. Complications were limited with one instance of questionable GI bleeding after cystgastrostomy creation. Ninety-eight of 98 (100%) cases were technically successful.Conclusion/Discussion: EUS has been shown to be performed safely and successfully in the pediatric population by pediatric endosonographers. This study and review support its use in pediatric practice and demonstrate the wide variety of indications for EUS such as pancreatic cystgastrostomy, celiac plexus neurolysis, and evaluation of chronic pancreatitis. This literature review also demonstrates areas of potential development for EUS within the practice of pediatric gastroenterology.

scholarly journals Spectrum of infectious dermatoses in pediatric population attending tertiary care centers in Central India: an observational study

2019 ◽  
Vol 6 (11) ◽  
pp. 567-571
Author(s):  
Dr. Akhil Shah ◽  
◽  
Dr. Parikshit Sharma ◽  
Dr. Surendra Singh Bhati ◽  
Dr. Anushtha Tomar ◽  
...  
Keyword(s):  
Observational Study ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Central India ◽  
Tertiary Care Centers

scholarly journals Prevalence, Causes and Management of Encephalitis

2021 ◽  
pp. 312-318
Author(s):  
Ibrahim Mahmoud H. Ajwah ◽  
Samirah Nawaf Naif Alrashidi ◽  
Nouf Zayed Omer Al Mutairi ◽  
Ahmad Mazroa Almazroa ◽  
Abdulrahman Jaser F. Almutairi ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Clinical Manifestations ◽  
Brain Parenchyma ◽  
Drug Induced ◽  
Nmda Receptor Encephalitis ◽  
Intravenous Acyclovir ◽  
Previous Infection ◽  
Antiviral Medications ◽  
The Brain ◽  
Infectious Encephalitis

Encephalitis is a major cause of morbidity, mortality, and permanent neurological disability in both adults and children. The term "encephalitis" literally means inflammation of part or all of the "brain" or the brain parenchyma. Encephalitis affects people of all ages; however, the incidence is higher in the pediatric population. Although both genders are affected, most studies showed slight dominance in men. There are two main types with different causes: primary or infectious encephalitis can develop when a fungus, virus, or bacteria infects the brain and accounts for approximately 70% of confirmed cases of encephalitis, and secondary or post-infectious encephalitis when the immune system is active and reacts. to a previous infection and mistakenly attacks the brain. The clinical manifestations depend on whether the brain parenchyma or the meninges are predominantly involved and cause an encephalitic or meningitis syndrome. Diagnostic tests should include a lumbar puncture, an MRI of the brain, and an EEG for suspected  encephalitis. In encephalitis, a broad differential diagnosis, both infectious and non-infectious, should be considered. These alternatives include malignancy, autoimmune or paraneoplastic diseases (eg, anti-NMDA receptor encephalitis), brain abscess, drug-induced tuberculosis or delirium, neurosyphilis, or bacterial, fungal, protozoal, or helminthic encephalitis. Antiviral medications, such as intravenous acyclovir, are often given at the initial diagnosis of encephalitis before the cause is known. Acyclovir is the best treatment for herpes simplex encephalitis. If medication can be started soon after symptoms appear, the chance of a full recovery is much higher.

scholarly journals Acute Injection of Omega-3 Triglyceride Emulsion Provides Very Similar Protection as Hypothermia in a Neonatal Mouse Model of Hypoxic-Ischemic Brain Injury

2021 ◽  
Vol 11 ◽  
Author(s):  
Denny Joseph Manual Kollareth ◽  
Hylde Zirpoli ◽  
Vadim S. Ten ◽  
Richard J. Deckelbaum
Keyword(s):  
Rectal Temperature ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Acute Administration ◽  
Omega 3 ◽  
Ischemic Brain ◽  
Neonatal Mice ◽  
Tertiary Care Centers ◽  
Acute Injection ◽  
The Brain

Therapeutic hypothermia (HT) is a currently accepted treatment for neonatal asphyxia and is a promising strategy in adult stroke therapy. We previously reported that acute administration of docosahexaenoic acid (DHA) triglyceride emulsion (tri-DHA) protects against hypoxic-ischemic (HI) injury in neonatal mice. We questioned if co-treatment with HT and tri-DHA would achieve synergic effects in protecting the brain from HI injury. Neonatal mice (10-day old) subjected to HI injury were placed in temperature-controlled chambers for 4 h of either HT (rectal temperature 31–32°C) or normothermia (NT, rectal temperature 37°C). Mice were treated with tri-DHA (0.375 g tri-DHA/kg bw, two injections) before and 1 h after initiation of HT. We observed that HT, beginning immediately after HI injury, reduced brain infarct volume similarly to tri-DHA treatment (~50%). Further, HT delayed 2 h post-HI injury provided neuroprotection (% infarct volume: 31.4 ± 4.1 vs. 18.8 ± 4.6 HT), while 4 h delayed HT did not protect against HI insult (% infarct volume: 30.7 ± 5.0 vs. 31.3 ± 5.6 HT). HT plus tri-DHA combination treatment beginning at 0 or 2 h after HI injury did not further reduce infarct volumes compared to HT alone. Our results indicate that HT offers similar degrees of neuroprotection against HI injury compared to tri-DHA treatment. HT can only be provided in tertiary care centers, requires intense monitoring and can have adverse effects. In contrast, tri-DHA treatment may be advantageous in providing a feasible and effective strategy in patients after HI injury.

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