Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽  
1986 ◽  
Vol 18 (2) ◽  
pp. 190-193 ◽  
Author(s):  
Frederick M. Vincent ◽  
J. Eric Zimmerman ◽  
James Van Haren
Keyword(s):  
Creatine Kinase ◽  
Head Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Treatment Modalities ◽  
Dantrolene Sodium ◽  
Closed Head Injuries ◽  
Closed Head

Abstract Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.

Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 216-218
Author(s):  
Frank J. Genuardi ◽  
William D. King
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Medical Society ◽  
Discharge Instructions ◽  
Youth Athletes ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Grade 3

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

scholarly journals Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Dara Oliver Kavanagh ◽  
Conor Lynam ◽  
Thorsten Düerk ◽  
Mary Casey ◽  
Paul W. Eustace
Keyword(s):  
Head Injury ◽  
Early Recognition ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Favourable Outcome ◽  
Speech And Language ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Common ◽  
Surgical Unit

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

Evoked Potential Correlates of Posttraumatic Amnesia after Closed Head Injury

Neurosurgery ◽  
1984 ◽  
Vol 14 (6) ◽  
pp. 676-678 ◽  
Author(s):  
Andrew C. Papanicolaou ◽  
Harvey S. Levin ◽  
Howard M. Eisenberg ◽  
Bartlett D. Moore ◽  
Katherine E. Goethe ◽  
...  
Keyword(s):  
Head Injury ◽  
Evoked Potential ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Normal Subjects ◽  
Physiological Index ◽  
Closed Head Injuries ◽  
Posttraumatic Amnesia ◽  
Closed Head ◽  
Degree Of Orientation

Abstract The P-300 component of evoked potentials to a rare tone was measured in normal volunteers and in patients with closed head injuries who either were confused (in posttraumatic amnesia) or had recovered from posttraumatic amnesia and were oriented at the time of recording. The latency of this component, which reflects cortical processing of stimuli, varied reliably, with the degree of orientation being longest for confused patients and shortest for normal subjects. On the basis of these data, we suggest that the P-300 latency can be used as a physiological index of cognitive function in patients with closed head injury.

Late Effects of Closed Head Injuries: Psychiatric Observations

1946 ◽  
Vol 92 (386) ◽  
pp. 1-18 ◽  
Author(s):  
E. Guttmann
Keyword(s):  
Head Injury ◽  
Late Effects ◽  
Late Stage ◽  
Head Injuries ◽  
Closed Head Injuries ◽  
Clinical Stages ◽  
Closed Head

In discussing the late stage of head injuries, it is necessary first to define the clinical stages in the treatment of these conditions. With Donald Munroe, it is considered expedient to classify cases of head injury in general into— (a) Operative and (b) Non-operative cases.

Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service

2016 ◽  
Vol 5 (2) ◽  
pp. 65-69
Author(s):  
Dan Parrish ◽  
Shannon Rosati ◽  
Malkit Singh ◽  
Andrew Green ◽  
Jeffrey Haynes
Keyword(s):  
Injury Severity ◽  
Social Issues ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Inclusion Criteria ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Gcs Score

ABSTRACT Introduction Annually in the United States, there are an estimated 474,000 traumatic brain injury (TBI) related Emergency Department (ED) visits in children under age 15 years. While their evaluation and management are not standardized, guidelines generally include a neurological examination and head computed tomography (CT) with neurosurgical and/or pediatric surgical consultation, and admission generally based on imaging as well as persistent neurological symptoms. The primary purpose of this study was to review our experience with admitted isolated closed head injuries in children. We evaluated the safety of their management on a nonsurgical service after ED pediatric neurosurgical consultation deemed the injuries nonoperative. Study design A retrospective review was conducted of pediatric patients with closed head injuries between 2008 and 2013 (n = 837). Inclusion criteria were isolated closed head injury, discharged within 48 hours of admission, Glasgow Coma Scale (GCS) score greater than 13, and admission to a nonsurgical service. A total 272 patients met the inclusion criteria. These patients were divided into two groups based on whether or not they received a neurosurgical consult. Results Of the 272 patients, 221 received a pediatric neurosurgery consult while 51 did not. Those that received a neurosurgical consult had a higher Injury Severity Score (ISS) (7.5 vs 3.6), younger age (4.4 vs 6.9), longer length of stay, higher admission acuity, and were more likely to receive a repeat head CT. There was no difference in GCS score (14.9 vs 15), and the most common discharge symptom was a headache. With admission to nonsurgical services, no complications, readmissions, or missed injuries occurred. Conclusion As pediatric neurosurgery is a limited resource, we evaluated the safety of admitting patients deemed nonsurgical to a medical service for management and follow-up of the TBI, as well as the social issues which are often present. The practice resulted in no morbidity or mortality with efficient management of ancillary consult services. How to cite this article Parrish D, Rosati S, Singh M, Green A, Haynes J. Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service. Panam J Trauma Crit Care Emerg Surg 2016;5(2):65-69.

Physiological and metabolic response to isolated closed-head injury

1986 ◽  
Vol 64 (1) ◽  
pp. 89-98 ◽  
Author(s):  
Clifford Scott Deutschman ◽  
Frank N. Konstantinides ◽  
Sandra Raup ◽  
Phudiphorn Thienprasit ◽  
Frank B. Cerra
Keyword(s):  
Head Injury ◽  
Nutritional Support ◽  
Metabolic Response ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Bed Rest ◽  
Nitrogen Excretion ◽  
Fluid Restriction ◽  
Content Type ◽  
Closed Head

✓ Studies of the metabolic and physiological response to closed-head injury have intimated the presence of persistent hypermetabolism. To more fully define and evaluate the metabolic response to head trauma, a prospective study was conducted in patients with isolated closed-head injuries. Metabolic and cardiopulmonary data were obtained for a 7-day period. Patients with multiple injuries or infections, or those who received steroids, were excluded. The basic treatment regimen utilized hyperventilation, bed rest with head elevation, intracranial pressure monitoring, mild fluid restriction, and mannitol as needed. No exogenous nutritional support was given. Intrastudy trends and comparsion with data from unstressed fasting patients and stressed patients were noted. Mean Glasgow Coma Scale scores were 4.4 ± 1.5 initially, but rose to a mean of 8.2 ± 3.7 by Day 7. While the responses of cardiac index, CO2 production, lactate/pyruvate ratio, and arteriovenous O2 content difference (AVO2D) were initially elevated, these parameters declined over the course of 7 days. The AVO2D was equivalent to the fasting level by Day 5. Metabolic data, including most amino acid levels in plasma, showed an initial equivalence to stress control levels and a pattern similar to that in non-stressed control subjects by Day 7. Nitrogen and 3-methyl histidine excretion were persistently elevated for the full 7 days. Patients with isolated closed-head injury seemed to be initially hypermetabolic, but this process appeared to resolve by 1 week; the persistent nitrogen excretion may reflect equilibration of muscle mass to the existing level of activity (bed rest). After the first few days, nitrogen excretion may give an erroneous index of the level of metabolic stress and the type or amount of nutritional support needed.

scholarly journals The evolution of the treatment of traumatic cerebrovascular injury during wartime

2010 ◽  
Vol 28 (5) ◽  
pp. E5 ◽  
Author(s):  
Randy S. Bell ◽  
Robert D. Ecker ◽  
Meryl A. Severson ◽  
John E. Wanebo ◽  
Benjamin Crandall ◽  
...  
Keyword(s):  
Head Injury ◽  
Resource Availability ◽  
Head Injuries ◽  
Endovascular Techniques ◽  
Traumatic Aneurysm ◽  
Minimal Intervention ◽  
Closed Head Injuries ◽  
Cerebrovascular Injury ◽  
Penetrating Head Injury ◽  
Closed Head

The approach to traumatic craniocervical vascular injury has evolved significantly in recent years. Conflicts prior to Operations Iraqi and Enduring Freedom were characterized by minimal intervention in the setting of severe penetrating head injury, in large part due to limited far-forward resource availability. Consequently, sequelae of penetrating head injury like traumatic aneurysm formation remained poorly characterized with a paucity of pathophysiological descriptions. The current conflicts have seen dramatic improvements with respect to the management of severe penetrating and closed head injuries. As a result of the rapid field resuscitation and early cranial decompression, patients are surviving longer, which has led to diagnosis and treatment of entities that had previously gone undiagnosed. Therefore, in this paper the authors' purpose is to review their experience with severe traumatic brain injury complicated by injury to the craniocervical vasculature. Historical approaches will be reviewed, and the importance of modern endovascular techniques will be emphasized.

Neuroleptic Malignant Syndrome Complicating Closed Head Injury

1986 ◽  
Vol 30 (5) ◽  
pp. 297
Author(s):  
F. M. VINCENT ◽  
J. E. ZIMMERMAN ◽  
J. VAN HAREN
Keyword(s):  
Head Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Closed Head Injury ◽  
Closed Head

scholarly journals Psychological and neuropsychological correlates of postconcussional disorder

2008 ◽  
Author(s):  
Joy Helena Wymer B.S.
Keyword(s):  
United States ◽  
Head Injury ◽  
Brain Injuries ◽  
Spinal Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Room Visits ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Risk Takers

Each year approximately 2 million people in the United States suffer closed head injuries (CHI); approximately 500,000 are severe enough to require hospitalization (Brown, Fann & Grant, 1994). Other researchers have estimated the incidence of CHI in the United States at over 9 million (Miller & Berenguer-Gil, 1994). CHI account for about 10% of all emergency room visits (Sherer, Madison & Hannay, 2000). This number has recently decreased, possibly due to decreased hospitalization of individuals with mild brain injuries. According to the National Head Injury and Spinal Injury Survey of 1980, the typical male is four times more likely to experience a head injury than a female (Kalsbeek, McLaughlin, Harris & Miller, 1980). Men are believed to sustain more head injuries because they have been found to be greater risk-takers, more likely to be engaged in potentially dangerous work, more impulsive, and more likely to abuse alcohol or drugs. Alcohol is reported to be involved in 30% of head injuries suffered by males and 10% of those suffered by females (Bennett, 1987).

Acute Tissue Tear Hemorrhages of the Brain: Computed Tomography and Clinicopathological Correlations

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 208-213 ◽  
Author(s):  
James E. Wilberger ◽  
William E. Rothfus ◽  
Janet Tabas ◽  
Andrew L. Goldberg ◽  
Ziad L. Deeb
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Closed Head Injury ◽  
Sensitive Information ◽  
Computed Tomographic ◽  
Clinicopathological Correlations ◽  
Closed Head ◽  
The Brain

Abstract Tissue tear hemorrhages (TTHs) are often seen on high-resolution computed tomographic scans after closed head injury. Generally, TTHs have been thought to be visible manifestations of more severe forms of diffuse axonal injury and thus portend a poor prognosis. Computed tomographic scans from 600 patients with head injuries were reviewed: 48 (8%) were found to have TTHs. The clinical spectrum of TTHs was characterized. No direct relationship could be established between either the presence or the number of TTHs and the severity and/or outcome from the head injury in this group, except that patients with TTHs in both the brain stem and the corpus callosum uniformly had a poor outcome. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.

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