Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar Infarction

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 539-544 ◽  
Author(s):  
Jörg Baldauf ◽  
Joachim Oertel ◽  
Michael R. Gaab ◽  
Henry W.S. Schroeder
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Glasgow Outcome Scale ◽  
Endoscopic Third Ventriculostomy ◽  
External Ventricular Drainage ◽  
Third Ventriculostomy ◽  
Cerebellar Infarction ◽  
Ventricular Drainage ◽  
Occlusive Hydrocephalus

Abstract OBJECTIVE: The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases. METHODS: Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale. RESULTS: In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4. CONCLUSION: Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.

scholarly journals Mortality and Functional Outcome Predictors in Combat-Related Penetrating Brain Injury Treatment in a Specialty Civilian Medical Facility

2020 ◽  
Vol 185 (5-6) ◽  
pp. e774-e780
Author(s):  
Andrii Sirko ◽  
Grigoriy Pilipenko ◽  
Dmytro Romanukha ◽  
Alexander Skrypnik
Keyword(s):  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Treatment Outcomes ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Glasgow Outcome Scale ◽  
Outcome Predictors ◽  
Septic Complications ◽  
Penetrating Brain Injury ◽  
Injury Treatment

Abstract Introduction The combined use of new types of weapons and new types of personal protective equipment has led to changes in the occurrence, nature, and severity of penetrating brain wounds. The availability of modern equipment, methods of treatment, and trained medical personnel in a civilian hospital, as well as advanced specialty medical care, has improved treatment outcomes. There have been a limited number of publications regarding analysis and predictors of treatment outcomes in patients with combat-related penetrating brain injury in contemporary armed conflicts. The purpose of this study was to analyze the results of surgical treatment of patients with penetrating brain injury and to identify significant outcome predictors in these patients. Materials and Methods This was a prospective analysis of penetrating brain injury in patients who were admitted to Mechnikov Dnipropetrovsk Regional Clinical Hospital, Ukraine, from May 9, 2014, to December 31, 2017. All wounds were sustained during local armed conflict in Eastern Ukraine. The primary outcomes of interest were mortality rate at 1 month and Glasgow Outcome Scale score at 12 months after the injury. Results In total, 184 patients were identified with combat-related brain injury; of those, 121 patients with penetrating brain injury were included in our study. All patients were male soldiers with a mean age of 34.1 years (standard deviation [SD], 9.1 years). Mean admission Glasgow Coma Scale score was 10 (SD, 4), and mean admission Injury Severity Score was 27.7 (SD, 7.6). Mortality within 1 month was 20.7%, and intracranial purulent-septic complications were diagnosed in 11.6% of the patients. Overall, 65.3% of the patients had favorable outcome (good recovery or moderate disability) based on Glasgow Outcome Scale score at 12 months after the injury. The following were predictors of mortality or poor functional outcome at 1 year after the injury: low Glasgow Coma Scale score on admission, gunshot wound to the head, dural venous sinuses wound, presence of intracerebral hematomas, intraventricular and subarachnoid hemorrhage accompanied by lateral or axial dislocation, and presence of intracranial purulent-septic complications. Conclusions Generally, combat-related penetrating brain injuries had satisfactory treatment outcomes. Treatment outcomes in this study were comparable to those previously reported by other authors in military populations and significantly better than outcomes of peacetime penetrating brain injury treatment.

Retroclival Epidural Hematomas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 404-407 ◽  
Author(s):  
R. Shane Tubbs ◽  
Christoph J. Griessenauer ◽  
Todd Hankinson ◽  
Curtis Rozzelle ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Coma Scale ◽  
Presenting Symptoms ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

Epidural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 35-44
Author(s):  
Lydia Kaoutzani ◽  
Martina Stippler
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Epidural Hematoma ◽  
Emergency Situation ◽  
Intracranial Injury ◽  
Coma Scale ◽  
Sagittal Sinus ◽  
Interosseous Artery ◽  
Neurologically Intact

Although epidural hematomas (EDH) are not frequently seen with intracranial injury in trauma, they present an emergency situation that can result in significant mortality if not diagnosed and treated in a timely manner. EDH stems from bleeding from the bone rupturing an interosseous artery, the bone itself, or from a venous sinus laceration. Most EDH present with a classic biconvex shape on CT images. Venous EDH can cross the midline and are often found under the transverse or sagittal sinus. The current school of thought is that patients who present with a small (<10 mm maximal thickness) EDH with no neurological symptoms can be treated conservatively. Patients neurologically intact with a normal Glasgow Coma Scale score but an EDH of greater than 30 cc should undergo surgery.

Comparison of AVPU Scale and the Glasgow Coma Scale Score in Assessing Encephalitis in Children

2016 ◽  
Vol 01 (04) ◽  
Author(s):  
Nguyen Thi Huyen Sam ◽  
Pham Ngoc Toan ◽  
Truong Thi Mai Hong ◽  
Le Thanh Hai
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale

Devastating Consequences of Subway Accidents: Traumatic Amputations

2006 ◽  
Vol 72 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Alexandra A. Maclean ◽  
Andrea M. O'Neill ◽  
H. Leon Pachter ◽  
Maurizio A. Miglietta
Keyword(s):  
New York ◽  
Glasgow Coma Scale ◽  
Limb Salvage ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Vital Signs ◽  
Wound Infection Rate ◽  
Operative Procedures ◽  
Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

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