Alcohol, Drugs, and Head Injury

To the Editor.— Jacobson and colleagues (Pediatrics 1986;77:236-24l) present a convincing case for comprehensive reassessment of adolescents with serious closed head injuries. However, they make no mention of evaluating such patients for drug or alcohol abuse. Such abuse/dependency can contribute significantly to the etiology of traumatic injuries. We interviewed 202 middle-class adolescents in treatment for drug/alcohol abuse/dependency: 86 (43%) had been involved in at least one motor vehicle accident while intoxicated by drugs, alcohol, or both; 50% had been involved in more than one such incident.

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Fetal closed head injuries following maternal motor vehicle accident

Medicine ◽

10.1097/md.0000000000013133 ◽

2018 ◽

Vol 97 (44) ◽

pp. e13133

Author(s):

Naoki Nishida ◽

Shihomi Ina ◽

Yukiko Hata ◽

Yuko Nakanishi ◽

Shin Ishizawa ◽

...

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Head Injuries ◽

Closed Head Injuries ◽

Vehicle Accident ◽

Closed Head

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Serious Head Injury in Infants: Accident or Abuse?

PEDIATRICS ◽

10.1542/peds.75.2.340 ◽

1985 ◽

Vol 75 (2) ◽

pp. 340-342 ◽

Cited By ~ 10

Author(s):

M. Elaine Billmire ◽

Patricia A. Myers

Keyword(s):

Child Abuse ◽

Head Injury ◽

Medical Records ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Head Injuries ◽

Skull Fracture ◽

Intracranial Injury ◽

Vehicle Accident ◽

History Of

The medical records and computed tomography (CT) scans of all children less than 1 year of age admitted to the hospital with head injury over a 2-year period were reviewed. Sixty-four percent of all head injuries, excluding uncomplicated skull fracture, and 95% of serious intracranial injuries were the result of child abuse. The occurrence of intracranial injury in infants, in the absence of a history of significant accidental trauma, such as a motor vehicle accident, constitutes grounds for an official child abuse investigation.

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Closed head injury and the treatment of sequelae after a motor vehicle accident

Journal of Clinical Anesthesia ◽

10.1016/s0952-8180(05)80020-0 ◽

1994 ◽

Vol 6 (5) ◽

pp. 437-449 ◽

Cited By ~ 4

Author(s):

Joseph Stachniak ◽

A. Joseph Layon ◽

Susan Black ◽

Richard Fessler

Keyword(s):

Head Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Closed Head Injury ◽

Vehicle Accident ◽

Closed Head

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Return of Memory and Sleep Efficiency Following Moderate to Severe Closed Head Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308325268 ◽

2008 ◽

Vol 23 (4) ◽

pp. 320-326 ◽

Cited By ~ 52

Author(s):

Michael J. Makley ◽

Lisa Johnson-Greene ◽

Patrick M. Tarwater ◽

Andrew J. Kreuz ◽

J. Spiro ◽

...

Keyword(s):

Brain Injury ◽

Head Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Closed Head Injury ◽

Recovery Phase ◽

Sleep Efficiency ◽

Rehabilitation Unit ◽

Closed Head ◽

Unit Increase

Objective. Sleep disturbance is common in the subacute recovery phase following brain injury. A previous study from the authors' group found 68% of patients with closed head injury (CHI) had disrupted sleep on a rehabilitation unit. In the present study, the authors investigated whether improvement in sleep efficiency correlates with duration of posttraumatic amnesia (PTA) after CHI. Methods. Fourteen CHI patients were enrolled and followed prospectively. Mechanism of injury included motor vehicle accident, fall, and blunt assault. An actigraph was placed on each subject's wrist within 72 hours of admission to the rehabilitation unit and recorded data for the duration of their stay. A minimum of 7 days of continuous actigraphy data was obtained on all subjects. PTA was measured daily using the Orientation Log (O-LOG). Results. Seventy-eight percent of subjects had mean week-1 sleep efficiency scores of ≤63%. Patients admitted having already cleared PTA had significantly better week-1 sleep efficiency scores than those with ongoing amnesia ( P = .032). For those patients admitted with ongoing PTA, each 10-unit increase in sleep efficiency score correlated with 1 unit increase in O-LOG score ( P = .056). Conclusions. Disrupted sleep is common in the postacute stage following CHI. Improved sleep efficiency correlates with resolution of PTA. Decreased sleep efficiency may negatively affect memory return after traumatic brain injury. Actigraphy is uniquely suited to study the sleep patterns of these patients.

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Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽

10.1542/peds.95.2.216 ◽

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.

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Late Effects of Closed Head Injuries: Psychiatric Observations

Journal of Mental Science ◽

10.1192/bjp.92.386.np ◽

1946 ◽

Vol 92 (386) ◽

pp. 1-18 ◽

Cited By ~ 15

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.

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Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽

10.1227/00006123-198602000-00013 ◽

1986 ◽

Vol 18 (2) ◽

pp. 190-193 ◽

Cited By ~ 17

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.

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