scholarly journals Korelasi Marshall CT score sebagai prediktor mortalitas pada penderita cedera kepala di RSUD dr Abdul Aziz Singkawang

2019 ◽  
Vol 5 (4A) ◽  
pp. 1507
Author(s):  
Titah Arif Cahyo Kumoro ◽  
Sonny Giat Raja Saragih ◽  
Diana Natalia
Keyword(s):  
Ct Scan ◽  
Mass Lesion ◽  
Diffuse Injury

Latar Belakang: Cedera kepala termasuk masalah global dan salah satu penyebab terbanyak kematian dan kecacatan diseluruh dunia. Insiden cedera kepala banyak terjadi pada usia produktif, yaitu pada usia 15-24 tahun. Di Indonesia kasus trauma merupakan penyebab kematian terbanyak ke-4 setelah stroke, tuberkulosis dan hipertensi. Insiden terjadinya cedera kepala di Indonesia relatif tinggi, terutama cedera kepala akibat kecelakaan lalu lintas yang mencapai angka 19,6%. Di Kalimantan Barat sendiri jumlah korban meninggal akibat kecelakaan lalu lintas terjadi sebanyak 560 orang pada tahun 2013, 550 orang pada tahun 2014 dan 470 orang pada tahun 2015. Sedangkan insiden kecelakaan lalu lintas di Kota Singkawang tercatat 211 kasus pada tahun 2012, 168 kasus pada tahun 2013, 120 kasus pada tahun 2014, 110 kasus pada tahun 2015 dan terdapat 71 kasus pada tahun 2016. Metode: Penelitian ini bersifat analitik dengan menggunakan pendekatan potong lintang. Dilakukan di RSUD Dr Abdul Aziz Kota Singkawang. Penelitian ini menggunakan total sampling dari seluruh rekam medis pasien bedah saraf dengan cedera kepala sedang dan berat diRSUD Abdul Aziz Kota Singkawang. Data yang diambil adalah hasil penilaian CT Scan pasien menggunakan Marshall CT Score dan penilaian hasil keluar, yang diambil berdasarkan rekam medis pasien. Sampel minimal yang diambil sebanyak 30 sampel yang sesuai dengan kriteria inklusi dan eksklusi. Hasil: terdapat korelasi positif yang sangat kuat antara Marshall CT Score dan mortalitas pada pasien cedera kepala sedang dan berat dengan nilai r mencapai 0.943 dari 66 data. Kesimpulan: Terdapat korelasi positif yang sangat kuat antara Marshall CT Score dan mortalitas, yang mana semakin tinggi nilai Marshall maka semakin tinggi angka mortalitas. Nilai GCS yang terbanyak pada subjek penelitian adalah 12. Nilai Marshall CT Score terbanyak yaitu kategori diffuse injury II, dan persentase mortalitas tertinggi pada kategori non evacuated mass lesion. Angka mortalitas pada pasien cedera kepala sedang dan berat adalah 26 orang.

scholarly journals Hubungan Kadar Interleukin 6 Serum dan Klasifikasi CT Marshal pada Penderita Cedera Otak Berat Akibat Trauma

2019 ◽  
Vol 11 (1) ◽  
pp. 41
Author(s):  
Mervin Manginte ◽  
Eko Prasetyo ◽  
Maximillian Ch. Oley
Keyword(s):  
Ct Scan ◽  
Interleukin 6 ◽  
Venous Blood ◽  
Cross Sectional ◽  
Coefficient Corrélation ◽  
Severe Tbi ◽  
Diffuse Injury ◽  
Cross Sectional Design ◽  
The Relationship ◽  
The Brain

Abstract: Increase of interleukin 6 (IL-6) level occurs in the brain after traumatic brain injury (TBI), however, studies about IL-6 as a prodictor based on CT-scan is still limited. This study was aimed to evaluate the relationship between serum IL-6 level and CT Marshall classification in patients with severe TBI. This was an observational study with a cross sectional design. There were 20 patients with severe TBI admitted at the Emergency Surgery Installation of Prof. Dr. R. D. Kandou Hospital Manado in this study. CT-scan was performed on them to determine the CT Marshall classification and to categorize the hemorrhage location (extra-axial, intra-axial, both), hemisphere (midline/diffuse, dextral, sinistral), and area (frontal, parietal, temporal, occipital, multiple). Venous blood sample used for IL-6 examination was drawn less than 24 hours after trauma. The results showed that mean IL-6 level was 22.0060 pg/mL (SD 4.64494 pg/mL). Patients were distributed relatively uniform in 4 detected categories (diffuse injury II, III, V, and VI) of CT Marshall classification. Final regression model consisted of IL-6, age, and temporal injury as predictors. The Spearman coefficient correlation showed rs = -0.005 (P=0.491). Conclusion: There was no significant relationship between serum Il-6 level and CT Marshall classification, albeit, both of them increased consistantly following the severity of TBI and could be potential predictors to determine the prognosis of severe TBI patients.Keywords: IL-6, CT Marshall, severe TBIAbstrak: Pada cedera otak berat akibat trauma (COBT) terjadi peningkatan ekspresi IL-6 di otak namun penelitian mengenai kemampuannya untuk memrediksi hasil berdasarkan klasifikasi CT scan masih terbatas. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar IL-6 serum dan klasifikasi CT Marshall pada pasien dengan COBT. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 20 pasien yang dirawat dengan COBT di IRDB RSUP Prof. Dr. R. D. Kandou Manado. CT-scan segera digunakan untuk menentukan klasifikasi CT Marshall dan untuk mengategorikan lokasi (ekstra-aksial, intra-aksial, keduanya), belahan (garis tengah/difus, dekstra, sisnitra), dan area otak yang terlibat dalam cedera. Sampel darah vena untuk IL-6 diambil kurang dari 24 jam setelah trauma. Hasil penelitian mendapatkan rerata kadar IL-6 22,0060 pg/mL (SD 4,64494 pg/mL). Pasien didistribusikan relatif seragam dalam empat kategori yang terdeteksi (difus cedera II, III, V, dan VI) dari klasifikasi CT Marshall. Model regresi akhir terdiri dari IL-6, usia, dan cedera pada area temporal sebagai prediktor. Korelasi antara kadar IL-6 serum dan klasifikasi CT Marshall dianalisis dengan koefisien korelasi Spearman dan mendapatkan rs = -0,005 (P=0,491). Simpulan: Walaupun secara statistik tidak terdapat hubungan bermakna antara kadar Il-6 serum dan CT Marshall namun keduanya secara konsisten meningkat mengikuti COBT dan dapat menjadi prediktor potensial untuk menentukan prognosis pada pasien dengan COBT.Kata kunci: IL-6, CT Marshall, COBT

Role of intracranial pressure monitoring in severely head-injured patients without signs of intracranial hypertension on initial computerized tomography

1994 ◽  
Vol 80 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Michael G. O'Sullivan ◽  
Patrick F. Statham ◽  
Patricia A. Jones ◽  
J. Douglas Miller ◽  
N. Mark Dearden ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ct Scan ◽  
Intracranial Hypertension ◽  
Mass Lesion ◽  
Midline Shift ◽  
Pressure Monitoring ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Previous studies have suggested that only a small proportion (< 15%) of comatose head-injured patients whose initial computerized tomography (CT) scan was normal or did not show a mass lesion, midline shift, or abnormal basal cisterns develop intracranial hypertension. The aim of the present study was to re-examine this finding against a background of more intensive monitoring and data acquisition. Eight severely head-injured patients with a Glasgow Coma Scale score of 8 or less, whose admission CT scan did not show a mass lesion, midline shift, or effaced basal cisterns, underwent minute-to-minute recordings of arterial blood pressure, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) derived from blood pressure minus ICP. Intracranial hypertension (ICP ≥ 20 mm Hg lasting longer than 5 minutes) was recorded in seven of the eight patients; in five cases the rise was pronounced in terms of both magnitude (ICP ≥ 30 mm Hg) and duration. Reduced CPP (≤ 60 mm Hg lasting longer than 5 minutes) was recorded in five patients. Severely head-injured (comatose) patients whose initial CT scan is normal or does not show a mass lesion, midline shift, or abnormal cisterns nevertheless remain at substantial risk of developing significant secondary cerebral insults due to elevated ICP and reduced CPP. The authors recommend continuous ICP and blood pressure monitoring with derivation of CPP in all comatose head-injured patients.

A new classification of head injury based on computerized tomography

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S14-S20 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Sharon Bowers Marshall ◽  
Melville R. Klauber ◽  
Marjan van Berkum Clark ◽  
Howard M. Eisenberg ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Midline Shift ◽  
New Classification ◽  
Content Type ◽  
Diffuse Injury

✓ A new classification of head injury based primarily on information gleaned from the initial computerized tomography (CT) scan is described. It utilizes the status of the mesencephalic cisterns, the degree of midline shift in millimeters, and the presence or absence of one or more surgical masses. The term “diffuse head injury” is divided into four subgroups, defined as follows: Diffuse Injury I includes all diffuse head injuries where there is no visible pathology; Diffuse Injury II includes all diffuse injuries in which the cisterns are present, the midline shift is less than 5 mm, and/or there is no high- or mixed-density lesion of more than 25 cc; Diffuse Injury III includes diffuse injuries with swelling where the cisterns are compressed or absent and the midline shift is 0 to 5 mm with no high- or mixed-density lesion of more than 25 cc; and Diffuse Injury IV includes diffuse injuries with a midline shift of more than 5 mm and with no high- or mixed-density lesion of more than 25 cc. There is a direct relationship between these four diagnostic categories and the mortality rate. Patients suffering diffuse injury with no visible pathology (Diffuse Injury I) have the lowest mortality rate (10%), while the mortality rate in patients suffering diffuse injury with a midline shift (Diffuse Injury IV) is greater than 50%. When used in conjunction with the traditional division of intracranial hemorrhages (extradural, subdural, or intracerebral), this categorization allows a much better assessment of the risk of intracranial hypertension and of a fatal or nonfatal outcome. This more accurate categorization of diffuse head injury, based primarily on the result of the initial CT scan, permits specific subsets of patients to be targeted for specific types of therapy. Patients who would appear to be at low risk based on a clinical examination, but who are known from the CT scan diagnosis to be at high risk, can now be identified.

scholarly journals Lissauer form of paretic neurosyphilis with a cerebral mass lesion

1988 ◽  
Vol 46 (3) ◽  
pp. 316-319
Author(s):  
Ricardo Nitrini ◽  
Antonio A. Zambón ◽  
Roberto Hirsh ◽  
Sérgio Rosemberg ◽  
M. Scaff
Keyword(s):  
Cerebrospinal Fluid ◽  
Ct Scan ◽  
Cerebral Hemisphere ◽  
Brain Biopsy ◽  
Mass Lesion ◽  
Progressive Dementia ◽  
Right Cerebral Hemisphere ◽  
Penicillin Therapy ◽  
Cerebrospinal Fluid Examination ◽  
The Right

A 40-year-old male patient with progressive dementia presented adversive seizures, and CT scan showed an enlarging focal mass lesion in the right cerebral hemisphere. Cerebrospinal fluid examination and brain biopsy confirmed the diagnosis of neurosyphilis. After a course of penicillin therapy there was disappearance of the cerebral mass lesion and the CT scan showed focal atrophy in the right cerebral hemisphere. This case suggests that Lissauer form of paretic neurosyphilis may present as a focal mass lesion.

Neurosyphilis Presenting as a Focal Mass Lesion: A Case Report

Neurosurgery ◽  
1984 ◽  
Vol 14 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Lawrence Kulla ◽  
James A. Russell ◽  
Thomas W. Smith ◽  
Joseph L. Zito ◽  
Robin Davidson
Keyword(s):  
Case Report ◽  
White Matter ◽  
Ct Scan ◽  
White Matter Lesion ◽  
Mass Effect ◽  
Mass Lesion ◽  
Low Density ◽  
Computed Tomographic ◽  
Serological Examination

Abstract A patient with subacute aphasia and hemiparesis was found to have a low density white matter lesion with mass effect on the computed tomographic (CT) scan. Serological examination and biopsy established the diagnosis of paretic neurosyphilis. This CT appearance has not previously been described in cases of neurosyphilis. Neurosyphilis should be considered as a potentially treatable cause of a cerebral mass lesion.

1596: Lymph Node Staging in Prostate Cancer by the use of 11C-CHOLIN-PET/CT Scan Imaging

2005 ◽  
Vol 173 (4S) ◽  
pp. 432-432
Author(s):  
Georg C. Bartsch ◽  
Norbert Blumstein ◽  
Ludwig J. Rinnab ◽  
Richard E. Hautmann ◽  
Peter M. Messer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Ct Scan ◽  
Lymph Node Staging ◽  
Pet Ct ◽  
Pet Ct Scan

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Rajkovic ◽  
Zelic ◽  
Papes ◽  
Cizmek ◽  
Arslani
Keyword(s):  
Atrial Fibrillation ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Abdominal Cavity ◽  
Celiac Axis ◽  
Contrast Administration ◽  
Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient’s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

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