Prophylactic phenytoin in severe head injuries

1979 ◽  
Vol 51 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Richard N. W. Wohns ◽  
Allen R. Wyler
Keyword(s):  
Retrospective Study ◽  
Head Injury ◽  
High Probability ◽  
Late Onset ◽  
Head Injuries ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
Fine Print

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

Head injuries due to falls caused by seizures: a group at high risk for traumatic intracranial hematomas

1997 ◽  
Vol 86 (3) ◽  
pp. 433-437 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Jennifer Brown ◽  
Irene Sullivan ◽  
Richard J. Moulton
Keyword(s):  
Head Injury ◽  
Alcohol Intoxication ◽  
Head Injuries ◽  
Chi Square ◽  
Focal Neurological Deficit ◽  
Content Type ◽  
Intracranial Hematomas ◽  
Chi Square Analysis ◽  
Mass Lesions ◽  
Fine Print

✓ This prospective review of adult patients with head injuries examines the incidence of head injuries due to falls caused by seizures, the incidence and severity of intracranial hematomas, and the morbidity and mortality rates in this patient population. A head injury was attributed to a fall caused by a seizure if the seizure was witnessed to have caused the fall, or the patient had a known seizure history, appeared postictal or was found convulsing after the fall, and no other cause for the fall was evident. A total of 1760 adult head-injured patients were consecutively admitted to the authors' service between 1986 and 1993. Five hundred eighty-two head injuries (33.1%) were due to falls and 22 (3.8%) of these were caused by seizures. Based on the prevalence rates for epilepsy in the general population of 0.5 to 2%, these results indicate that epileptics are several times more likely to suffer a head injury due to a fall. Mass lesions were found in 20 (90.9%) of these 22 patients and the remaining two patients suffered mild diffuse head injuries. There was a high incidence of extraaxial mass lesions: 17 (85%) of the 20 intracranial hematomas were either epidural (five cases) or acute subdural (12 cases) hematomas. Eighteen (81.8%) of the 22 patients required evacuation of a hematoma. Both the incidence of intracranial hematomas (90.9% vs. 39.8%; p < 0.001, chi-square analysis) and the rate of hematoma evacuation (81.8% vs. 32.3%; p < 0.001) was significantly greater in patients injured in falls due to seizures (22 cases) than in the group injured in falls from all other causes (560 cases). The higher incidence of hematomas and the need for evacuation were not explained by differences in age, severity of head injury, or incidence of alcohol intoxication. Despite the greater incidence of mass lesions and the need for operative treatment in patients injured because of seizures, their mortality rate was similar to that of patients injured in falls from other causes. On the basis of their review of patients admitted to a neurosurgical center with complaints of head injury, the authors conclude that patients with head injuries due to a fall caused by a seizure should undergo computerized tomography scanning early in their management. Until a mass lesion has been excluded, any decrease in level of consciousness or focal neurological deficit should not be attributed to the seizure itself.

Treatment of head injuries in the American Civil War

1993 ◽  
Vol 78 (5) ◽  
pp. 838-845 ◽  
Author(s):  
Howard H. Kaufman
Keyword(s):  
Civil War ◽  
Head Injury ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Gunshot Wounds ◽  
American Civil War ◽  
Content Type ◽  
Severity Of Injury ◽  
Surgical History ◽  
Fine Print

✓ At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

The syndrome of carotid occlusion following minor craniocerebral trauma

1970 ◽  
Vol 33 (6) ◽  
pp. 636-639 ◽  
Author(s):  
Richard A. Olafson ◽  
Lee A. Christoferson
Keyword(s):  
Head Injury ◽  
Young Patient ◽  
Head Injuries ◽  
Craniocerebral Trauma ◽  
Carotid Occlusion ◽  
Content Type ◽  
Delayed Onset ◽  
Visual Defects ◽  
A Minor ◽  
Fine Print

✓ A new syndrome of carotid occlusion following a minor head injury not obviously involving the neck is reported in two patients. The characteristic delayed onset of unilateral motor, sensory, and visual defects in the relatively young patient is discussed. The authors have also hypothesized a mechanism for carotid occlusion produced by minor head injuries.

Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon

2002 ◽  
Vol 97 (3) ◽  
pp. 542-548 ◽  
Author(s):  
Hiroshi Nakaguchi ◽  
Kazuo Tsutsumi
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Sports Injuries ◽  
Head Injuries ◽  
Acute Subdural Hematoma ◽  
Opposite Edge ◽  
Winter Sports ◽  
Content Type ◽  
Shear Injury ◽  
Fine Print

Object. To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms. Methods. The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries. The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441). Conclusions. The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding.

Moderate head injury: a guide to initial management

1992 ◽  
Vol 77 (4) ◽  
pp. 562-564 ◽  
Author(s):  
Sherman C. Stein ◽  
Steven E. Ross
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
Ct Scanning ◽  
Ct Scans ◽  
Initial Examination ◽  
Content Type ◽  
Injury Group ◽  
Intracranial Lesions ◽  
Gcs Score ◽  
Fine Print

✓ The purpose of this study is to determine the initial treatment of patients who appear to have sustained moderate head injuries when first evaluated. The authors reviewed the records of 341 patients whose initial Glasgow Coma Scale (GCS) scores ranged from 9 to 12, as well as another 106 patients with GCS scores of 13. All patients underwent cranial computerized tomography (CT) at the time of admission. In 40.3% of these patients the CT scans were abnormal (30.6% had intracranial lesions), and 8.1 % required neurosurgical intervention (craniotomies for hematoma in 12, elevation of depressed fractures in five, and insertion of intracranial pressure monitors in 19). Four patients died of their intracranial injuries. A similar incidence of lesions found on CT and at surgery suggests that an initial GCS score of 13 be classified with the moderate head injury group. Skull fractures were found to be poor indicators of intracranial abnormalities. These results suggest that all patients with head injury thought to be moderate on initial examination be admitted to the hospital and undergo urgent CT scanning. Patients with intracranial lesions require immediate neurosurgical consultation, surgery as needed, and admission to a critical-care unit. Scans should be repeated in patients whose recovery is less rapid than expected and in all patients with evidence of clinical deterioration; this was necessary in almost half of the patients in this group, and 32% were found to have progression of radiological abnormalities on serial CT scans.

Bilateral trigeminal and abducens neuropathies following low-velocity, crushing head injury

1979 ◽  
Vol 50 (4) ◽  
pp. 508-511 ◽  
Author(s):  
C. Gail Summers ◽  
Jonathan D. Wirtschafter
Keyword(s):  
Head Injury ◽  
Head Trauma ◽  
Head Injuries ◽  
Large Diameter ◽  
Low Velocity ◽  
Content Type ◽  
Diameter Pipe ◽  
Closed Head ◽  
Closed Head Trauma ◽  
Fine Print

✓ A case is presented of bilateral injury to the trigeminal and abducens nerves following closed head trauma in which the patient survived crushing of the head by a heavy, large-diameter pipe. Bilateral trigeminal and unilateral abducens neuropathies persisted for more than 1 year. These unusual findings are discussed in regard to localization and possible mechanisms of injury. The effects of this type of low-velocity, crushing head injury are compared and contrasted with those of acceleration-deceleration head injuries.

Risk factors predicting operable intracranial hematomas in head injury

1992 ◽  
Vol 77 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Michael B. Gutman ◽  
Richard J. Moulton ◽  
Irene Sullivan ◽  
Gillian Hotz ◽  
William S. Tucker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head Injury ◽  
Head Injuries ◽  
Mass Effect ◽  
Content Type ◽  
Logistic Analysis ◽  
Intracranial Hematomas ◽  
Gcs Score ◽  
Mass Lesions ◽  
Fine Print

✓ A study was performed to examine the incidence of operable traumatic intracranial hematomas accompanying head injuries of differing degrees of severity, and to see if factors predicting operable mass lesions could be identified. Logistic analysis was used to identify independent predictors of operable traumatic intracranial hematomas. Data were gathered prospectively on 1039 patients admitted with head injury between January, 1986, and December, 1990. Patient age, Glasgow Coma Scale (GCS) score, pupillary inequality, and injury by falling were all independent predictors of the presence of operable intracranial hematomas (p = 0.0000, 0.0000, 0.0182, and 0.0001, respectively). Injury to vehicle occupants was less likely to result in operable mass lesions (p = 0.0001) than injury by other means. The incidence of traumatic intracranial hematomas in patients over 50 years old was three to four times higher than in those under 30 years of age. Not surprisingly, the incidence of operable hematomas increased with decreasing GCS scores. However, even at a GCS score of 13 to 15, patients with other risk factors had a substantial incidence of operable mass lesions. There was a 29% incidence of operable intracranial hematomas for patients with a GCS score of 13 to 15, aged over 40 years and injured in a fall. It is suggested that patients who are middle-aged or older, or those injured in falls, are at particular risk for traumatic intracranial hematomas even if their GCS score is high. These patients should have early definitive investigation with computerized tomography in order to identify operable hematomas and to initiate surgical treatment prior to neurological deterioration from mass effect.

Quantitative pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury

2003 ◽  
Vol 98 (1) ◽  
pp. 205-213 ◽  
Author(s):  
William R. Taylor ◽  
Jeff W. Chen ◽  
Hal Meltzer ◽  
Thomas A. Gennarelli ◽  
Cynthia Kelbch ◽  
...  
Keyword(s):  
Head Injury ◽  
Healthy Volunteers ◽  
New Technology ◽  
Head Injuries ◽  
Mass Effect ◽  
Midline Shift ◽  
Content Type ◽  
Cardiology Clinic ◽  
Diffuse Brain Swelling ◽  
Fine Print

✓ The authors prospectively used a new hand-held point-and-shoot pupillometer to assess pupillary function quantitatively. Repetitive measurements were initially made in more than 300 healthy volunteers ranging in age from 1 to 87 years, providing a total of 2432 paired (alternative right eye, left eye) measurements under varying light conditions. The authors studied 17 patients undergoing a variety of nonintracranial, nonophthalmological, endoscopic, or surgical procedures and 20 seniors in a cardiology clinic to learn more about the effects of a variety of drugs. Additionally, the authors carried out detailed studies in 26 adults with acute severe head injury in whom intracranial pressure (ICP) was continuously monitored. Finally, five patients suffering from subarachnoid hemorrhage were also studied. Quantitative pupillary measurements could be reliably replicated in the study participants. In healthy volunteers the resting pupillary aperture averaged 4.1 mm and the minimal aperture after stimulation was 2.7 mm, resulting in a 34% change in pupil size. Constriction velocity averaged 1.48 ± 0.33 mm/second. Pupillary symmetry was striking in both healthy volunteers and patients without intracranial or uncorrected visual acuity disorders. In the 2432 paired measurements in healthy volunteers, constriction velocity was noted to fall below 0.85 mm/second on only 33 occasions and below 0.6 mm/second on eight occasions (< one in 310 observations). In outpatients, the reduction in constriction velocity was observed when either oral or intravenous narcotic agents and diazepam analogs were administered. These effects were transient and always symmetrical. Among the 26 patients with head injuries, eight were found to have elevations of ICP above 20 mm Hg and pupillary dynamics in each of these patients remained normal. In 13 patients with a midline shift greater than 3 mm, elevations of ICP above 20 mm Hg, when present for 15 minutes, were frequently associated with a reduction in constriction velocity on the side of the mass effect to below 0.6 mm/second (51% of 156 paired observations). In five patients with diffuse brain swelling but no midline shift, a reduction in constriction velocities did not generally occur until the ICP exceeded 30 mm Hg. Changes in the percentage of reduction from the resting state following stimulation were always greater than 10%, even in patients receiving large doses of morphine and propofol in whom the ICP was lower than 20 mm Hg. Asymmetry of pupillary size greater than 0.5 mm was observed infrequently (< 1%) in healthy volunteers and was rarely seen in head-injured patients unless the ICP exceeded 20 mm Hg. Pupillometry is a reliable technology capable of providing repetitive data on quantitative pupillary function in states of health and disease.

Prognostic factors in the persistence of posttraumatic epilepsy

1972 ◽  
Vol 37 (2) ◽  
pp. 164-169 ◽  
Author(s):  
George H. Weiss ◽  
William F. Caveness
Keyword(s):  
Prognostic Factors ◽  
Korean War ◽  
Head Injuries ◽  
Craniocerebral Trauma ◽  
Prognostic Indicators ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
The Korean War ◽  
Special Concern ◽  
Fine Print

✓ A group of 356 patients who received head injuries in the Korean War during 1951–1953 have been reviewed with special concern for the prognostic indicators in posttraumatic epilepsy. Factors that operate in the occurrence of seizures after craniocerebral trauma are degree of brain destruction, length of coma, and, to a lesser extent, site of injury. None of these factors is related to the persistence of attacks once they have begun. For the latter, the most useful prognostic factors are derived from the time of onset and frequency of seizures.

Severe head injury managed without intracranial pressure monitoring

1983 ◽  
Vol 59 (4) ◽  
pp. 601-605 ◽  
Author(s):  
Gordon G. Stuart ◽  
Glen S. Merry ◽  
James A. Smith ◽  
John D. N. Yelland
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Head Injuries ◽  
Pressure Monitoring ◽  
Intracranial Hematoma ◽  
Content Type ◽  
Airway Control ◽  
Life Threatening ◽  
Fine Print

✓ A prospective series of 100 consecutive severe head injuries is presented. There were 34 deaths. Intracranial pressure (ICP) was not monitored in this series, and it is suggested that the outcome compares favorably with series in which ICP monitoring was performed. Early evacuation of life-threatening intracranial hematoma and airway control remain essentials of treatment of severe head injury.

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