Neurological course and correlated computerized tomography findings after severe closed head injury

1980 ◽  
Vol 52 (5) ◽  
pp. 611-624 ◽  
Author(s):  
Guy L. Clifton ◽  
Robert G. Grossman ◽  
Merry E. Makela ◽  
Michael E. Miner ◽  
Stanley Handel ◽  
...  
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Mass Effect ◽  
Neurological Deterioration ◽  
Content Type ◽  
Diffuse Brain Injury ◽  
Clinical Series ◽  
Closed Head

✓ This study includes 124 patients with closed head injuries and with Glasgow Coma Scale (GCS) scores of ≤ 8, who were admitted over a 7 1/2-month period. The time at which death occurred after injury was bimodal: deaths occurred either within 48 hours or after 7 days or longer after injury. Neurological deterioration, however, occurred with equal frequency on Days 2 to 7 after injury. Patients who survived the first 48 hours and then suffered neurological deterioration did not differ from the total population in age, sex, GCS scores on admission, or pupillary reactivity, but had a much higher incidence of intracranial hematomas of all types. Deterioration occurred three times more frequently in those with hematomas than in those with diffuse brain injury. Patients who deteriorated were rarely among the 35% of those who rapidly improved in the first 48 hours (4 points or more on the GCS). Computerized tomography (CT) scans of those deteriorating (24 patients) could be divided into four categories: 1) those without new mass effect (eight cases); 2) those with new or increased hemispheric edema (six cases); 3) those with generalized edema (two cases); and 4) those with focal or lobar areas of new edema or hemorrhage (eight cases). Of the patients in coma who deteriorated, 19% had large, delayed intracerebral hematomas. In 11 of 16 cases deteriorating with new mass effect, prior compression by overlying extracerebral hematoma, disruption of brain by intra-cerebral hematoma, or preexisting hemispheric edema preceded the brain swelling that caused deterioration. Areas of disruption or compression on CT scan typically developed decreased attenuation 2 to 7 days after injury, but did not cause deterioration unless new mass effect accompanied the lucency appearing on CT scan. A mortality rate of 29% was achieved for the 124 cases, which were managed with early evacuation of hematomas and control of intracranial pressure. Certain methods are suggested for evaluating therapy and for comparing clinical series.

The impact-absorbing effects of facial fractures in closed-head injuries

1987 ◽  
Vol 66 (4) ◽  
pp. 542-547 ◽  
Author(s):  
K. Francis Lee ◽  
Louis K. Wagner ◽  
Y. Eugenia Lee ◽  
Jung Ho Suh ◽  
Seung Ro Lee
Keyword(s):  
Head Injuries ◽  
Closed Head Injury ◽  
Neurological Deficits ◽  
Facial Fractures ◽  
Contingency Table Analysis ◽  
Chi Square ◽  
Content Type ◽  
Closed Head ◽  
Table Analysis ◽  
The Impact

✓ A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

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.

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.

Computerized tomography findings in arteriovenous malformations of the brain

1979 ◽  
Vol 51 (6) ◽  
pp. 765-772 ◽  
Author(s):  
Richard Leblanc ◽  
Roméo Ethier ◽  
John R. Little
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Brain Infarction ◽  
Mass Effect ◽  
Seizure Disorder ◽  
Neurological Dysfunction ◽  
Common Finding ◽  
Content Type ◽  
Additional Information ◽  
The Brain

✓ Computerized tomography (CT) scans of 54 patients with an arteriovenous malformation (AVM) of the brain were reviewed. The 31 males and 23 females (mean age: 33 years) were classified according to clinical presentation: 1) intracranial hemorrhage (30 patients); 2) seizure disorder (19 patients); and 3) other neurological disturbance (five patients). A brain hematoma was identified in all of the patients in the hemorrhage group having a CT scan within 1 week of the bleed. Extension of hemorrhage into the ventricular system as seen in eight cases was invariably accompanied by severe neurological dysfunction. A high-density lesion without associated mass effect was found in 48% of patients presenting with a seizure disorder. Dilatation of the ipsilateral lateral ventricle, a common finding in this group of patients, was thought to indicate an atrophic process. Evidence of discrete brain infarction was unusual. Intravenous infusion with Hypaque provided additional information in 31 of the 35 patients so studied. Demonstration of prominent or enlarged feeding arteries and/or draining veins occurred in 20% of patients with large malformations. Six cases of angiographically occult AVM's were found. A correlation of the CT scan with clinical, angiographic, and histological findings is presented.

Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries

1987 ◽  
Vol 66 (5) ◽  
pp. 706-713 ◽  
Author(s):  
Harvey S. Levin ◽  
Eugenio Amparo ◽  
Howard M. Eisenberg ◽  
David H. Williams ◽  
Walter M. High ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Head Injury ◽  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Neuropsychological Testing ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Lesion Volume ◽  
Resonance Imaging ◽  
Content Type

✓ Twenty patients admitted for minor or moderate closed-head injury were studied to investigate the relationship between magnetic resonance imaging (MRI) and neurobehavioral sequelae. The MRI scans demonstrated 44 more intracranial lesions than did concurrent computerized tomography (CT) scans in 17 patients (85%); most of these lesions were located in the frontal and temporal regions. Estimates of lesion volume based on MRI were frequently greater than with CT; however, MRI disclosed no additional lesions that required surgical evacuation. Neuropsychological assessment during the initial hospitalization revealed deficits in frontal lobe functioning and memory that were related to the size and localization of the lesions as defined by MRI. Follow-up MRI and neuropsychological testing at 1 month (13 cases) and 3 months (six cases) disclosed marked reduction of lesion size paralleled by improvement in cognition and memory. These findings encourage further investigation of the prognostic utility of MRI for the clinical management and rehabilitation of mild or moderate head injury.

Long-term effects of head injuries sustained during life in three male populations

1987 ◽  
Vol 67 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Gudrun Silverbåge Carlsson ◽  
Kurt Svärdsudd ◽  
Lennart Welin
Keyword(s):  
Alcohol Intake ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Cumulative Effect ◽  
Long Term Effects ◽  
Impaired Consciousness ◽  
Content Type ◽  
Closed Head ◽  
Self Assessed Health

✓ Data on defined head injuries, suffered during life, were related to possible long-term sequelae among 1112 men aged 30, 50, or 60 years who were sampled from the general population of Gothenburg, Sweden. There was a significant relationship between closed-head injury associated with reported impaired consciousness and occurrence of symptoms of the postconcussional type, self-assessed health variables, and the performance of finger-tapping and reaction-time tests. There was a cumulative effect of repeated head injuries: the more head injuries that were suffered, the more symptoms and more inferior performance were noted. Age at the time of the accident did not influence the occurrence of reported sequelae. Alcohol intake and smoking were powerful factors confounding the postinjury picture, but after taking these factors into account the results were generally the same. The study indicates that head injuries with impaired consciousness, no matter how short, are capable of causing permanent sequelae.

scholarly journals Differential Leukocyte and Platelet Profiles in Distinct Models of Traumatic Brain Injury

Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 500
Author(s):  
William Brad Hubbard ◽  
Meenakshi Banerjee ◽  
Hemendra Vekaria ◽  
Kanakanagavalli Shravani Prakhya ◽  
Smita Joshi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Closed Head Injury ◽  
Diffuse Brain Injury ◽  
Blood Brain ◽  
Closed Head ◽  
Leukocyte Counts ◽  
Neutrophil Aggregation ◽  
Blood Leukocyte

Traumatic brain injury (TBI) affects over 3 million individuals every year in the U.S. There is growing appreciation that TBI can produce systemic modifications, which are in part propagated through blood–brain barrier (BBB) dysfunction and blood–brain cell interactions. As such, platelets and leukocytes contribute to mechanisms of thromboinflammation after TBI. While these mechanisms have been investigated in experimental models of contusion brain injury, less is known regarding acute alterations following mild closed head injury. To investigate the role of platelet dynamics and bioenergetics after TBI, we employed two distinct, well-established models of TBI in mice: the controlled cortical impact (CCI) model of contusion brain injury and the closed head injury (CHI) model of mild diffuse brain injury. Hematology parameters, platelet-neutrophil aggregation, and platelet respirometry were assessed acutely after injury. CCI resulted in an early drop in blood leukocyte counts, while CHI increased blood leukocyte counts early after injury. Platelet-neutrophil aggregation was altered acutely after CCI compared to sham. Furthermore, platelet bioenergetic coupling efficiency was transiently reduced at 6 h and increased at 24 h post-CCI. After CHI, oxidative phosphorylation in intact platelets was reduced at 6 h and increased at 24 h compared to sham. Taken together, these data demonstrate that brain trauma initiates alterations in platelet-leukocyte dynamics and platelet metabolism, which may be time- and injury-dependent, providing evidence that platelets carry a peripheral signature of brain injury. The unique trend of platelet bioenergetics after two distinct types of TBI suggests the potential for utilization in prognosis.

The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report

1993 ◽  
Vol 79 (3) ◽  
pp. 354-362 ◽  
Author(s):  
Donald W. Marion ◽  
Walter D. Obrist ◽  
Patricia M. Earlier ◽  
Louis E. Penrod ◽  
Joseph M. Darby
Keyword(s):  
Head Injury ◽  
Therapeutic Hypothermia ◽  
Closed Head Injury ◽  
Metabolic Effects ◽  
Secondary Brain Injury ◽  
Content Type ◽  
Closed Head ◽  
Hypothermia Group ◽  
Rebound Increase ◽  
Fine Print

✓ Animal research suggests that moderate therapeutic hypothermia may improve outcome after a severe head injury, but its efficacy has not been established in humans. The authors randomly assigned 40 consecutively treated patients with a severe closed head injury (Glasgow Coma Scale score 3 to 7) to either a hypothermia or a normothermia group. Using cooling blankets and cold saline gastric lavage, patients in the hypothermia group were cooled to 32° to 33°C (brain temperature) within a mean of 10 hours after injury, maintained at that temperature for 24 hours, and rewarmed to 37° to 38°C over 12 hours. Patients in the normothermia group were maintained at 37° to 38°C during this time. Deep-brain temperatures were monitored directly and used for all temperature determinations. Intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate for oxygen (CMRO2) were measured serially for all patients. Hypothermia significantly reduced ICP (40%) and CBF (26%) during the cooling period, and neither parameter showed a significant rebound increase after patients were rewarmed. Compared to the normothermia group, the mean CMRO2 in the hypothermia group was lower during cooling and higher 5 days after injury. Three months after injury, 12 of the 20 patients in the hypothermia group had moderate, mild, or no disabilities; eight of the 20 patients in the normothermia group had improved to the same degree. Both groups had a similar incidence of systemic complications, including cardiac arrhythmias, coagulopathies, and pulmonary complications. It is concluded that therapeutic moderate hypothermia is safe and has sustained favorable effects on acute derangements of cerebral physiology and metabolism caused by severe closed head injury. The trend toward better outcome with hypothermia may indicate that its beneficial physiological and metabolic effects limit secondary brain injury.

Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Guidance System ◽  
Production Model ◽  
Ct Scanner ◽  
Content Type ◽  
Ct Scanners ◽  
Guidance Systems ◽  
Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

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.

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