Traumatic intracerebellar hematomas

1982 ◽  
Vol 56 (5) ◽  
pp. 691-694 ◽  
Author(s):  
Eugenio Pozzati ◽  
Claudio Grossi ◽  
Roberto Padovani
Keyword(s):  
Clinical Course ◽  
Head Injuries ◽  
Medical Complications ◽  
Content Type ◽  
Limited Size ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Study Support ◽  
Results Of Surgery ◽  
Fine Print

✓ Seven patients with “isolated” traumatic intracerebellar hematomas due to closed head injuries are presented. Computerized tomography parameters useful in the correct management of these hematomas include: location (hemisphere or midline), size, and appearance of the posterior fossa cisterns (intact or obliterated). Three patients with hemispheric hematomas were treated conservatively and recovered. One patient with a midline hematoma was managed conservatively and died. Three hematomas (one hemispheric and two midline) were operated on. The immediate results of surgery were good, but two patients died later due to medical complications. The results of this study support the concept that large hematomas (3 cm or greater) generally need surgery and that hemispheric hematomas of limited size (less than 3 cm) may be treated conservatively. The clinical course and prognosis of midline hematomas is grave, and evacuation of accessible hematomas should be considered early in the course of the disease.

The oval pupil: clinical significance and relationship to intracranial hypertension

1983 ◽  
Vol 58 (4) ◽  
pp. 566-568 ◽  
Author(s):  
Lawrence F. Marshall ◽  
David Barba ◽  
Belinda M. Toole ◽  
Sharon A. Bowers
Keyword(s):  
Intracranial Hypertension ◽  
Head Injuries ◽  
Transitional Stage ◽  
Content Type ◽  
Closed Head Injuries ◽  
Transtentorial Herniation ◽  
Neurosurgical Patients ◽  
Closed Head ◽  
Third Nerve ◽  
Fine Print

✓ The oval pupil, or what has also been termed the “oblong” or “football” pupil, has been observed in 15 neurosurgical patients over a 2-year period. In 14 of the 15 patients, the intracranial pressure (ICP) was elevated, ranging from 18 to 38 mm Hg. While the oval pupil was primarily seen in patients suffering closed head injuries (11 cases), it was also observed in two patients with elevated ICP following hemorrhage from an arteriovenous malformation. In nine of the 14 patients in whom the pupillary abnormality was associated with intracranial hypertension, the oval pupil disappeared when the ICP was reduced to below 20 mm Hg. In four cases, the ICP could not be controlled and the pupil became progressively larger, and finally fixed and unreactive. The oval pupil represents a transitional stage indicating transtentorial herniation with third nerve compression. Although it may be seen in the absence of intracranial hypertension (one case in this series), this appears to be relatively uncommon. The presence of such a pupil on examination in a patient suffering an intracranial catastrophe, be it head injury, subarachnoid hemorrhage, or intracerebral hemorrhage, suggests impending transtentorial herniation with brain-stem compression.

Delayed traumatic intracerebral hematomas

1978 ◽  
Vol 48 (6) ◽  
pp. 1019-1022 ◽  
Author(s):  
Frederick D. Brown ◽  
Sean Mullan ◽  
Eugene E. Duda
Keyword(s):  
Head Injuries ◽  
Content Type ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Fine Print

✓ Three patients are reported who developed delayed intracerebral hematomas following closed head injuries. Two patients showed hematomas within 24 hours after a normal computerized tomogram. All three were treated surgically, and two had good results.

Early diagnosis of delayed posttraumatic intracerebral hematomas

1979 ◽  
Vol 50 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Fernando G. Diaz ◽  
Douglas H. Yock ◽  
David Larson ◽  
Gaylan L. Rockswold
Keyword(s):  
Medical Center ◽  
Head Injuries ◽  
Ct Scans ◽  
Intracerebral Hematoma ◽  
Pertinent Literature ◽  
Content Type ◽  
Closed Head Injuries ◽  
Hennepin County ◽  
Closed Head ◽  
Cranial Injury

✓ Nine cases of delayed posttraumatic intracerebral hematomas (DTICH) were found retrospectively among 656 patients with closed head injuries admitted to the Hennepin County Medical Center in a 12-month period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography (CT) varied from 8 hours to 13 days. Eight patients were comatose on admission, three had focal seizures, and three had focal findings. The diagnosis was made on repeat CT scans obtained because of the development of focal findings in four cases, lack of improvement in four cases, and general neurological deterioration in one case. Four patients had initially negative CT scans. Four demonstrated only extracerebral hematomas on initial CT scan. One patient showed intracerebral hematoma on the initial scan followed by new hematomas on repeat study. The cases presented are discussed in light of pertinent literature.

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.

Clinical, arteriographic, and cisternographic observations after removal of acute subdural hematoma

1975 ◽  
Vol 43 (1) ◽  
pp. 27-31
Author(s):  
Julian Hoff ◽  
John Grollmus ◽  
Barbara Barnes ◽  
M. Theodore Margolis
Keyword(s):  
Subdural Hematoma ◽  
Head Injuries ◽  
Acute Subdural Hematoma ◽  
Content Type ◽  
Closed Head Injuries ◽  
Postoperative Changes ◽  
Closed Head ◽  
Diagnostic Usefulness ◽  
Burr Holes

✓ The authors review 47 patients with closed-head injuries requiring treatment for acute subdural hematoma and report that 21 (45%) survived for 5 days or more. Follow-up study of these 21 survivors led to the following observations: that clinical evaluation of these patients is the most reliable index of their postoperative progress; that the diagnostic usefulness of postoperative cerebral arteriograms is limited because immediate postoperative changes tend to persist; that craniotomy is preferable to burr holes for removal of an acute hematoma; and that the value of cisternography, unless done serially, is limited since posttraumatic hydrocephalus develops rapidly and may persist indefinitely.

Intracranial carotid artery injury in closed head trauma

1987 ◽  
Vol 66 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Michael K. Morgan ◽  
Michael Besser ◽  
Ian Johnston ◽  
Raymond Chaseling
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Clinical Course ◽  
Carotid Artery Injury ◽  
Content Type ◽  
Head Injured ◽  
Closed Head ◽  
Closed Head Trauma ◽  
Injured Patients ◽  
Fine Print

✓ Six patients with trauma to the intracranial internal carotid artery are reported. One patient died and two are permanently disabled due to ischemic sequelae. The incidence of this complication of trauma is unknown because of the infrequent use of angiography in head-injured patients. The pathology, clinical course, and management of this condition are discussed with reference to the 25 previously reported cases in addition to the six in this series.

Cerebral blood flow and metabolism in comatose patients with acute head injury

1984 ◽  
Vol 61 (2) ◽  
pp. 241-253 ◽  
Author(s):  
Walter D. Obrist ◽  
Thomas W. Langfitt ◽  
Jurg L. Jaggi ◽  
Julio Cruz ◽  
Thomas A. Gennarelli
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Head Injuries ◽  
Global Cerebral Ischemia ◽  
Content Type ◽  
Closed Head Injuries ◽  
Acute Head Injury ◽  
Significant Depression ◽  
Fine Print ◽  
Reduced Flow

✓ Cerebral blood flow (CBF) measurements were made in 75 adult patients with closed head injuries (mean Glasgow Coma Scale score 6.2), using the xenon-133 intravenous injection method with eight detectors over each hemisphere. All patients were studied acutely within 96 hours of trauma, and repeatedly observed until death or recovery (total of 361 examinations). Arteriojugular venous oxygen differences (AVDO2) were obtained in 55 of the patients, which permitted assessment of the balance between metabolism and blood flow, and provided estimates of cerebral metabolic rate for oxygen (CMRO2). Based on mean regional CBF, the patients were classified into two groups: those who exhibited hyperemia on one or more examinations, and those who had a consistently reduced flow during their acute illness. “Hyperemia” was defined as a normal or supernormal CBF in the presence of coma, a definition that was independently confirmed by narrow AVDO2's indicative of “luxury perfusion.” During coma, all patients showed a significant depression in CMRO2. Forty-one patients (55%) developed an acute hyperemia with an average duration of 3 days, while 34 patients (45%) consistently had subnormal flows. Although more prevalent in younger patients, hyperemia was found at all age levels (15 to 85 years). There was a highly significant association between hyperemia and the occurrence of intracranial hypertension, defined as an intracranial pressure above 20 mm Hg. Patients with reduced flow showed little or no evidence of global cerebral ischemia, but instead revealed the expected coupling of CBF and metabolism. The CBF responses to hyperventilation were generally preserved, with the hyperemic patients being slightly more reactive. In 10 patients with reduced flow, hyperventilation resulted in wide AVDO2's suggestive of ischemia.

Closed Head Injuries in Athletes

1990 ◽  
Vol 9 (2) ◽  
pp. 247-261 ◽  
Author(s):  
Lawrence B. Lehman ◽  
Steven J. Ravich
Keyword(s):  
Head Injuries ◽  
Closed Head Injuries ◽  
Closed Head

scholarly journals A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982566 ◽  
Author(s):  
John S. Strickland ◽  
Marie Crandall ◽  
Grant R. Bevill
Keyword(s):  
United States ◽  
Head Injuries ◽  
The United States ◽  
Weighted Estimate ◽  
Body Parts ◽  
Facial Injuries ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Mean ◽  
Race Ethnicity

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.

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.

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