Long-term follow-up review of 31 children with severe closed head trauma

1990 ◽  
Vol 73 (5) ◽  
pp. 684-687 ◽  
Author(s):  
Hanan Costeff ◽  
Zeev Groswasser ◽  
Ruth Goldstein
Keyword(s):  
Head Trauma ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acute Stage ◽  
Ct Scans ◽  
Permanent Disability ◽  
Content Type ◽  
Closed Head ◽  
Closed Head Trauma ◽  
Fine Print

✓ Thirty-one children aged 3 to 15 years were followed for 5 to 11 years after suffering severe closed head trauma which caused coma for 1 week or more (median duration of coma 3 weeks). One patient remained in a persistent vegetative state until his death 9 years later. The other 30 recovered consciousness and were discharged. All suffered diminution of their abilities, and 24 of them had major permanent disability. The most common motor disabilities were pure spastic hemiparesis (seven cases), basal ganglia syndromes (four cases), ataxia (three cases), and a combination of hemiparesis and ataxia (five cases). Of the 30 patients, 26 regained independent ambulation, seven were epileptic, and 14 were dysarthric in various degrees. Only 10 had the cognitive ability to profit from the normal educational system, and none had attempted postsecondary education. Social problems were common. The worst outcomes were associated with intracranial bleeding and/or brain contusion seen on computerized tomography (CT) scans at the acute stage; the best were associated with normal CT scans. The degree of residual disability in these children seems no less than that of adults with trauma of similar severity.

Neuroprotective effects of NPS 846, a novel N-methyl-d-aspartate receptor antagonist, after closed head trauma in rats

1998 ◽  
Vol 88 (6) ◽  
pp. 1066-1074 ◽  
Author(s):  
Boris Gurevich ◽  
Alan A. Artru ◽  
Arthur M. Lam ◽  
Alan L. Mueller ◽  
Vladimir Merkind ◽  
...  
Keyword(s):  
Specific Gravity ◽  
Receptor Antagonist ◽  
Head Trauma ◽  
Content Type ◽  
Aspartate Receptor ◽  
Hemorrhagic Necrosis ◽  
Ischemic Tissue ◽  
Closed Head ◽  
Closed Head Trauma ◽  
Fine Print

Object. The authors sought to determine whether 3,3-bis (3-fluorophenyl) propylamine (NPS 846), a novel noncompetitive N-methyl-d-aspartate receptor antagonist, alters outcome after closed head trauma in rats. Methods. The experimental variables were: presence or absence of closed head trauma, treatment with NPS 846 or no treatment, and time at which the rats were killed (24 or 48 hours). The NPS 846 (1 mg/kg) was administered intraperitoneally at 1 and 3 hours after closed head trauma or sham operation. Outcome measures were the neurological severity score (NSS), ischemic tissue volume, hemorrhagic necrosis volume, and specific gravity, water content, and concentrations of calcium, sodium, potassium, and magnesium in brain tissue. The following closed head trauma—induced changes in the injured hemisphere (expressed as the mean ± the standard deviation) were reversed by NPS 846: decreased specific gravity of 1.035 ± 0.006 at 24 hours was increased to 1.042 ± 0.004; the decreased potassium level of 0.583 ± 0.231 mg/L at 48 hours and at 24 hours was increased to 2.442 ± 0.860 mg/L; the increased water content of 84.7 ± 2.6% at 24 hours was decreased to 79.8 ± 2%; the increased calcium level of 0.592 ± 0.210 mg/L at 24 hours was decreased to 0.048 ± 0.029 mg/L; and the increased sodium level of 2.035 ± 0.649 mg/L was decreased to 0.631 ± 0.102 mg/L. Administration of NPS 846 also lowered the NSS (improved neurological status) at 48 hours (7 ± 3) and caused no significant changes in ischemic tissue or hemorrhagic necrosis volumes in the injured hemisphere at 24 or 48 hours. Conclusions. In this model of closed head trauma, NPS 846 improved neurological outcome, delayed the onset of brain edema, and improved brain tissue ion homeostasis.

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.

Matrix metalloproteinase—9 concentration after spontaneous intracerebral hemorrhage

2003 ◽  
Vol 99 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Sònia Abilleira ◽  
Joan Montaner ◽  
Carlos A. Molina ◽  
Jasone Monasterio ◽  
José Castillo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Diseases ◽  
Neurological Status ◽  
Acute Stage ◽  
Ct Scans ◽  
Enzyme Linked Immunosorbent Assay ◽  
Content Type ◽  
Blood Brain Barrier Disruption ◽  
Brain Barrier Disruption ◽  
Fine Print

Object. Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood—brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE). Methods. Concentrations of MMP-9 and related proteins were determined in plasma by performing an enzyme-linked immunosorbent assay of samples drawn after hospital admission (< 24 hours after stroke) from 57 patients with ICH. The diagnosis of ICH was made on the basis of findings on computerized tomography (CT) scans. The volumes of ICH and PHE were measured on baseline and follow-up CT scans at the same time that the patient's neurological status was assessed using the Canadian Stroke Scale and the Glasgow Coma Scale. Increased expression of MMP-9 was found among patients with ICH. In cases of deep ICH, MMP-9 was significantly associated with PHE volume (r = 0.53; p = 0.01) and neurological worsening (237.4 compared with 111.3 ng/ml MMP-9; p = 0.04). A logistic regression model focusing on the study of absolute PHE volume showed ICH volume as an independent predictor (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.1–10.3; p = 0.03). A second analysis of relative PHE volume (absolute PHE volume/ICH volume) in patients with deep ICH demonstrated that the only factor related to it was MMP-9 concentration (OR 11.6; 95% CI 1.5–89.1; p = 0.018). Conclusions. Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.

Clinicopathological investigation of gyral high density on computerized tomography following severe head injury in children

1995 ◽  
Vol 82 (6) ◽  
pp. 995-1001 ◽  
Author(s):  
Takehide Onuma ◽  
Yasuko Shimosegawa ◽  
Motonobu Kameyama ◽  
Hiroaki Arai ◽  
Kiyoshi Ishii
Keyword(s):  
Computerized Tomography ◽  
Head Trauma ◽  
Brain Atrophy ◽  
High Density ◽  
Ct Scans ◽  
Severe Head Trauma ◽  
Content Type ◽  
Subacute Stage ◽  
Fine Print ◽  
Diffuse Brain

✓ The authors have treated five cases of severe head trauma in children in which abnormally high density along gyri, “gyral high density,” was seen on plain computerized tomography (CT) scans in the subacute stage of the injury. The prognosis in all cases was poor, with either severe disability or a vegetative state as the outcome due to significant brain atrophy following gyral high density. This pathology was classified into three clinical stages: 1) acute stage, cerebral ischemia in which there is diffuse low density of the cerebrum on CT scans (most marked on the 3rd and 4th days); 2) subacute stage, hemorrhagic infarction showing gyral high density on plain CT scans (between 1 and 4 weeks); and 3) chronic stage, brain atrophy (beginning 4 weeks after the trauma). In their consecutive series of head-injured patients (516 children, 1459 adults), the authors did not find gyral high density on CT scan in adults. This is probably due to the fact that adults who suffer the severe head trauma associated with diffuse brain swelling or diffuse brain edema cannot survive, thus making this gyral high density unique to children.

The pseudodelta sign in acute head trauma

1988 ◽  
Vol 69 (6) ◽  
pp. 867-868 ◽  
Author(s):  
Joel W. Yeakley ◽  
John S. Mayer ◽  
Larry L. Patchell ◽  
K. Francis Lee ◽  
Michael E. Miner
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Ct Scans ◽  
Content Type ◽  
Sagittal Sinus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Triangular Area ◽  
Fine Print

✓ The “delta sign” is a triangular area of high density with a low-density center seen on contrast-enhanced computerized tomography (CT) scans in the location of the superior sagittal sinus. It indicates thrombosis of the sinus. The authors describe the “pseudodelta sign,” which is similar but is seen on non-contrast-enhanced CT scans and which has a high correlation with hemorrhage secondary to acute head trauma.

Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases

2001 ◽  
Vol 94 (3) ◽  
pp. 422-426 ◽  
Author(s):  
Koichi Satoh ◽  
Junichiro Satomi ◽  
Norio Nakajima ◽  
Shunji Matsubara ◽  
Shinji Nagahiro
Keyword(s):  
Fourth Ventricle ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Vascular Anomaly ◽  
Venous Drainage ◽  
Massive Hemorrhage ◽  
Cerebellar Hemorrhage ◽  
Content Type ◽  
The Right ◽  
Fine Print

Object. In this study the authors performed a retrospective analysis of five cases in which the patients (three women and two men) were treated for intracranial dural arteriovenous fistulas (AVFs) associated with cerebellar hemorrhage. On the basis of their findings, the authors evaluated the characteristics of this unusual symptom. Methods. The dural AVFs were located in the right cavernous sinus in one patient, the left transverse—sigmoid sinus in three patients, and the right superior petrosal sinus (SPS) in one patient. All patients presented with severe headache and/or loss of consciousness. Computerized tomography scans revealed a small cerebellar hemorrhage near the fourth ventricle and hydrocephalus in four cases, and a massive hemispheric cerebellar hemorrhage in the remaining case. The four patients with small hemorrhages underwent ventriculostomy and endovascular treatment; all recovered. The patient suffering from a massive hemorrhage because of a dural AVF in the SPS was treated by suboccipital craniectomy, hematoma evacuation, and removal of the vascular anomaly. This patient remains in a persistent vegetative state. In four cases, results of angiography demonstrated retrograde leptomeningeal venous drainage through the SPS to the anastomotic lateral mesencephalic vein (ALMV) and/or to the vein of the lateral recess of the fourth ventricle (VLR4V). Retrograde leptomeningeal venous drainage to the ALMV and/or VLR4V was responsible for cerebellar hemorrhage in these cases. Conclusions. Thus, it is important to consider dural AVF in cases in which there is even a small hemorrhage near the fourth ventricle accompanied by intraventricular perforation and a decreased level of consciousness.

Pituitary apoplexy following closed head trauma

1983 ◽  
Vol 59 (4) ◽  
pp. 677-679 ◽  
Author(s):  
Renn O. Holness ◽  
Fadegbola A. Ogundimu ◽  
Roland A. Langille
Keyword(s):  
Head Trauma ◽  
Pituitary Apoplexy ◽  
Pathological Examination ◽  
Partial Recovery ◽  
Minor Head Trauma ◽  
Endocrine Effects ◽  
Pituitary Fossa ◽  
Content Type ◽  
Closed Head ◽  
Closed Head Trauma

✓ The authors report a case of chiasmal compression resulting from hemorrhage into a pituitary adenoma following minor head trauma. The adenoma was still confined to the pituitary fossa and only in retrospect had caused any endocrine effects prior to the accident. The diagnosis in this case was established by computerized tomography, angiography, subsequent surgery, and pathological examination of the specimen. There was significant but partial recovery of vision following surgery.

The persistent vegetative state after closed head injury: clinical and magnetic resonance imaging findings in 42 patients

1998 ◽  
Vol 88 (5) ◽  
pp. 809-816 ◽  
Author(s):  
Andreas Kampfl ◽  
Gerhard Franz ◽  
Franz Aichner ◽  
Bettina Pfausler ◽  
Hans-Peter Haring ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Vegetative State ◽  
Axonal Injury ◽  
Persistent Vegetative State ◽  
Diffuse Axonal Injury ◽  
Resonance Imaging ◽  
Content Type ◽  
Temporal Lobes ◽  
Fine Print

Object. In this retrospective study, the authors analyzed the frequency, anatomical distribution, and appearance of traumatic brain lesions in 42 patients in a posttraumatic persistent vegetative state. Methods. Cerebral magnetic resonance (MR) imaging was used to detect the number of lesions, which ranged from as few as five to as many as 19, with a mean of 11 lesions. In all 42 cases there was evidence on MR imaging of diffuse axonal injury, and injury to the corpus callosum was detected in all patients. The second most common area of diffuse axonal injury involved the dorsolateral aspect of the rostral brainstem (74% of patients). In addition, 65% of these patients exhibited white matter injury in the corona radiata and the frontal and temporal lobes. Lesions to the basal ganglia or thalamus were seen in 52% and 40% of patients, respectively. Magnetic resonance imaging showed some evidence of cortical contusion in 48% of patients in this study; the frontal and temporal lobes were most frequently involved. Injury to the parahippocampal gyrus was detected in 45% of patients; in this subgroup there was an 80% incidence of contralateral peduncular lesions in the midbrain. The most common pattern of injury (74% in this series) was the combination of focal lesions of the corpus callosum and the dorsolateral brainstem. In patients with no evidence of diffuse axonal injury in the upper brainstem (26% in this series), callosal lesions were most often associated with basal ganglia lesions. Lesions of the corona radiata and lobar white matter were equally distributed in patients with or without dorsolateral brainstem injury. Moreover, cortical contusions and thalamic, parahippocampal, and cerebral peduncular lesions were also similarly distributed in both groups. Conclusions. The data indicate that diffuse axonal injury may be the major form of primary brain damage in the posttraumatic persistent vegetative state. In addition, the authors demonstrated in this study that MR imaging, in conjunction with a precise clinical correlation, may provide useful supportive information for the accurate diagnosis of a persistent vegetative state after traumatic brain injury.

Cerebral acid—base homeostasis after severe traumatic brain injury

2005 ◽  
Vol 103 (4) ◽  
pp. 597-607 ◽  
Author(s):  
Tobias Clausen ◽  
Ahmad Khaldi ◽  
Alois Zauner ◽  
Michael Reinert ◽  
Egon Doppenberg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Tissue ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acid Base ◽  
Content Type ◽  
Time Points ◽  
Tissue Acidosis ◽  
Fine Print

Object. Brain tissue acidosis is known to mediate neuronal death. Therefore the authors measured the main parameters of cerebral acid—base homeostasis, as well as their interrelations, shortly after severe traumatic brain injury (TBI) in humans. Methods. Brain tissue pH, PCO2, PO2, and/or lactate were measured in 151 patients with severe head injuries, by using a Neurotrend sensor and/or a microdialysis probe. Monitoring was started as soon as possible after the injury and continued for up to 4 days. During the 1st day following the trauma, the brain tissue pH was significantly lower, compared with later time points, in patients who died or remained in a persistent vegetative state. Six hours after the injury, brain tissue PCO2 was significantly higher in patients with a poor outcome compared with patients with a good outcome. Furthermore, significant elevations in cerebral concentrations of lactate were found during the 1st day after the injury, compared with later time points. These increases in lactate were typically more pronounced in patients with a poor outcome. Similar biochemical changes were observed during later hypoxic events. Conclusions. Severe human TBI profoundly disturbs cerebral acid—base homeostasis. The observed pH changes persist for the first 24 hours after the trauma. Brain tissue acidosis is associated with increased tissue PCO2 and lactate concentration; these pathobiochemical changes are more severe in patients who remain in a persistent vegetative state or die. Furthermore, increased brain tissue PCO2 (> 60 mm Hg) appears to be a useful clinical indicator of critical cerebral ischemia, especially when accompanied by increased lactate concentrations.

Traumatic subarachnoid hemorrhage as a predictable indicator of delayed ischemic symptoms

1996 ◽  
Vol 84 (5) ◽  
pp. 762-768 ◽  
Author(s):  
Mamoru Taneda ◽  
Kazuo Kataoka ◽  
Fumiharu Akai ◽  
Toshiharu Asai ◽  
Ikuhiro Sakata
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Close Correlation ◽  
Ct Scans ◽  
Content Type ◽  
Main Site ◽  
Traumatic Subarachnoid Hemorrhage ◽  
Closed Head Trauma ◽  
Subarachnoid Blood ◽  
Fine Print

✓ This report provides findings of an investigation of the influence of traumatic subarachnoid hemorrhage on the development of delayed cerebral ischemia caused by vasospasm. The authors prospectively studied 130 patients with closed-head trauma, who exhibited subarachnoid blood on admission computerized tomography (CT) scans. Ten (7.7%) of these patients developed delayed ischemic symptoms between Days 4 and 16 after the head injury. They consisted of three (3.0%) of 101 patients with small amounts of subarachnoid blood and seven (24.1%) of 29 patients with massive quantities of subarachnoid blood on admission CT scans. In each of the 10 patients, severe vasospasm was demonstrated by angiography performed soon after development of ischemic symptoms. There was a close correlation between the main site of the subarachnoid blood and the location of severe vasospasm. In seven of the patients, follow-up CT scans showed development of focal ischemic areas in the cerebral territories corresponding to the vasospastic arteries. These results demonstrate that traumatic subarachnoid hemorrhage, especially if massive, is a predictable indicator of delayed ischemic symptoms.

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