scholarly journals Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital

2020 ◽  
Vol 15 (1) ◽  
pp. 75-78
Author(s):  
Md Shohidul Islam ◽  
Md Fashiur Rahman ◽  
Md Aminul Islam
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Surgical Intervention ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Public Health Problem ◽  
Armed Forces ◽  
Military Hospital

Introduction: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes. Objective: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&C) department following intensive care with or without surgical intervention. Materials and Methods: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS). Results: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS<8 on admission), associated other injuries and delayed resuscitative care and interventions. Conclusion: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78

scholarly journals Study of Traumatic Brain Injury Due To Recent Earthquake in Manipal Teaching Hospital

2016 ◽  
Vol 12 (2) ◽  
pp. 63-66
Author(s):  
Bal G Karmacharya ◽  
Brijesh Sathian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Teaching Hospital ◽  
Brain Injuries ◽  
Injury Severity ◽  
Traumatic Brain Injuries ◽  
The Body ◽  
Mild Head Injury ◽  
Associated Injuries

The objective of this study was to review the demographics, causes injury, severity, treatment and outcome of traumatic brain injuries in victims of the April 2015 earthquake who were admitted in Manipal Teaching Hospital, Pokhara. A total of 37 patients was admitted under Neurosurgery Services. Collapse of buildings was the commonest cause of head injury. The majority of them had mild head injury. Associated injuries to other parts of the body were present in 40.54% patients.Nepal Journal of Neuroscience 12:63-66, 2015

scholarly journals Circadian Blood Pressure and Heart Rate Changes in Patients in a Persistent Vegetative State After Traumatic Brain Injury

2005 ◽  
Vol 7 (12) ◽  
pp. 734-739 ◽  
Author(s):  
Paolo Pattoneri ◽  
Giovanni Tirabassi ◽  
Giovanna Pelà ◽  
Ettore Astorri ◽  
Anna Mazzucchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Traumatic Brain Injury ◽  
Heart Rate ◽  
Brain Injury ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Circadian Blood Pressure

scholarly journals Persistent vegetative state after traumatic brain injury - a case report and review of the literature

2014 ◽  
Vol 13 (3) ◽  
pp. 358-365 ◽  
Author(s):  
Mohammad Yousuf Rathor ◽  
Mohammad Fauzi Abdul Rani ◽  
TCA Shahrin ◽  
HZ Hashim
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Medical Science ◽  
Persistent Vegetative State ◽  
Disorder Of Consciousness ◽  
End Of Life Decisions ◽  
The Past ◽  
Late Recovery ◽  
Behavioural Evidence

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like.  Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system.  The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19159 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.358-365

scholarly journals Manajemen Anestesia pada Evakuasi Epidural Haemorrhage (EDH) dengan Pendarahan Masif

2021 ◽  
Vol 10 (1) ◽  
pp. 29-39
Author(s):  
Nurul Huda ◽  
◽  
Buyung Hartiyo Laksono
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Good Condition ◽  
Massive Bleeding ◽  
Red Blood Cell Transfusion ◽  
Mortality And Morbidity ◽  
Hemodynamic Status ◽  
Poor Outcome

Traumatic brain injury causes mortality and morbidity worldwide. Epidural Haemorrhage (EDH) is a form of head injury where time is an indicator that must be considered in its management. The main focus during traumatic brain injury management is patient stabilization and control of intracranial pressure, as well as maintaining brain oxygenation and perfusion. Subsequently, surgical decompression was performed. Evacuation and bleeding control should be done in a short time to avoid further injury. The practice of neuroanesthesia, as a support in the management of traumatic brain injuries, is often associated with blood loss that results in anemia during the intraoperative and postoperative periods. Although anemia correlates with poor outcome in brain-injured patients, red blood cell transfusion to correct anemia also correlates with poor outcome in patients. There are still no clear recommendations regarding the administration of transfusions, whether restrictive or massive, regarding the benefits provided. Male patient, age 51 years with complaints of decreased consciousness and vomiting, referred from the previous hospital with a diagnosis of moderate head injury 225 with 96cc temporoparietal EDH, 11mm midline shift to the right, and cerebral edema. During the operation period, there was massive bleeding that interfered with the hemodynamic status so that blood components were transfused until a stable hemodynamic status was obtained. In postoperative care in the ICU, the patient is relatively in good condition.

scholarly journals Ligoninėje gydytos galvos smegenų traumos epidemiologija Vilniuje ir Vilniaus krašte

2007 ◽  
Vol 5 (1) ◽  
pp. 0-0
Author(s):  
Aidanas Preikšaitis ◽  
Saulius Ročka
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Subdural Hemorrhage ◽  
Mild Traumatic Brain Injuries ◽  
Vilnius University ◽  
Gcs Score

Aidanas Preikšaitis, Saulius RočkaVilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 VilniusVilniaus universiteto Neurologijos ir neurochirurgijos klinikos Neurochirurgijos skyrius,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected]; [email protected] Įvadas / tikslas Pasaulyje galvos trauma patiriama kas penkiolika sekundžių, kas dvylika minučių nuo jos miršta žmogus. Daugiausia asmenų iki 40 metų miršta dėl išorinių priežasčių, tarp jų ir įvairių traumų. Mirtys dėl galvos smegenų traumų sudaro apie 30% visų trauminių mirčių. Ši studija buvo suplanuota dėl to, kad epidemiologinė galvos smegenų traumos situacija mūsų krašte yra neaiški. Ligoniai ir metodai Retrospektyvusis tyrimas atliktas Vilniaus greitosios pagalbos universitetinėje ligoninėje. Buvo ištirta 622 dėl galvos smegenų traumos hospitalizuotų pacientų. Duomenys buvo renkami į asmeninį kompiuterį ir apdoroti naudojant "MS office Excel 2003" ir "SPSS 10" programas. Rezultatai Vyrai galvos smegenų traumą patiria vidutiniškai tris kartus dažniau negu moterys. 20–59 metų žmonės sudarė 72,5%. Dažniausios galvos smegenų traumos priežastys: kritimai (40,7%), eismo nelaimės (20,5%) ir smurtiniai sužalojimai (19%). Lengvų galvos smegenų traumų (pagal Glasgow komų skalę (GKS) 13–15 balų) pasitaikė 67,8% atvejų, vidutinio sunkumo (GKS 9–12 balų) buvo 15,2%, o sunkių galvos smegenų traumų (GKS < 8 balai) – 17%. Remiantis radiologiniais duomenimis dažniausiai buvo diagnozuojama subduralinė kraujosruva (29,1%), kiek rečiau – trauminė subarachnoidinė kraujosruva (19,5%). Net 86,4% baigtis buvo gera (pagal Glasgow baigčių skalę 4–5 balai), 6,4% pacientų, patyrusių galvos smegenų traumą, neišgyveno. Išvados Galvos smegenų traumą reikšmingai dažniau patiria 20–59 metų vyrai. Dažniausia traumos priežastis – kritimai. Vilniaus ligoninėse dažniausiai gydomi pacientai, patyrę lengvą galvos smegenų traumą (GKS 15–13 balų). Net trys ketvirtadaliai baigčių yra labai geros. Pusė žmonių, patyrusių sunkią galvos traumą (GKS 3 balai), neišgyvena. Pasitvirtino ankstyvieji galvos smegenų traumos prognoziniai veiksniai: atvykimo GKS, amžius, vyzdžių skersmuo ir jų reakcija į šviesą, pakitimai galvos kompiuterinėje tomogramoje. Vilniaus ligoninėje hospitalizuojama santykinai daugiau lengvą galvos smegenų traumą patyrusių pacientų negu kitose pasaulio klinikose. Pagrindiniai žodžiai: galvos trauma, galvos smegenų trauma, neurochirurgija, epidemiologija The epidemiology of in-hospital-treated brain traumas in Vilnius city and region AIDANAS PREIKŠAITIS, SAULIUS ROČKAVilnius University, Faculty of Medicine, M. K. Čiurlionio str. 21, LT-03101 Vilnius, LithuaniaVilnius University, Clinic of Neurology and Neurosurgery, Department of Neurosurgery,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected]; [email protected] Background / objective Every fifteen seconds a head injury happens in the world, and every twelve minutes it causes a death. Most individuals younger than 40 years die due to external causes including different traumas. Deaths caused by traumatic brain injury comprise about 30% of all traumatic deaths. This study has been planned because of the unclear epidemiology of traumatic brain injuries in our country. Patients and methods A retrospective study was carried out at Vilnius University Emergency Hospital. 622 hospitalized traumatic brain injury patients were enrolled in the study. The data were stored in a personal computer and analyzed using Microsoft Excel 2003 and SPSS 10 statistical package. Results The male gender was dominant among the brain-injured. 72.5% of these patients were 20–59 years of age. Most frequent causes of traumatic brain injuries were falls (40.7%), traffic accidents (20.5%) and assaults (19%). Mild traumatic brain injuries (Glasgow Coma Scale (GCS) 13–15) were proved in 67.8%, moderate (GCS 9–12) in 15.2% and severe (GCS < 8) – in 17.0% of cases. Radiological evaluation revealed subdural hemorrhage in 29.1% and traumatic subarachnoid hemorrhage in 19.5% of victims. Good outcomes (according to GOS 4–5) were reGBStered in 86.4% patients, 6.4% patients did not survive. Conclusions Traumatic brain injuries in males were three times more frequent than in females. The age group of 20–59 years was prevalent. The most frequent cause of trauma was fall. Mild traumatic brain injuries (GCS 15–13) prevailed in Vilnius among the in-hospital patients. Three quarters of the outcomes were very good. Half of the patients brought in with three-point coma did not survive. The following early prognostic factors of traumatic brain injury were approved: GCS score, age, pupils diameter and light reflex, CT features. It was established that hospitalization of mild traumatic brain injuries in Lithuania was more frequent than in neurosurgical departments of other countries. Keywords: head injury, traumatic brain injury, neurosurgery, epidemiology

scholarly journals Complications of decompressive craniectomy for traumatic brain injury

2009 ◽  
Vol 26 (6) ◽  
pp. E7 ◽  
Author(s):  
Shirley I. Stiver
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Perioperative Complications ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Surgical Decompression ◽  
Cerebral Herniation ◽  
Life Threatening ◽  
Detailed Search

Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries

2009 ◽  
Vol 3 (4) ◽  
pp. 334-339 ◽  
Author(s):  
Matthew A. Adamo ◽  
Doniel Drazin ◽  
John B. Waldman
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Physical Examination ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Brain Lesion ◽  
High Rate

Object Infants with severe traumatic brain injury represent a therapeutic challenge. The internal absence of open space within the infant cranial vault makes volume increases poorly tolerated. This report presents 7 cases of decompressive craniectomy in infants with cerebral edema. Methods The authors reviewed the medical charts of infants with brain injuries who presented to Albany Medical Center Hospital between January 2004 and July 2007. Variables that were examined included patient age, physical examination results at admission, positive imaging findings, surgery performed, complications, requirement of permanent CSF diversion, and physical examination results at discharge and outpatient follow-up using the King's Outcome Scale for Childhood Head Injury. Seven infants met the inclusion criteria for the study. Six infants experienced nonaccidental trauma, and 1 had a large infarction of the middle cerebral artery territory secondary to a carotid dissection. At admission, all patients were minimally responsive, 4 had equal and minimally reactive pupils, 3 had anisocoria with the enlarged pupil on the same side as the brain lesion, and all had right-sided hemiparesis. Six patients received a left hemicraniectomy, whereas 1 received a left frontal craniectomy. In all cases, bone was cultured and stored at the bone bank. Results Postoperatively, 3 patients who developed draining CSF fistulas needed insertions of external ventricular drains, with incisions oversewn using nylon sutures and a liquid bonding agent. After prolonged CSF drainage and wound care, these patients all developed epidural and subdural empyemas necessitating surgical drainage and debridement. Methicillin-resistant Staphylococcus aureus was found in 2 patients and Enterococcus in the third. All patients developed hydrocephalus necessitating the insertion of a ventriculoperitoneal shunt, and all had bone replaced within 1–6 months from the time of the original operation. Two patients required reoperation due to bone resorption. At outpatient follow-up visits, all had scores of 3 or 4 on the King's Outcome Scale for Childhood Head Injury. Each patient was awake, interactive, and could sit, as well as either crawl or walk with assistance. All had persistent, improving right-sided hemiparesis and spasticity. Conclusions Despite poor initial examination results, infants with severe traumatic brain injury can safely undergo decompressive craniectomy with reasonable neurological recovery. Postoperative complications must be anticipated and treated appropriately. Due to the high rate of CSF fistulas encountered in this study, it appears reasonable to recommend both the suturing in of a dural augmentation graft and the placement of either a subdural drain or a ventriculostomy catheter to relieve pressure on the healing surgical incision. Also, one might want to consider using a T-shaped incision as opposed to the traditional reverse question mark-shaped incision because wound healing may be compromised due to the potential interruption of the circulation to the posterior and inferior limb with this latter incision.

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