scholarly journals Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features

2021 ◽  
Vol 10 (11) ◽  
pp. 2524
Author(s):  
Yingchi Shan ◽  
Yihua Li ◽  
Xuxu Xu ◽  
Junfeng Feng ◽  
Xiang Wu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Hounsfield Unit ◽  
Radiological Feature ◽  
Cranial Computed Tomography ◽  
Clinical Expertise ◽  
Midline Shift ◽  
Model Features

Background: Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. Methods: In this retrospective study, 47 patients with a closed TBI were recruited. Hounsfield unit features from the last cranial CT and the initial ICP value were collected. Three models were established to predict intracranial hypertension with Hounsfield unit (HU model), midline shift (MLS model), and clinical expertise (CE model) features. Results: The HU model had the highest ability to predict intracranial hypertension. In 34 patients with unilateral injury, the HU model displayed the highest performance. In three classifications of intracranial hypertension (ICP ≤ 22, 23–29, and ≥30 mmHg), the HU model achieved the highest F1 score. Conclusions: This radiological feature-based noninvasive quantitative approach showed better performance compared with conventional methods, such as the degree of midline shift and clinical expertise. The results show its potential in clinical practice and further research.

scholarly journals Comparison of the predictive strength of total white blood cell count within 24 hours on the outcome of traumatic brain injury with cranial computed tomography scan in a resource-limited tertiary health centre in sub-Saharan Africa

2019 ◽  
pp. 55-59
Author(s):  
Eghosa Morgan ◽  
Olufemi Bankole ◽  
Okezie Kanu ◽  
Omotayo Ojo ◽  
Edward Poluyi
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Cell ◽  
White Blood Cell ◽  
Cranial Computed Tomography ◽  
Total White Blood Cell ◽  
Wbc Count ◽  
Predictive Strength ◽  
Tomography Scan

Background: The enormous disease burden of patients with traumatic brain injury (TBI) remains a huge source of concern to the patient and caregivers. Computed tomography (CCT) scan is a valuable investigative tool in patients with traumatic brain injury which can be used to predict the outcome of TBI. The use of total white blood cell as a predictive parameter in patients with TBI is still at a primordial stage. This study aimed to compare the predictive strength of total WBC count within 24 hours of TBI with cranial computed tomography scan. Methods: This research was done over one-year period at the Lagos University Teaching Hospital, Lagos. One hundred and fifty-eight patient who met the inclusion criteria were studied and the male to female ratio of 3.6:1. Results: The mean total WBC count was 14,279.94 and the area under the curve of total WBC count and CCT scan was 0.633 and 0.855 respectively. Conclusion: Our conclusion was that despite both parameters been a predictor of the outcome of TBI, the total white blood cell is a weaker predictor of outcome compared to cranial computerize tomography scan.

scholarly journals Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury

2015 ◽  
Vol 10 (2) ◽  
pp. 4-9
Author(s):  
SK Sah ◽  
ND Subedi ◽  
K Poudel ◽  
M Mallik
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Midline Shift ◽  
Female Ratio ◽  
Coma Scale ◽  
Acute Traumatic Brain Injury ◽  
Gcs Score

OBJECTIVE To correlate Computed Tomography (CT) findings with Glasgow Coma Scale (GCS) in patients with acute traumatic brain injury attending in Chitwan Medical College teaching hospital Chitwan, Nepal.MATERIALS AND METHODS A cross-sectional study was performed among 50 patients of acute (less than24 hours) cases of craniocerebral trauma over a period of four months. The patient’s level of consciousness (GCS) was determined and a brain CT scan without contrast media was performed. A sixth generation General Electric (GE) CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.RESULT The age range of the patients was 1 to 75 years (mean age 35.6± 21.516 years) and male: female ratio was 3.1:1. The most common causes of head injury were road traffic accident (RTA) (60%), fall injury (20%), physical assault (12%) and pedestrian injuries (8%). The distribution of patients in accordance with consciousness level was found to be 54% with mild TBI (GCS score 12 to 14), 28% with moderate TBI (GCS score 11 to 8) and 18% with severe TBI (GCS score less than 7). The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan was accompanied by lower GCS.CONCLUSION The presence of mixed lesions and midline shift regardless of the underlying lesion on CT scan were accompanied with lower GCS. Patients having single lesion had more GCS level than mixed level and mid line shift type of injury.Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 4-9

scholarly journals Tooth in Intracranial Compartment after Traumatic Brain Injury

2017 ◽  
Vol 36 (01) ◽  
pp. 26-28
Author(s):  
Benedito Pereira ◽  
Radmila Holanda ◽  
José Targino Neto ◽  
Luciano Holanda
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Foreign Body ◽  
Ct Scan ◽  
Frontal Sinus ◽  
Case Reports ◽  
Cranial Computed Tomography ◽  
Skull Radiography

AbstractA 25-year-old patient was admitted to the emergency room presenting headaches after a traumatic brain injury (TBI) 30 days before, when he collided frontally with another driver. After a skull radiography, the presence of a foreign body was observed in the frontal sinus. A cranial computed tomography (CT) scan found that it was a tooth. The patient underwent surgical treatment for the removal of the tooth. Traumatic brain injury caused by non-missile penetrating objects is unusual, and has been described in case reports in the literature. To the best of our knowledge, no similar reports can be found in the literature.

scholarly journals SAT-235 Young Male with Persistent Central Diabetes Insipidus After a Car Accident

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Liudmila Yesaulava ◽  
Caroline Houston ◽  
Sanjeda Sultana
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Specific Gravity ◽  
Diabetes Insipidus ◽  
Intracranial Hypertension ◽  
Serum Sodium ◽  
Mass Effect ◽  
Midline Shift ◽  
Pituitary Dysfunction ◽  
Ct Head

Abstract BACKGROUND: Central diabetes insipidus (CDI) occurs in 20% of cases of traumatic brain injury (TBI). Most cases of post-TBI CDI resolve within 2–5 days. Only 6% of long-term survivors of TBI have evidence of persistent CDI.1 We report a patient with persistent CDI after TBI. Clinical Case: A 27 year old male was referred for polyuria. Three months prior he was in a rollover motor vehicle accident. At that time, CT head revealed frontal and occipital contusions with scattered subarachnoid, subdural, and intraventricular blood. There was no evidence of skull fracture, mass-effect, or midline shift. On hospital day 4, his urine output increased to > 3L/day, with serum sodium of 146 mEq/L (n 135–145) and urine specific gravity of 1.015 (n 1.005–1.030). Repeat head CT revealed bilateral subdural hematomas causing mild mass effect. During the rest of his 2-month hospitalization, he continued to have polyuria with specific gravity as low as 1.005, and occasional hypernatremia, with a peak serum sodium of 149 mEq/L. Serum sodium on discharge was 144 mEq/L. On presentation to our clinic, his family and caretakers reported polydipsia, polyuria and nocturia. He had no history of diabetes mellitus or lithium use. On exam he was tachycardic but normotensive with no signs of dehydration. Neurologic exam was normal except for distractibility and impaired long- and short-term memory. After 3 hours of water deprivation, laboratory testing revealed serum sodium 150 mEq/L, serum osmolality 307 mOsmol/kg (n 270–295), urine osmolality 119 mOsmol/kg (n 300–900), and ADH 3 pmol/L (n </= 14); consistent with CDI. Oral desmopressin led to resolution of polydipsia and polyuria. Evaluation of anterior pituitary function was normal. Six months post TBI, CT head revealed increased left frontal subdural hematoma with effacement of the right lateral ventricle and 1cm left-to-right midline shift. A burr hole procedure was performed but CDI persisted. Conclusion: Animal studies have shown that neurohypophyseal apoptosis occurs by inducing intracranial hypertension lasting 12 hours or more.2 Persistent DI may herald rising intracranial pressure (ICP), as reflected by our patient’s case.1 Clinicians should be aware of the reciprocal association between increased ICP and persistent CDI following TBI. References: (1) Tudor R. M., Thompson C. J. Posterior pituitary dysfunction following traumatic brain injury: review. Pituitary. 2019 Jun; 22(3):296–304. (2) Tan H., et al. Assessment of the role of intracranial hypertension and stress on hippocampal cell apoptosis and hypothalamic-pituitary dysfunction after TBI. Sci Rep. 2017 Jun; 7(1):3805.

Haemostatic and cranial computed tomography characteristics in patients with acute and delayed coagulopathy after isolated traumatic brain injury

Brain Injury ◽  
2012 ◽  
Vol 26 (12) ◽  
pp. 1464-1471 ◽  
Author(s):  
Gaby Franschman ◽  
Sjoerd Greuters ◽  
Wim H. Jansen ◽  
Linda M. Posthuma ◽  
Saskia M. Peerdeman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cranial Computed Tomography

Isoflurane-Associated Mydriasis Mimicking Blown Pupils in a Patient Treated in a Neurointensive Care Unit

2016 ◽  
Vol 78 (04) ◽  
pp. 403-406 ◽  
Author(s):  
Eva Korf ◽  
Volker Tronnier ◽  
Jan Gliemroth ◽  
Jan Küchler
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cranial Computed Tomography ◽  
Elevated Intracranial Pressure ◽  
Neurointensive Care Unit ◽  
Intravenous Treatment ◽  
Cerebral Herniation ◽  
Diagnostic Investigations

AbstractWe report a misinterpretation of bilateral mydriasis as blown pupils related to elevated intracranial pressure (ICP) under volatile sedation with isoflurane (Anesthetic Conserving Device [AnaConDa], Hudson RCI, Uppland Vasby, Sweden) in a 59-year-old patient with a severe traumatic brain injury with frontal contusion. The patient showed bilateral mydriasis and a missing light reflex 8 hours after changing sedation from intravenous treatment with midazolam and esketamine to volatile administration of isoflurane. Because cranial computed tomography ruled out signs of cerebral herniation, we assumed the bilateral mydriasis was caused by isoflurane and reduced the isoflurane supply. Upon this reduction the mydriasis regressed, suggesting the observed mydriasis was related to an overdose of isoflurane. Intensivists should be aware of the reported phenomenon to avoid unnecessary diagnostic investigations that might harm the patient. We recommend careful control of the isoflurane dose when fixed and dilated pupils appear in patients without other signs of elevated ICP.

343 A New Computed Tomography-based Frontal Contusion Score for Patients with Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 277-277
Author(s):  
Qiang Yuan
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Area Under The Curve ◽  
Neurological Deterioration ◽  
Stepwise Logistic Regression ◽  
Basal Cistern ◽  
Unit Increase ◽  
Acute Neurological Deterioration

Abstract INTRODUCTION Frontal contusions are characterized by gradually progressing hematoma/edema and rapid deterioration owing to central herniation, even if the patient is conscious at the time of admission. This study 1) examined how to better characterize frontal contusion in a series of traumatic brain injury (TBI) patients, and 2) developed and validated a new frontal contusion score (FCS) based on the shape of the frontal contusion to facilitate rapid, accurate assessment of the computed tomography (CT) findings of frontal contusion. METHODS This study retrospectively analyzed data from 206 consecutive patients with isolated frontal contusions. The new score is based mainly on the shape of the frontal brain contusion. Forward stepwise logistic regression was used to identify independent predictors of acute neurological deterioration and refractory intracranial hypertension. A receiver-operating characteristic (ROC) curve was then drawn based on the FCS. RESULTS >The incidence of acute neurological deterioration increased significantly as the FCS increased. FCS, obliteration of the basal cistern, and a serum sodium decrease of more than 10 mm ol/L within 24 hours were independent predictors of acute neurological deterioration. Each one-unit increase in FCS led to a 57% increase in the odds of acute neurological deterioration [odds ratio (OR), 1.57; 95% confidence interval (CI), 1.25 1.95]. The area under the curve (AUC) of the FCS that predicted acute neurological deterioration was 0.727 (95% CI 0.656 0.797). The incidence of refractory intracranial hypertension increased significantly with an increase in the FCS. Only FCS and obliteration of the basal cistern remained predictors of refractory intracranial hypertension. Each one-unit increase in FCS led to a 49% increase in the odds of refractory intracranial hypertension (OR, 1.49; 95% CI, 1.06 2.10). The area under the curve (AUC) of the FCS for predicting refractory intracranial hypertension was 0.647 (95% CI 0.532 0.763). The FCS was not an independent predictor of the 6-month mortality (OR, 0.87; 95% CI, 0.59 1.28) or 6-month unfavorable outcome (OR, 1.32; 95% CI, 0.93 1.87). CONCLUSION Therefore, the FCS is a valid evaluator of the character of frontal contusion. The clinical utility and generalizability of this score need to be validated in a large sample.

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