Acute arterial infarcts in patients with severe head injuries

Abstract To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Patients with severe head injury (Glasgow coma score (GCS) ≤8) presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT) head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS) at 1 month post-injury or at death (whichever came earlier). Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1%) had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3–85 years). Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1–3) was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21) in patients with severe head injury without arterial infarct. A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-à-vis patient without these findings

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Outcome in elderly individuals with moderate and severe head injury: a tertiary centre experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184199 ◽

2018 ◽

Vol 6 (11) ◽

pp. 3509

Author(s):

Gurusamy Rajasekaran ◽

Raju Venkatesh

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Head Injuries ◽

The Elderly ◽

Early Prediction ◽

Elderly Individuals ◽

Good Outcome ◽

Tertiary Centre ◽

The Mean ◽

The Impact

Background: The prognosis of patients with moderate and severe head injuries is poor in elderly individuals which affects not only their families and also the society. An accurate and early prediction of survival and functional outcome becomes essential and important to decide the aggressiveness of treatment after the informed counseling of relatives. The aim of the present study was to assess the impact of the age on the outcome of the elderly individual with moderate and severe head injury and to compare it with the outcome of younger age group.Methods: Authors retrospectively evaluated 250 patients with moderate (GCS 9-13) and severe (GCS 3-8) TBI after categorizing them into group A (above 60 years of age) and group B (20-59 years of age). Age, sex, mode of injury, level of consciousness as in GCS, management and CT findings were assessed for outcome and comparisons were made.Results: The mean age for good outcome in elderly group is 66.8 and for bad outcome is 70.1 years. The mean age for good outcome in younger group is 33.2 and for bad outcome is 47.5 years. Elderly patients fare worse in all factors assessed when compared to younger group.Conclusions: Head injuries in old age associated with poor GCS serves as a basis for making early prediction for the likelihood of poor outcome.

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Utility of the Hobby WISC—R Split-Half Short Form for Children and Adolescents with Severe Head Injury

Psychological Reports ◽

10.2466/pr0.1993.72.2.371 ◽

1993 ◽

Vol 72 (2) ◽

pp. 371-376 ◽

Cited By ~ 1

Author(s):

Stephen R. Hooper ◽

Kreig D. Roof

Keyword(s):

Head Injury ◽

Children And Adolescents ◽

Severe Head Injury ◽

Short Form ◽

Pediatric Population ◽

Neuropsychological Testing ◽

Head Injuries ◽

Older Children ◽

Closed Head Injuries ◽

Classification Agreement

This study investigated the utility of the Hobby WISC—R Split-half Short Form in a sample of children and adolescents with severe head injury. Subjects included 30 patients with severe closed-head injuries who were referred for neuropsychological testing as part of their hospitalization in a pediatric rehabilitation center. Subjects ranged in age from 7.5 to 16.2 years and were of the low to middle socioeconomic range. Analyses yielded significant correlations between scores on the standard WISC—R and the Split-half Short Form. Except for the WISC—R Split-half Short Form slightly overestimating scores on Object Assembly, no other score differences were obtained between the two forms. Patterns of strengths and weaknesses were variable for the two forms, with over-all agreements ranging from 46% on the Performance subtests to 53.7% on the Verbal subtests. The rate of classification agreement between the standard and short-form formats in assigning a child to one of five traditional IQ categories was 76.7%, with nearly all scores on the short form falling within one standard error of measurement of the standard WISC—R scores. There was a tendency for younger children to show more stability in their classification categories across the two WISC—R forms than older children. Issues related to the use of the WISC—R Split-half Short Form for a severely head-injured pediatric population are discussed.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119825660 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982566 ◽

Cited By ~ 1

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.

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Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽

10.1542/peds.95.2.216 ◽

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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The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents

Neurosurgical FOCUS ◽

10.3171/2018.1.focus17796 ◽

2018 ◽

Vol 44 (5) ◽

pp. E7 ◽

Cited By ~ 5

Author(s):

Xinli You ◽

Boon S. Liew ◽

Azmin K. Rosman ◽

Kamarul Imran Musa ◽

Zamzuri Idris ◽

...

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Traffic Accidents ◽

Road Traffic ◽

Cost Of Care ◽

Road Traffic Accidents ◽

Traumatic Head Injury ◽

Traumatic Head ◽

The Mean ◽

Mean Cost

OBJECTIVETraumatic brain injury due to road traffic accidents occurs mainly in the younger age group in which injury-related disability leads to long-term impact on employment and economic and social consequences across the lifespan. This study was designed to assign a monetary cost (in Malaysian ringgits [RM]) to the treatment of patients with surgically treated isolated traumatic head injury as determined up to 1 year after injury.METHODSRelevant resource items used were identified and valued using the direct measurement of costs method, cost accounting methods, standard unit costs method, fees, charges and/or market prices method. These values were then tabulated to generate the total costs for each patient, via a combination of macro-costing and micro-costing methods. Malaysian currency values were converted to US dollars according to the average conversion rate for the period from January to May 2016: RM1 = US$0.2452.RESULTSThis costing study analyzed data from 49 patients. The estimated cost for the 1st year of care for all patients was RM1,471,919.80 (US$360,914.735), with a mean (± SD) cost per case of RM30,039.18 ± 22,986.25 or $7365.61 ± $5636.23. The mean cost of care per case was RM11,041.35 ± 10,936.88 or $2707.34 ± $2681.72 for mild head injury, RM32,550.00 ± 20,998.76 or $7981.26 ± $5148.90 for moderate head injury, and RM36,917.86 ± 23,697.34 or $9052.26 ± $5810.59 for severe head injury. Severe head injury (p = 0.001), sustaining 2 or more intracranial pathologies (p = 0.01), having a poor Glasgow Outcome Scale (GOS) score (GOS score 1–3) (p = 0.02), requiring a tracheostomy (p < 0.001), and contracting pneumonia (p < 0.001) were significantly associated with higher cost. Logistic regression analysis revealed that cost of care increased by RM591.60 or $145.06 per year increment of age (β = RM591.60, p = 0.05).CONCLUSIONSThe mean cost of treatment for traumatic head injury is high compared to the per capita income of RM37,900 in 2016. The cost values generated in this study provide baseline cost estimates that the authors hope will be used as a guide to determine where adequate funding should be allocated to provide timely and appropriate delivery of care.

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Late Effects of Closed Head Injuries: Psychiatric Observations

Journal of Mental Science ◽

10.1192/bjp.92.386.np ◽

1946 ◽

Vol 92 (386) ◽

pp. 1-18 ◽

Cited By ~ 15

Author(s):

E. Guttmann

Keyword(s):

Head Injury ◽

Late Effects ◽

Late Stage ◽

Head Injuries ◽

Closed Head Injuries ◽

Clinical Stages ◽

Closed Head

In discussing the late stage of head injuries, it is necessary first to define the clinical stages in the treatment of these conditions. With Donald Munroe, it is considered expedient to classify cases of head injury in general into— (a) Operative and (b) Non-operative cases.

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Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.5.1 ◽

1997 ◽

Vol 2 (5) ◽

pp. E1

Author(s):

Peter D. Le Roux ◽

David W. Newell ◽

Arthur M. Lam ◽

M. Sean Grady ◽

H. Richard Winn

Keyword(s):

Head Injury ◽

Cerebral Infarction ◽

Cerebral Perfusion ◽

Severe Head Injury ◽

Cerebral Metabolism ◽

Jugular Bulb ◽

Group A ◽

The Mean ◽

Group B ◽

Oxygen Difference

Jugular bulb oxygen monitoring can be used to estimate the adequacy of cerebral blood flow to support cerebral metabolism after severe head injury. In the present study, the authors studied the cerebral arteriovenous oxygen difference (AVDO2) before and after treatment in 32 head-injured patients (Glasgow Coma Scale scores ¾ 8) to examine the relationships among AVDO2 and cerebral perfusion pressure (CPP), delayed cerebral infarction, and outcome. Fifteen patients (Group A) underwent craniotomy for hematoma evacuation and 17 (Group B) received mannitol for sustained intracranial hypertension (intracranial pressure > 20 mm Hg, > 10 minutes). Radiographic evidence of delayed cerebral infarction was observed in 14 patients. Overall, 17 patients died or were severely disabled. Cerebral AVDO2 was elevated before craniotomy or mannitol administration; the mean AVDO2 for all patients before treatment was 8.6 ± 1.8 vol%. Following craniotomy or mannitol administration, the AVDO2 decreased in 27 patients and increased in five patients (mean AVDO2 6.2 ± 2.1 vol% in all patients; 6 ± 1.9 vol% in Group A; and 6.4 ± 2.4 vol% in Group B). The mean CPP was 75 ± 9.8 mm Hg and no relationship with AVDO2 was demonstrated. Before treatment, the AVDO2 was not associated with delayed cerebral infarction or outcome. By contrast, a limited improvement in elevated AVDO2 after craniotomy or mannitol administration was significantly associated with delayed cerebral infarction (Group A: p < 0.001; Group B: p < 0.01). Similarly, a limited improvement in elevated AVDO2 after treatment was significantly associated with an unfavorable outcome (Group A: p < 0.01; Group B: p < 0.001). In conclusion, these findings strongly indicate that, despite adequate cerebral perfusion, limited improvement in elevated cerebral AVDO2 after treatment consisting of either craniotomy or mannitol administration may be used to help predict delayed cerebral infarction and poor outcome after traumatic brain injury.

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Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽

10.1227/00006123-198602000-00013 ◽

1986 ◽

Vol 18 (2) ◽

pp. 190-193 ◽

Cited By ~ 17

Author(s):

Frederick M. Vincent ◽

J. Eric Zimmerman ◽

James Van Haren

Keyword(s):

Creatine Kinase ◽

Head Injury ◽

Neuroleptic Malignant Syndrome ◽

Complete Resolution ◽

Head Injuries ◽

Closed Head Injury ◽

Treatment Modalities ◽

Dantrolene Sodium ◽

Closed Head Injuries ◽

Closed Head

Abstract Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.

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Characterizing Discourse Deficits Following Penetrating Head Injury: A Preliminary Model

American Journal of Speech-Language Pathology ◽

10.1044/1058-0360(2013/12-0076) ◽

2013 ◽

Vol 22 (2) ◽

Cited By ~ 26

Author(s):

Carl Coelho ◽

Karen Lê ◽

Jennifer Mozeiko ◽

Mark Hamilton ◽

Elizabeth Tyler ◽

...

Keyword(s):

Head Injury ◽

Structural Equation ◽

Head Injuries ◽

Equation Modeling ◽

Story Grammar ◽

Closed Head Injuries ◽

Discourse Production ◽

Penetrating Head Injury ◽

Preliminary Model ◽

Proposed Model

Purpose Discourse analyses have demonstrated utility for delineating subtle communication deficits following closed head injuries (CHIs). The present investigation examined the discourse performance of a large group of individuals with penetrating head injury (PHI). Performance was also compared across 6 subgroups of PHI based on lesion locale. A preliminary model of discourse production following PHI was proposed and tested. Method Story narratives were elicited from 2 groups of participants, 167 with PHI and 46 non brain–injured (NBI). Micro- and macrostructural components of each story were analyzed. Measures of memory, executive functions, and intelligence were also administered. All measures were compared across groups and PHI subgroups. The proposed model of discourse production was tested with a structural equation modeling procedure. Results No differences for the discourse measures were noted across the six PHI subgroups. Three measures distinguished the PHI and NBI groups: narrative length, story grammar, and completeness. The proposed model of discourse production had an adequate-to-good fit with the cognitive and discourse data. Conclusion In spite of differing mechanisms of injury, the PHI group's discourse performance was consistent with what has been reported for individuals with CHI. The model tested represents a preliminary step toward understanding discourse production following traumatic brain injury.

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