A fatal case of traumatic brain injury with severe coagulopathy due to Rhabdophis tigrinus (yamakagashi) bites: a case report

Background Yamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite. Case presentation An 80-year-old man fell and developed systemic tonic–clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Although eighteen units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died about 18 h after a head injury. Conclusion In this case of a yamakagashi bite with active bleeding due to trauma, early administration of yamakagashi antivenom should be considered to control coagulopathy.

ROLE OF THE CELLULAR IMMUNITY IN THE PATHOGENESIS OF BRAIN CONTUSION

Traumatic brain injury (TBI) is one of the most common pathologies of the central nervous system in the world, and the use of structural neuroimaging methods – computed tomography (CT) and magnetic resonance imaging (MRI) – often doesn’t allow assessment of the severity of the brain injury that has occurred. This situation predetermines the need to search for new methods of differential diagnosis of the severity of TBI and predicting the risk of consequences.One of these promising areas is the study of the immune status, since traumatic brain injury is characterized by a high rate of complications.One of these promising areas is the study of the immune status in patients with TBI in the acute period. It is now known that in response to brain damage, a response from the immune system is triggered.The reactions from the immune system, which develop after brain injury and directed against its own antigens, in the early period of the disease are related to damage to the nervous tissue. However, according to the latest available data, they are subsequently able to stimulate the processes of repair and regeneration in the brain tissue. In the course of damage to the nervous tissue, in response to endogenous molecules formed during the destruction of cells and the extracellular matrix, the cells of the immune system are activated.Current evidence indicates that T-cells play a role in both the formation of secondary damage and repair mechanisms. They are able to protect neurons through the production of neurotrophic factors such as brain neurotrophic factor (BDNF), which stimulates the growth of neurons, the formation of synapses.Using multicolor cytometric analysis within the framework of this work, a study was carried out to determine the number of the main subpopulations of CD3+CD4+-lymphocytes. The relative number of Th17 (CXCR5- CXCR3- CCR6+CCR4- ) and Th17/Th22 (CXCR5- CXCR3- CCR6+CCR4+), Th1/Th17 (CXCR5- CXCR3+CCR6+CCR4- ) among total CD45RA-negative CD3+CD4+-cells population is significantly increased in comparison with the values in the control group, in turn, the Th1(CXCR5- CXCR3+CCR6- CCR4- ) subpopulations among total CD45RA-negative CD3+CD4+-cells are significantly decreased with the values in the control group. The results obtained so far make it possible to consider immune responses among the key links in the pathogenesis of brain contusion TBI. And, perhaps, a comprehensive immunological examination of the victims in the first day after the injury will determine the parameters that will help predict the nature of possible complications in patients with brain contusion.

The factors of the outcome of neurosurgical treatment in traumatic brain injury

The purpose of the research: to improve the results of neurosurgical treatment in patients with traumatic brain injury by detecting an optimal way of craniotomy. Material and methods. The study includes the analysis of 127 patients operated on in the Department of Neurosurgery. The examination sample consisted of 109 (85.8%) male and 18 (14.2%) female patients. Patients’ ages varied from 16 to 85 years. The average age of the patients was 43.8 ± 4.2 years. Results. Not depending on craniotomy method, there was not a statistically significant difference in outcome in patients with traumatic brain injury. Using of trephination, craniectomy and osteoplastic craniotomy revealed no significant differences in outcomes in patients with traumatic brain injury. Patients’ age over 60 years, consciousness degree 4-6 scores according to Glasgow Coma Scale, and dislocation syndrome are unfavorable prognostic factors. Resection craniotomy in traumatic brain injury may be effective even in deep coma consciousness level and dislocation syndrome, but in absence of intraoperative brain edema. Conclusion. During the planning of craniotomy method in traumatic brain injury, 4-9 score consciousness degree according to Glasgow Coma Scale, brain contusion foci, acute subdural and intracerebral hematomas, brain compression volume of 30-150 cm³, patient’ age and dislocation syndrome should be considered, which, in total, predicts an outcome.

Direct Clipping of Paraclinoid Aneurysm in Conjunction with Extradural Anterior Clinoidectomy: Technical Nuance and Functional Outcome

Objective Because of their anatomical features, treatment for paraclinoid aneurysms has remained to be challenging. Thus, the aim of this report is to prove the validity of our surgical method for unruptured paraclinoid aneurysms, together with surgical videos. Study Design Between August 2017 and November 2019, we were able to perform surgical clipping for 11 patients with unruptured paraclinoid aneurysm using a completely unified method. This study investigated the effect of surgery on multiple measures, including visual impairment, brain contusion, temporalis muscle atrophy, and multiple neurocognitive functions. Results Of the 67 unruptured aneurysms treated at our hospital, 17 were identified to be paraclinoid aneurysm, and 11 of them were treated by direct clipping using anterior clinoidectomy. Three were ophthalmic artery aneurysms, three were superior hypophyseal artery aneurysms, and five were anterior carotid wall aneurysms without branch projection. Only one patient had asymptomatic mild enlargement of the Marriott blind spots postoperatively. No brain contusion and temporalis muscle atrophy were observed in any cases. Only the Trail Making test (TMT) showed a significant worsening in the acute postoperative period: mean pre- and postoperative TMT scores were 59.1 ± 29.1 and 72.7 ± 37.3 for Part A (p = 0.018) and 80.5 ± 35.5 and 93.8 ± 39.9 for Part B (p = 0.030), respectively. However, it improved in the chronic phase. Conclusion We can conclude that our surgical method is safe and can be considered an acceptable treatment. Although surgical stress can cause temporary executive dysfunction shortly after surgery, this decline is temporary.

The effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation

Objectives Injuries induced by the brain trauma from mild to life-threatening therefore prevents these complications need psychological, environmental, and physical support. Acupressure by reduces muscle tension, improves blood circulation and stimulates endorphins secretion naturally reduce pain in these patients therefore the aim of this study was to evaluate effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation. Methods The present study was a clinical trial with a sample size of 64 brain contusion patients who were selected based on available sampling and then randomly assigned to control and experimental groups. Demographic information and check list of blood pressure, heart rate, and respiratory rate were recorded before intervention in two groups then acupressure at the p6 point for 10 min in both hands at the morning and evening for two consecutive days is done in intervention group while in control group this pressure was applied at the same time point at an inactive point such as thumb hands. After acupressure for both groups, physiological index was measured immediately, half and 1 h after every acupressure. Data were collected using a demographic questionnaire and physiological sheet. Data was analyzed using SPSS 21 software and analytical statistical tests (independent t-test, chi-square, Fisher’s exact test). Results The mean of blood pressure, heart rate, and respiratory rate before acupressure there was no significant statistical difference between two groups (p>0.05). but the mean of two consecutive days of blood pressure, heart rate, and respiratory rate after acupressure in the intervention group than control group was significantly different (p<0/05). Therefore, physiologic index before acupressure than after acupressure in the intervention group was significant statistical difference (p<0.001). The mean difference before the intervention than 12 h after the last intervention between two group was significant statistical difference (p<0/05) which that detected the stability of the effect of acupressure. Conclusions The results indicate that p6 point acupressure in the brain contusion patients under mechanical ventilation has been associated with improved blood pressure, pulse rate, and respiratory rate. While confirmation of these results requires further studies, but use of complementary medicine in recovery the physical condition and strengthening of the effect of nursing care of these patients should be considered.

Cerebrovascular diseases in two patients with entire NSD1 deletion

We describe two patients with NSD1 deletion, who presented with early-onset, or recurrent cerebrovascular diseases (CVDs). A 39-year-old female showed developmental delay and abnormal gait in infancy, and developed slowly-progressive intellectual disability and movement disorders. Brain imaging suggested recurrent parenchymal hemorrhages. A 6-year-old male had tremor as a neonate and brain imaging revealed subdural hematoma and brain contusion. This report suggests possible involvement of CVDs associated with NSD1 deletion.

A Fatal Case of Traumatic Brain Injury With Severe Coagulopathy Due to Rhabdophis Tigrinus (Yamakagashi) Bites, A Case Report

Background Yamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite. Case Presentation: An 80-year-old man fell and developed systemic tonic–clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Even though 18 units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died approximately 13 hours after admission. Conclusion In this case of a yamakagashi bite with active bleeding due to trauma, early administration of Yamakagashi antivenom should be considered to control coagulopathy.