Cranial Nerve Injuries In Patients With Moderate To Severe Head Trauma – Analysis of 91,196 Patients From The TraumaRegister DGU® Between 2008 And 2017

BackgroundTraumatic brain injury (TBI) constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries (CNI) in moderate to severe TBI are largely unknown. We aimed to determine the prevalence of CNI in a large European cohort of TBI patients as well as clinical differences between TBI cases with and without concomitant CNI (CNI vs. control group) by means of a multinational trauma registry.MethodsThe TraumaRegister DGU® was evaluated for trauma patients with head injuries ≥2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables.Results1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3±20.6 vs. 51.8±23.0 years) but did not differ regarding sex distribution (CNI 69.4%; control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p<0.001; chi-squared test) and falls more commonly in the control group (45.2% vs. 37.1%; p<0.001). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p<0.001) and skull base fractures (51.0% vs. 23.5%; p<0.001). Despite similar mean Injury Severity Score (CNI 21.8±11.3; control 21.1±11.7) and Glasgow Coma Scale score (CNI 10.9±4.2, control 11.1±4.4), there was a considerably higher rate of anisocoria in CNI patients (20.1% vs. 11.2%; p<0.001). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p<0.001).ConclusionsCNI as rare adjuncts to TBI should raise the suspicion of complicating skull base fractures and indicate higher rates of functional impairment following primary care.

A Prospective Study on the Incidence and Outcome of Cranial Nerve Injuries in Patients with Traumatic Brain Injuries

Background Posttraumatic cranial nerve injuries are not uncommon and can occur by shearing forces, rapid acceleration/deceleration, or injury to the skull base. The incidence of cranial nerve injury in craniocerebral trauma varies between 5 and 23 percent in various literature. Methodology A prospective study was conducted on the incidence and outcome of cranial nerve injuries (CNI) in 256 consecutive cases of traumatic brain injuries (TBI). Patients over the age of 5 years with a follow-up of 6 months in the period from September 2017 to November 2018 in our institution were sampled. Results A total of 256 patients were included in our study. The incidence of CNI in TBI patients was 14.8% (38 patients). Facial nerve was the most common cranial nerve to be involved, followed by olfactory nerve and vestibulocochlear nerve. Cranial nerve injury was more common in patients with severe head injury (p < 0.005), younger age group, associated base of skull fractures (p < 0.001), and facial fractures (p < 0.005). Twenty-eight patients (73.7%) had a delayed presentation of CNI (p < 0.001). Of the 73.6% patients who recovered, 16 (42%) patients had partial recovery, while 12 (31%) patients had complete recovery. Younger age group (p < 0.05) and delayed onset of deficit (p < 0.001) were associated with significant better outcome. Conclusions CNI are a major cause of morbidity in TBI patients. All patients admitted with TBI should be examined meticulously for CNI on follow-up.

The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study

Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.

ASSESSMENT OF INTERVENTIONS COMPLETED BY THE VOIVODESHIP RESCUE SERVICE IN KATOWICE IN THE SILESIAN VOIVODESHIP IN 2018 DUE TO INJURIES

Aim: To assess the trips made by Emergency Medical Teams due to injuries (ICD-10 code: S) completed by Voivodeship Medical Rescue Teams in Katowice in 2018. Material and methods: Analysis of the characteristics of the trips was done based on information contained on “Emergency ambulance travel cards”. Statistical analysis was carried out using the t-Student, ANOVA variance as well as the Tukey post-hoc tests (p<0.05). Results: The whole number of trips made by the Emergency Medical Teams in the Silesian Voivodeship totalled 211,896, of which due to the reported injury, the total number of trips was 202,946 cases (183,827 calls were in town – 91%; 19,119 calls were out of town – 9%; p<0.05). The most common cause for calls were due to head injuries (S03 – dislocation, sprain and strain of joints and ligaments of the head as well as S04 – cranial nerve injuries). Statistically significant differences in the number of trips depending on cause identification (p<0.05) were determined, as well as in comparison to the number of cases identified as S03 and S04 between the in town and out of town territory (p<0.05). The median arrival time to an in town site was 7 minutes and 42 second, whereas in out of town sites it was 13 minutes and 19 seconds. Conclusion: The characteristics of the trips made by Emergency Medical Teams depends on the time, and what is affected by organizational changes in the emergency medical system.

Comparative Analysis of the Outcomes of Carotid Stenting and Carotid Endarterectomy in the Management of Carotid Stenosis

Carotid Stenosis is an important cause of stroke (20%) which is associated with high morbidity and mortality rates. The management is mainly by surgery or carotid stenting. This study reviews 3 years of experience and the outcomes in the treatment of carotid stenosis by the two methods. The study aimed to evaluate and compare the outcomes of both procedures during a 3yr period at a vascular Surgery department of the Cisanello Hospital. 302 pts were retrospectively analyzed; 151 pts assigned for each procedure. The average intervention time was significantly higher for the CEA group O.R: 0.556; 95% C.I; 0.349- 0.886, P: 0.014 but technical successes were achieved in 100% of CEA pts, whereas were achieved in 91.39% of the CAS group. The periprocedural stroke was nonsignificant between the two procedures. The Periprocedural TIA were show significant difference with more incidences in CAS pts [O.R: 7.292, 95% C.I; 1.150- 45.856, P: 0.032] but almost all pts improved. The cranial nerve injuries were a specific complication of CEA [11.9%]. The recurrent stenosis was seen only in CAS pts [2.9%] with O.R: 0.493, 95% C.I; 0.104- 2.345, P: 0.410. Both procedures are effective and comparable in outcomes in the management of carotid Stenosis.

Cranial nerve injuries in adult faciomaxillary trauma: prospective study in a tertiary referral centre

<p class="abstract"><strong>Background:</strong> Cranial nerve injury is often an overlooked aspect of faciomaxillary trauma. Most of these injuries do require active intervention in the acute stage. Cranial nerve injuries require long-term management, repeated surgical procedures or reconstructive measures.</p><p><strong>Methods:</strong> The study was conducted for one-year prospective study of clinical evaluation of 180 patients with faciomaxillary injuries from May 2017 to May 2018 at tertiary care hospital. There were 154 male patients (86.3%) and 26 (13.7%) female patients. The patients from the age of 18 onwards were included in the study group after obtaining consent. A number of parameters, including age, gender, injury of cranial nerve injuries, sensory and motor deficit in relation to soft tissue trauma and bone fracture were evaluated. The objective of the present study is to evaluate early management and document the frequency of cranial nerve injuries associated with maxillofacial trauma.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 180 cases of faciomaxillary trauma, 60 patients presented with cranial nerve injuries including olfactory, optic, trigeminal, facial, vestibulocochlear, abducens nerve either as an isolated or combined cranial nerve injuries. Out of which most common nerve to get injured was trigeminal followed by facial nerve observed in our study.</p><p><strong>Conclusions:</strong> Cranial nerve injury in maxillofacial trauma is significant and it should be addressed at the time of treatment so that quality of life of patient is improved by getting back his sensory and motor functions of the injured nerves.</p>