1/28. head trauma and brain tumours revisited.The authors report a case of an anaplastic astrocytoma which on magnetic resonance imaging and direct visualisation was continuous with an area of gliosis in the left frontal lobe. This gliosis was secondary to a head injury received 19 years earlier that required evacuation of an intracerebral haematoma. This case largely meets the accepted criteria for brain tumour associated with head trauma.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/28. Isolated medulla oblongata function after severe traumatic brain injury.The objective was to report the first pathologically confirmed case of partly functionally preserved medulla oblongata in a patient with catastrophic traumatic brain injury.A patient is described with epidural haematoma with normal breathing and blood pressure and a retained coughing reflex brought on only by catheter suctioning of the carina. Multiple contusions in the thalami and pons were found but the medulla oblongata was spared at necropsy. In conclusion, medulla oblongata function may persist despite rostrocaudal deterioration. This comatose state ("medulla man") closely mimics brain death.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
3/28. golf buggy related head injuries.Our department has recently managed three cases of serious head injuries resulting from falls from golf buggies. One of them sustained moderate head injury with a small cerebral contusion and skull fracture. Two of them sustained severe head injury with extensive cerebral contusions, extradural haematoma requiring craniotomy. Of the three patients, two made good recoveries whereas the third remained vegetative.We feel that instruction on the safe use of golf buggies is inadequate and should be intensified.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
4/28. Subdural haematoma and non-accidental head injury in children.patients AND methods: In this retrospective study, 36 children referred to paediatric neurology and neurosurgery during April 1995-June 1998 with a diagnosis of subdural haematoma (SDH) were studied. Nine were accidental secondary to witnessed trauma and 4 were iatrogenic. Non-accidental head injury (NAHI) was suspected in the remaining 23 children. RESULTS: After a full clinical, radiological and social assessment, NAHI was diagnosed in 14, lateral sinus thrombosis in 1, 2 were accepted as accidental and 6 remained unexplained. In the NAHI group (n=14), 12 were between 4 and 16 weeks of age, 12 (85%) had retinal haemorrhages and skeletal surveys showed evidence of additional injury in 8. Computerised tomography (CT) brain scans showed bilateral SDH in 11, and 6 had inter-hemispheric bleeding along with loss of grey-white differentiation. Eleven had magnetic resonance imaging (MRI), which yielded additional information in 7. Seven required intensive care, and 2 died. Twelve had surgical aspiration. In the group with no satisfactory explanation for SDH ( n=6); 5 had neonatal problems, all except 1 were older than 5 months of age and not as ill with bilateral, old SDH. All but 1 had skeletal surveys, which were normal, and eye examination showed no retinal haemorrhages. A social services enquiry was non-contributory. CONCLUSIONS: SDH is frequently traumatic whether accidental or non-accidental. SDH due to NAHI tends to present before 4 months of age with an inconsistent history; the patients are more seriously ill and have other findings, such as fractures and retinal haemorrhages. A small subgroup of patients was identified who had isolated, old SDH and in whom full investigation remained inconclusive. A consistent, comprehensive approach needs to be maintained in all cases with the essential backup of detailed neuro-imaging including MRI.- - - - - - - - - - ranking = 5keywords = haematoma (Clic here for more details about this article) |
5/28. Sequentially evolved bilateral epidural haematomas.Sequentially evolved bilateral epidural haematomas, where the second haematoma evolves after surgical removal of the first haematoma, are rarely reported. We report two cases of this entity. One patient was involved in a road traffic accident and the other was suffering from a head injury after an assault. CT scans showed that both patients had an unilateral epidural haematoma with a thin presumably epidural haemorrhage on the opposite side. Both patients were operated for their epidural haematomas, but did not improve after surgical treatment, and postoperative CT scans revealed evolving of an epidural haematoma on the opposite side. After evacuation of the second epidural haematoma both patients recovered quickly. Sequentially evolved bilateral epidural haematomas are rare, but must be considered in the postoperative intensive care treatment in patients with epidural haematomas. Both cases emphasize the need for intensive care monitoring after an operation for an epidural haematoma and the need for CT scans if the patient does not improve quickly after removal of the haematoma. This is especially important if a small contralateral haematoma is seen on the initial CT scan.- - - - - - - - - - ranking = 16keywords = haematoma (Clic here for more details about this article) |
6/28. Post-traumatic hemifacial spasm.We report an early-onset post-traumatic hemifacial spasm and discuss possible aetiology. A 20-year-old man was admitted to our hospital for observation because of an injury to the right frontotemporal region, resulting in drowsiness. On the second day in hospital, he developed peripheral paresis of the facial nerve on the right, followed by hemifacial spasm on the same side. He improved after corticosteroid treatment, and was discharged one week later almost completely recovered. The neuroradiology and clinical response suggest that the patient's hemifacial spasm was due to hyperexcitability of the facial nerve nucleus induced by a haematoma in the lower central pons.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
7/28. Traumatic interhemispheric subdural haematomas.According to reports in the literature traumatic interhemispheric subdural haematomas (I.S.H.) are supposed to present acutely or subacutely with contralateral monoparesis of a lower extremity or hemiparesis or in bilateral haematomas even with paraparesis, and to need early operative evacuation. In our series of 5 cases none of them followed this "classical" clinical picture, and three of them recovered without operation. We conclude that the indication for operative evacuation depends on the clinical course and that in patients with spontaneously improving symptomatology non-surgical management under close supervision may be the better solution. Also the C.T. finding of open convexity cisterns may be possible indication for conservative management.- - - - - - - - - - ranking = 6keywords = haematoma (Clic here for more details about this article) |
8/28. Preservation of consciousness in a decerebrating head injured patient.We report a patient whose consciousness was preserved even as she developed decerebration following a head injury. Her brainstem reflexes were normal. A large left frontal haematoma was evacuated. She improved remarkably over the next 2 1/2 years.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
9/28. Acute isodense extradural haematoma.A case of acute isodense extradural Haematoma in a 30-year-old woman is reported. This uncommon computed tomography finding is discussed and the pathophysiology is reviewed.- - - - - - - - - - ranking = 4keywords = haematoma (Clic here for more details about this article) |
10/28. Chronic intracerebral haematoma.Chronic intracerebral haematoma is a rare entity. The natural history of this condition is unclear and its diagnosis is difficult. Two cases of chronic intracerebral haematoma from different sources are reported. We discuss the controversies about its pathogenesis, clinical presentation, CT diagnosis and treatment.- - - - - - - - - - ranking = 6keywords = haematoma (Clic here for more details about this article) |
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