1/21. Management of severe postnasal haemorrhage: the Kingsley splint revisited.Postnasal haemorrhage accompanying severe craniofacial trauma may have catastrophic consequences if not arrested promptly. The airway has usually been secured and the cervical spine stabilized, but apart from fluid replacement, other attempts to control haemorrhage in the resuscitation room of the accident and emergency department may be to no avail. We wish to draw attention to a simple device that was introduced over 100 years ago and which may rapidly aid haemostasis and prevent the onset of hypovolaemic shock.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/21. Delayed presentation of post-traumatic aneurysm of the posterior inferior cerebellar artery in a patient with spinal cord injury.STUDY DESIGN: A case report. OBJECTIVE: To present and discuss the case of a patient with serious head and spinal injuries who suffered delayed haemorrhage from a post-traumatic aneurysm of the right posterior inferior cerebellar artery following surgical treatment of vertebral fracture and hydrocephalus. SETTING: National spinal injuries Unit and Institute of Neurological Sciences, Southern General Hospital, Glasgow, scotland, UK. methods: Clinical and radiological follow-up of the patient. RESULTS: The aneurysm was treated by coil occlusion of the right vertebral artery. Post-operative films showed that the aneurysm had been successfully obliterated. CONCLUSION: Post-traumatic cerebral aneurysms are very rare. Neurosurgical and rehabilitation teams need to be aware of this late treatable sequela of head injury.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
3/21. 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 = 0.5keywords = haemorrhage (Clic here for more details about this article) |
4/21. A mysterious temporal penetrating head wound without fracture.Unwitnessed head injuries are often diagnostic and management dilemmas. Low-velocity penetrating head wounds are rare. This paper describes a case of an accidental low-velocity penetrating head wound through the soft tissue of the temporal region. This lesion resulted in a deep intra-cerebral haemorrhage, after the initial assessment revealed no evidence of skull fracture, missile or missile track. The diagnostic evaluation and medical course of this case are presented. This is the first case in the medical literature of a brain injury by an object that penetrated the calvarium at low velocity but which did not produce a fracture of the skull. The evolving diagnostic dilemma is outlined to its conclusion, through 3 years of follow-up observation.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
5/21. papaverine angioplasty to treat cerebral vasospasm following traumatic subarachnoid haemorrhage.The management of vasospasm associated with traumatic subarachnoid haemorrhage presents many challenges. We present a 20-year-old male admitted after sustaining a closed head injury complicated by a Fisher grade III traumatic subarachnoid haemorrhage. Despite treatment with intravenous nimodipine he developed a delayed ischaemic neurological deficit due to cerebral arterial vasospasm. The vasospasm was successfully managed with serial papaverine angioplasty.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
6/21. vacuum assisted delivery--the need for caution.In the United Kingdom and Republic of ireland 10% of all deliveries are vacuum assisted. The vacuum is preferred over forceps because it is easier to perform and associated with less maternal morbidity. It is, however, also associated with subaponeurotic haemorrhage that has an incidence of 6.4 per 1000 vacuum assisted deliveries and a mortality of 23%. Based on a figure of 77,500 births annually in ireland, North and South, it is possible that as many as 11 neonatal deaths each year may attributable to what is generally considered a safe obstetric intervention. In north america concerns about the safety of vacuum assisted delivery resulted in the issuing of public health advisories in both canada and the united states. To date such concerns have not been raised in either the United Kingdom or Republic of ireland. We report a case of fatal subaponeurotic haemorrhage to highlight and bring these concerns to the attention of obstetricians, paediatricians and midwives. We also call for the introduction of a national surveillance in order to assess the true extent of this potentially fatal complication.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
7/21. Intracranial haematoma resulting from lightning stroke.Intra-cerebral haemorrhage due to lightning stroke is extremely rare. We report a 45 year old woman who developed intracranial haemorrhage due to a direct lightning stroke. This was proved by CT scan. The haematoma was evacuated surgically, resulting in full neurological recovery of the patient.- - - - - - - - - - ranking = 0.52550553889973keywords = intracranial haemorrhage, haemorrhage (Clic here for more details about this article) |
8/21. Non-missile head injury: report of a patient surviving for 6 years.A female patient with non-missile head injury is described. She showed slight improvement in her level of consciousness, and survived for 6 1/2 years after injury. At autopsy, the white matter lesions were localized rather than diffuse in distribution. In addition to lesions in the corpus callosum, anterior commissure and dorsolateral quadrant of the rostral brain stem, those in the parasagittal cerebral white matter, and in the hilus of the dentate nucleus and superior cerebellar peduncle were considered to be due to primary axonal injury. A cavity in the frontal white matter was remarkable in that there was no evidence to indicate expansion of the lesion due to haemorrhage. These features suggested that the injurious physical forces had acted parallel to the direction of the axons.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
9/21. vertebral artery rupture in traumatic subarachnoid haemorrhage detected by postmortem angiography.A fatal subarachnoid haemorrhage from a ruptured normal intracranial vertebral artery in a 49-year-old male, following a blow to the head, was revealed by a postmortem angiographic technique using radiopaque silicone rubber as a contrast medium vulcanizing at room temperature. No fracture of the atlas or connection between intracranial vessels and extracranial soft tissue haematoma could be visualized. We advocate the use of postmortem angiography in the diagnosis of suspected head trauma sustained in fights.- - - - - - - - - - ranking = 0.83333333333333keywords = haemorrhage (Clic here for more details about this article) |
10/21. Fatal thrombosis of the basilar artery due to a minor head injury.A case is reported where a 20-year-old alcohol-intoxicated man was admitted to the hospital after a minor head injury. Initially there was no neurologic disturbances or complaints but after a few hours he became comatose, and he died 4 days later without regaining consciousness. The autopsy revealed no lesions of the upper cervical spine or the vertebral arteries, but the basilar artery was occluded in its entire length. No traumatic lesions could be seen by naked eye examination of the artery, and there was no accompanying subarachnoid haemorrhage. A thorough microscopic examination, however, using step-sectioning technique revealed a significant incomplete arterial rupture with an occluding luminal thrombosis superimposed, consisting predominantly of aggregated platelets. Only the very thin adventitia separated the vascular lumen from the subarachnoid space preventing the more well known fatal complication to a minor head injury: A subarachnoid haemorrhage. To the best of our knowledge, fatal thrombosis of the basilar artery due to a minor head injury has not previously been reported. The pathogenetic mechanism seems to be identical to that underlying fatal subarachnoid haemorrhage following a similar trauma apart from the resulting arterial rupture being incomplete instead of complete.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
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