1/111. spinal cord injury following an attempted thoracic epidural.Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/111. Rapid spontaneous resolution of an acute extradural haematoma: case report.A case of acute extradural haematoma with spontaneous resolution within 6 h of the head injury is presented. The literature is reviewed.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
3/111. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
4/111. Concomitant post-traumatic craniocervical junction epidural hematoma and pontomedullary junction infarction: clinical, neurophysiologic, and neuroradiologic features.STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of post-traumatic epidural hematoma of the craniocervical junction with concomitant brain stem infarction. SUMMARY OF BACKGROUND DATA: Post-traumatic epidural hematoma of the cervical spine and brain stem post-traumatic infarction are very rare disorders. Post-traumatic epidural hematoma is usually located dorsally in the epidural space. methods: The clinical, neuroradiologic, and neurophysiologic findings in one patient with post-traumatic epidural hematoma located ventrally at the cervicomedullary junction and associated with medial infarction at the pontomedullary junction are reported. RESULTS: The main clinical finding in this patient was bilateral corticospinal and corticobulbar tract involvement. A magnetic resonance image showed displacement and flattening of the medulla oblongata and of the most cranial portion of cervical cord, which were caused by the epidural hematoma associated with an ischemic lesion of the pontomedullary junction. Results of central motor conduction studies indicated that the abnormality of the central motor pathways was localized at brain stem level, and that there was normal conduction from the cervicomedullary junction to spinal cord. CONCLUSION: This is the first reported case of spinal epidural hematoma located ventrally in the cervical spine at the cervicomedullary junction level and concomitant infarction at the pontomedullary junction resulting from whiplash injury.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
5/111. Traumatic acute giant epidural hematoma in a hydrocephalic shunted child.Extradural hematoma (EDH) is considered to be a rare complication of head trauma in children, and represents a serious and urgent pathology from which complete recovery can be expected if specialized treatment is instituted in time. In this article, the authors report the potential danger to a hydrocephalic shunted child who was apparently asymptomatic at the time of hospital admission with a mild head injury and developed an EDH of venous origin. This child had a rapid (time interval from injury to decerebrate posture of about 2 h), atypical (remained asymptomatic most of the time until abruptly deterioration) and fatal course, stressing the importance of early diagnosis and rapid therapy in order to avoid the death of the patient. The authors discuss the role of the ventriculoperitoneal shunting system in the lack of clinical symptoms associated with the presence of a giant EDH and a rapid and fatal course, and stress the importance of computed tomographic (CT) scanning in these patients, even if they are asymptomatic. If a skull fracture is suspected, a CT scan must be performed without delay.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
6/111. Transverse clivus fracture: case presentation and significance of clinico-anatomic correlations.BACKGROUND: Bilateral transverse basal skull fractures resulting from lateral crushing injuries involve fractures of the clivus that present clinically with multiple cranial nerve injuries and possible delayed vascular injuries due to the tight neural and vascular entry and exit routes present in this region. A case of a young patient with an extensive basal skull fracture is presented with description of the clinical signs and symptoms in relation to the neuroradiological findings. Clinico-anatomic correlations have been reiterated. CASE DESCRIPTION: A case of a young patient suffering a bilateral crush injury resulting in a basal transverse clivus and petrous bone fracture is presented. Multiple cranial nerve injuries, unilateral and bilateral, were present (CN III, VI, VII). This clinical presentation correlated well with the anatomical location and extension of the respective cranial nerves at the level of the skull base and along the fracture line extending bilaterally through the clivus and petrous bone. CONCLUSIONS: Initial neurological and neuroradiological investigations should be aimed at promptly detecting cranial nerve injuries and their correlating fracture injuries at the skull base. The possible development and progression of delayed neurological deficits should also be kept in mind and investigated.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
7/111. CT scans essential after posttraumatic loss of consciousness.The frequency of "talk and deteriorate" in the emergency department (ED), subsequent deterioration of patients with seemingly "mild" head injury at the time of presentation, is summarized. Among the 1,073 patients with minor head injury treated in the last 5 years, five patients (0.5%) deteriorated in the ED. All of the five patients had experienced transient loss of consciousness (LOC) before presentation. Deterioration had occurred during treatment of trivial associated injuries in four-fifths of the cases. Computed tomography (CT) scans revealed four acute epidural hematomas and one cerebellar contusion. Retrospectively, immediate brain CT shortly after their arrival may have revealed the presence of traumatic intracranial hematomas before deterioration. Although routine use of CT scans in patients with mild head injury has been controversial, the authors conclude that CT scans should be taken if patients have experienced transient LOC to prevent or reduce the occurrence of deterioration in ED.- - - - - - - - - - ranking = 0.75keywords = injury (Clic here for more details about this article) |
8/111. Delayed epidural hematoma: presentation in a pediatric patient.Epidural hematomas remain at the pinnacle of neurosurgical emergencies, representing approximately 3% to 8% of all serious head injuries. mortality from this entity is usually prevented once the diagnosis is clear. Although readily recognized on non-contrast head CT, the occasional patient may go on to develop a clinically significant hematoma after an initial negative CT. This phenomenon is appropriately termed delayed epidural hematoma. We present a case in which a 3-year-old boy developed a large epidural hematoma, which was not evident until the second CT, several hours after the injury. We feel that maintaining a high clinical suspicion, coupled with a low threshold for CT scanning, is the key to morbidity prevention in this illness.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
9/111. The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma.Computed tomography (CT) has revolutionized the diagnosis and management of head-injured patients, and its increasing availability has led to its liberal use. CT scanning provides excellent anatomic detail of the brain as fixed static images, but the dynamic nature of human physiology means that many injury patterns will evolve in time. We describe an 8-year-old child who had fallen 8 feet from a tree. He had a brief loss of consciousness but a normal neurologic evaluation on arrival to the emergency department (ED). He underwent expedited cranial CT scanning, which revealed no acute brain injury. Two and one half hours later, the patient had a mild depression in consciousness, prompting a second CT scan in the ED, which revealed an acute epidural hematoma. He had acute surgical evacuation of the hematoma and made a full neurologic recovery. This case illustrates that a single early CT examination may at times provide a false sense of security and underscores the importance of serial neurologic examinations.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
10/111. The injured coach.The patient in this case was diagnosed as having an epidural hematoma (shown in x-ray at right). This results from hemorrhage between the dura mater and the skull. The hemorrhage may result from a traumatic insult to the side of the head, which can fracture the temporal bone and lacerate the middle meningeal artery. Since the hemorrhage is arterial in nature, the patient may deteriorate quickly. These patients may present with what is referred to as a "lucid interval." The patient typically has a significant blow to the head that results in a short period of unconsciousness. They then regain consciousness at a time that frequently coincides with the arrival of EMS. Once conscious, they are in a period known as the lucid interval. They will still have a headache, but may otherwise be acting normally and show no other physical findings on examination. Many such patients refuse treatment and transport. [table: see text] Inside the skull, however, the problem will grow. Broken arterial vessels are bleeding, causing an expanding hematoma. The patient typically will soon complain of a severe headache along with other associated complaints, such as nausea/vomiting, then will lose consciousness again and/or have a seizure. Initial physical findings may include contralateral weakness and a decreased Glasgow coma score. As the hematoma expands, cerebral herniation may occur, compressing the third cranial nerve, which presents as a "blown pupil." EMS providers should have a high suspicion of injuries that affect the side of the head and the base of the skull. It is important to not only assess such injuries, but also the mechanism of injury, and to know the complications or later presentation that can arise from such injuries. Given that this patient was alert, oriented, not obviously intoxicated, and accompanied by his wife, the providers in this case would have had no choice but to abide by a refusal of treatment and transport. However, that could lead to serious complications, such as ongoing minor neurological deficits, later on. If this is the case, contacting medical control should be the priority.- - - - - - - - - - ranking = 0.25keywords = injury (Clic here for more details about this article) |
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