Cases reported "Brain Concussion"

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1/19. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.

    OBJECT: Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). methods: The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 /- 14 years; median glasgow coma scale score of 8, range 3-15; male/female ratio 4.3: 1), the mean time from injury to first CT scan was 2 /- 1.6 hours and between first and second CT scans was 6.9 /- 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. CONCLUSIONS: Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan.
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keywords = subdural
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2/19. Efficacy of endovascular surgery for the treatment of acute epidural hematomas.

    BACKGROUND AND PURPOSE: Recent advances in the equipment and technology for endovascular surgery have led to an increasing number of patients undergoing this procedure to treat various lesions. The purpose of this study was to investigate the efficacy of early-stage endovascular surgery to treat growing acute epidural hematomas (AEDHs). methods: Over a period of 2.5 years, endovascular intervention was performed in nine patients with AEDHs, as shown by the extravasation of contrast medium and the recognition of growing hematomas on CT scans. Embolization was performed by using catheters superselectively advanced with a microguidewire until it reached the area just before the bleeding point. RESULTS: In all nine cases, bleeding from the middle meningeal artery ceased immediately after treatment, and further surgical intervention was avoided. In three of five patients with additional lesions, surgical intervention was also conducted to treat an acute subdural hematoma (two patients) or a contusion hematoma (one patient); in two cases, these lesions were located on the contralateral side. CONCLUSION: In patients with thin AEDHs in the early stage, angiography followed by endovascular intervention allows for conservative treatment. Notable clinical benefits can be achieved in patients with complicated, multiple lesions.
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3/19. aspirin as a risk factor for hemorrhage in patients with head injuries.

    The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. aspirin should not be prescribed to patients with post-traumatic headaches.
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4/19. Acute subdural haematoma successfully treated by percutaneous subdural tapping in an elderly patient.

    An elderly patient suffering acute subdural haematoma associated with cerebral contusion was treated by percutaneous subdural tapping while preparing for craniotomy. Most of the subdural haematoma, though of high density on computed tomography scanning, proved to be semiliquid. drainage of the haematoma yielded resolution of the mass effect, and was followed by a rapid improvement of consciousness. This observation suggests the significance of trial subdural tapping for the treatment of acute traumatic subdural haematoma prior to craniotomy.
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ranking = 13
keywords = subdural
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5/19. shaken baby syndrome.

    Violent shaking causes severe injury in infants, but the diagnosis of shaken baby syndrome is often difficult to make because of the lack of obvious external signs. Consultations by other specialists may not be helpful, since the findings of most organ systems, taken in isolation, are usually nonspecific. shaken baby syndrome should be considered in infants presenting with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, hypothermia, bradycardia, hypertension or hypotension, respiratory irregularities, coma or death. Shaken babies are usually less than one year old, and most are under six months of age. head injury (notably subdural hemorrhage) and retinal hemorrhages are the hallmarks of the syndrome.
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6/19. Delayed traumatic intracerebral hematomas: "Spat-Apoplexie". Report of two cases.

    Two patients who suffered a head trauma experienced sudden clinical deterioration more than 1 week after their injury. The initial computerized tomography (CT) scan demonstrated a small hematoma underlying a depressed skull fracture in one patient and a small interhemispheric subdural hematoma in the other. Both patients had made a complete recovery and follow-up CT scans were normal when clinical deterioration suddenly occurred. Both patients developed a large intracerebral hematoma and underwent emergency evacuation of the mass. The first patient recovered with the exception of a moderate hemiparesis and dysphasia, but the second patient died. Delayed traumatic intracerebral hematomas have been described in the literature. Since the advent of CT scanning, the incidence of this phenomenon has been estimated as between 1.7% and 7.4% of closed head injuries. In 1891, Otto Bollinger described four patients who suffered head injury, followed days to weeks later by death from an apoplectic event. His criteria for diagnosis of "traumatische Spat-Apoplexie" included the absence of preexisting vascular disease, a definite history of trauma, an asymptomatic interval of at least several days, and an apoplectic episode. These two cases reemphasize the existence of Spat-Apoplexie as a rare clinical condition. In the presence of CT findings of even small traumatic intracerebral or extracerebral hematomas, the possibility of this late complication should be kept in mind.
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keywords = subdural
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7/19. Features of chronic subdural haematoma developed from definitely identified acute subdural haematoma.

    Follow-up results for 13 cases of acute subdural haematoma, which were identified by CT scan within two days of head injury and treated conservatively, were classified into two groups: In the first group of seven cases the acute subdural haematoma disappeared spontaneously within two weeks; in the second group the other six cases revealed clinical signs and CT scan findings which were identical to chronic subdural haematoma and underwent surgery within three weeks after the head injury. This group showed low ICP signs, such as the chronic stage of cerebral thrombosis, atrophic brain or subdural fluid collection with acute subdural haematoma at the initial CT scan, and most of these cases had only minor head injury. Common features of the operative findings in this second group, in which chronic subdural haematoma developed, included the identification of an external haematoma capsule based on the fibrin layer and granulation tissue beneath the dura. Also, fluid type haematoma was present under these structures, but no inner membrane of the haematoma could be identified other than the non-transparent white arachnoid membrane. Our results indicate the importance of a low ICP in determining whether or not acute subdural haematoma progresses to chronic subdural haematoma.
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ranking = 16
keywords = subdural
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8/19. Zeta waves: a special type of slow delta waves.

    A special type of delta waves with a duration of 1-3 sec which, because of their saw-tooth or zed shape in the EEG, we have named 'zeta waves' has been described. They occur particularly in cases with rather severe brain lesions, usually with an acute or subacute onset and a space occupying character. In a period of 2 years during which 2500 EEGs have been reported we have seen zeta waves in 20 patients in whom 76 EEGs have been recorded. The characteristics of these waves and the types of lesions with which they occurred are described. The importance of an adequate recording technique for proper presentation of this EEG pattern is emphasized.
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ranking = 0.00053483150801177
keywords = space
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9/19. Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture.

    An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated.
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ranking = 1
keywords = subdural
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10/19. Acute subdural haematoma mimicking an epidural haematoma on a CT scan.

    This paper reports an acute subdural haematoma mimicking an epidural haematoma as seen on a non-enhanced computerized tomography (CT) scan of the head in a patient who had sustained a traumatic head injury. The patient had undergone a craniotomy 4 years prior to the injury described here.
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keywords = subdural
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