1/26. Traumatic encephalocele related to orbital roof fractures: report of six cases and literature review.BACKGROUND: Orbital roof fractures after blunt injury are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 15 cases published to date. methods: The clinical, radiological, and surgical findings of 6 cases of traumatic encephalocele treated at our institution from June 1998 to January 2000 are presented. They are also compared with previously published series. RESULTS: In contrast to other published cases, 5 out of 6 patients in our series were adults. The most common cause of trauma was road traffic accident. ecchymosis and preoperative exophthalmos/proptosis were frequent. In all of our patients a coronal CT scan (3 mm increments with bone windows) was obtained. It demonstrated the extension of the orbital roof fractures and a possible encephalocele in 4 cases. Associated frontal brain contusions were seen in 5 cases. An MRI was performed in 3 patients (and only in 2 previously published cases); it showed the extension of the brain herniation into the orbital cavity. Surgical treatment via a fronto-basal approach with evacuation of the contused herniated brain tissue and orbital roof reconstruction was performed.The outcome at 6 months was good recovery in five patients with one patient still in a persistent vegetative state. Postoperatively the ocular disturbances improved in 5 cases. A review of the other published cases confirmed recovery of normal ocular function in the vast majority of the cases. CONCLUSIONS: Whenever orbital roof fractures associated with frontal contusions are identified in an acute brain injured patient, an orbital encephalocele should be suspected. In our opinion MRI is the investigation of choice in such patients. If the encephalocele is confirmed, a surgical approach via the subfrontal route is indicated with resection of herniated contused brain tissue, dural closure, and orbital roof reconstruction. Good results in regard to the orbital symptoms (mainly exophthalmos) can be expected.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/26. Blunt basal head trauma: aspects of unconsciousness.Two cases of street violence directed to the skull base level and transverse to the cervical axis are described. No skeletal damage. The violence resulted in the so-called "traumatic subarachnoid haemorrhage", an often used, unspecified forensic "diagnosis"; it was here revealed to be due to rupture of the wall of the posterior inferior cerebellar artery (p.i.c.a). However, this was only one of the possible explanations for the acute symptoms of unconsciousness (concussion) and almost immediate death. The careful examination of these two cases and of a series of control cases revealed that at the trauma, stress and strain may have occurred to arterial branches serving as feeding perforant vessels to the medulla oblongata; in these cases they were coursing directly from the p.i.c.a. region.--The type of direct impact has often been regarded as mild! However, its location suboccipitally as in these cases can become dangerous. The resulting direct or indirect deficit of brain stem functions are discussed in these cases as well as "concussion-related symptoms" resulting after other types of head and neck injury.- - - - - - - - - - ranking = 28906.80852706keywords = unconsciousness, consciousness (Clic here for more details about this article) |
3/26. The postconcussion syndrome and the sequelae of mild head injury.The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small minority are malingerers, frauds, or have compensation neurosis, most patients have genuine complaints. Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.- - - - - - - - - - ranking = 68.474069557705keywords = consciousness (Clic here for more details about this article) |
4/26. Concussion in sports. Guidelines for the prevention of catastrophic outcome.Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.- - - - - - - - - - ranking = 136.94813911541keywords = consciousness (Clic here for more details about this article) |
5/26. 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.- - - - - - - - - - ranking = 68.474069557705keywords = consciousness (Clic here for more details about this article) |
6/26. Neuropsychological assessment and brain imaging technologies in evaluation of the sequelae of blunt head injury.A 43 year old man with a traumatic amnesic syndrome experienced only a brief, if any, loss of consciousness following an injury to the head. Four years after this injury, his results on standard psychometric assessment were normal. Long-latency evoked response potentials results were normal, and the neurological examination and computed tomography scans were unhelpful in explaining his amnesic symptoms. He had no history of alcohol abuse, yet his neuropsychological profile was that of a Korsakoff-like amnesia with frontal lobe features. Magnetic-resonance images demonstrated evidence of extensive frontal lobe damage, while cerebral blood flow studies provided additional evidence of bilateral frontal lobe dysfunction. The case highlights the need for those giving opinions in medico-legal head trauma cases to go beyond a reliance on routine indicators, such as duration of coma, results of standard psychometric assessment and computed tomography scans, to more specialised neuropsychological evaluations and magnetic-resonance imaging scans.- - - - - - - - - - ranking = 68.474069557705keywords = consciousness (Clic here for more details about this article) |
7/26. A case of post-traumatic tic disorder.We present the case of a 27-year-old man who developed multiple motor tics following closed head trauma with loss of consciousness. age of onset, lack of family history of tics, and atypical progression of tic severity and location make it unlikely that the patient had Gilles de la tourette syndrome. Previous reports of post-traumatic tic syndrome are discussed.- - - - - - - - - - ranking = 68.474069557705keywords = consciousness (Clic here for more details about this article) |
8/26. Post concussion syndrome: brainstem seizures, a case report.Following head injury and associated unconsciousness, a 19 year old woman developed chronic intractable headaches, absence attacks and a cluster of other symptoms which did not respond to conventional medical therapy. During the course of implanting a brain stimulation electrode for the treatment of chronic and recurring incapacitating headaches, diagnostic electrographic recordings revealed focal abnormal discharges in the mesothalamus. Electrical stimulation attenuated the discharges and alleviated the headaches and associated symptoms. A retrospective analysis of this case suggested that a head injury-induced brain stem gliosis was the source of the brainstem abnormal discharges. It is speculated that various biologic systems represented within the brainstem were implicated by the reticular formation generated discharges. Symptoms making up the chronic pain syndrome were thus thought to emanate from the electric malfunctioning of those biologic systems.- - - - - - - - - - ranking = 5781.3617054119keywords = unconsciousness, consciousness (Clic here for more details about this article) |
9/26. electroencephalography in minor head injury in children.EEG and CT scans of 280 cases of minor head injury in children under 15 years of age were studied. Abnormality on initial EEG was shown in 42.5%. Those who lost consciousness had a higher incidence of abnormality than those who did not, and it was higher between 4 and 13 years of age. The sleep state has much influence on the finding. The patients should be awake or in a light sleep stage. The most frequent abnormality was slow waves, seen predominantly in the occipital regions, and which tended to disappear more easily than the paroxysmal ones. The EEGs became or remained normal in 95%, excluding incompletely followed-up cases. There was no case of post-traumatic epilepsy in our series, but 4 cases of post-traumatic early convulsions, in which the EEGs were variable. CT scan disclosed abnormality in 6%.- - - - - - - - - - ranking = 69.474069557705keywords = consciousness, state (Clic here for more details about this article) |
10/26. A case of chronic subdural hematoma with anxiety states and concomitant regression-like symptoms.The authors described an epileptic suffering from head trauma in whom anxiety states and concomitant regression-like symptoms masked the diagnosis of chronic subdural hematoma. Along with the occurrence of chronic subdural hematoma, psychic symptoms were manifested including the anxiety and regression of personality. However, after the chronic subdural hematoma was neurosurgically evacuated, these psychic symptoms gradually disappeared. In the study of organic and symptomatic psychosis, Mackenzie and Popkin (1983) have proposed the concept of an organic anxiety syndrome on the ground that DSM-III provides no organic equivalent for anxiety disorders. Therefore, we presented a case of chronic subdural hematoma in which the direct effect on CNS of this pathological condition was considered to bring about the above-mentioned anxiety disorders with regression-like symptoms.- - - - - - - - - - ranking = 5keywords = state (Clic here for more details about this article) |
| | Next -> |