Cases reported "Craniocerebral Trauma"

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1/9. Can early postnatal closed head injury induce cortical dysplasia.

    PURPOSE: Increased availability of surgically resected epileptogenic tissues reveals often unsuspected cortical dysplasia (CD). There is some controversy about the ontogenic stages in which these occur. Although most take place during neuroblast proliferation and migration, there is some evidence for some CD occurring during postmigrational intrinsic cortical organization. It has been shown that various kinds of focal cortical manipulations in rats, if performed within 3-4 postnatal days, lead to the genesis of various cortical malformations including a four-layered microgyrus or an unlayered CD. It is not known whether such events also might occur in the human brain. methods: Two children sustained minor head trauma within 4 postnatal days and later developed intractable epilepsy, which was relieved by surgery. Neuropathologic analysis of the resected tissues revealed an unsuspected microdysplastic cortex immediately adjacent to a focal, modest meningeal fibrosis, presumably secondary to the old closed head trauma. RESULTS: The main histologic features were a disorganized, unlayered cortex; abnormal clusters of neurons, often with complex, randomly oriented proximal dendritic patterns with absent apical orientation; the presence of a number of heterotopic small and large neurons in the white matter; absence of inflammatory infiltrates, of hemosiderine, of reactive gliosis, or of an excessive number of blood vessels. The morphologic features in these surgical specimens suggest that these focal malformations occur because of a regional disorder of postmigrational intrinsic cortical remodeling. CONCLUSIONS: The clinical histories and the pathologic findings lend some support to the hypothesis that minor morbid events occuring in the immediate postnatal period may lead to microdysplasia in the human similar to those induced in rat pups. The animal model could be helpful to clarify the genesis of some cases of CD and of the epileptogenicity often manifesting later in life.
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2/9. Reconstruction of real world head injury accidents resulting from falls using multibody dynamics.

    OBJECTIVE: To reconstruct real life head injury accidents resulting from falls using multibody modelling software, with the aim of comparing simulation output to injuries sustained. BACKGROUND: Much previous research on head injury biomechanics has focussed on animals and cadavers. However, focus is increasingly turning towards the examination of real life head injury. Falls are a major cause of head injury and, in general, are simpler to model than other accident types. DESIGN AND methods: Five cases of simple falling accidents resulting in focal head injury were examined, and reconstructions were performed using a multibody model of the human body. Each case was reconstructed a number of times, varying the initial conditions and using two different sets of properties for head contact. RESULTS: Results obtained included velocities, accelerations and forces on the head during impact. This output appeared more sensitive to changes in head contact characteristics than to changes in initial conditions. Depending on the contact characteristics used, results were consistent with proposed tolerance limits from the literature for various lesion types. CONCLUSIONS: Provided it is used with caution, this method could prove a useful source of biomechanical data for the investigation of head injury biomechanics. RELEVANCE: Biomechanical investigation of real-life cases of head injury is very important, yet not as prevalent as work with animals and cadavers. Reconstruction of real life accidents is a good method of obtaining data that will aid in the investigation of mechanisms of head injury and human tolerance to head injury.
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3/9. Effect of pyritinol on EEG and SSEP in comatose patients in the acute phase of intensive care therapy.

    The extent and duration of acute disturbances of consciousness depend on the severity and localization of the underlying cerebral dysfunction. The glasgow coma scale (GCS) permits a relevant statement to be made on the course and recovery tendency of functional damage patterns in cerebral, mesencephalic, and brain stem structures. Therapy is directed at exerting a beneficial effect on the disturbed cerebral metabolism by administration of centrally active substances and at utilizing the available reserve plasticity of the brain for any possible recovery of mental performance. The bioavailability and profile of action of pyritinol have been well documented in animal experiments. We have studied the question as to the extent to which the substance influences the depth of coma in patients receiving acute intensive care therapy, and how this can be objectified electrophysiologically in the form of a specific central effect on basal brain structures. In a phase-II pilot study over five days the acute effect of intravenous 60-min. administration of 1,000 mg pyritinol on the depth of coma, the central conduction time (CCT) and the primary complex amplitude (N20/P25) of the SSEP, and on vigilance behavior (spectral edge frequencies and power) was investigated for 90 minutes in each case under intensive-medical steady-state conditions in 10 comatose patients. Because of the differences in the underlying brain damage, the primary depth of coma, age (30-89 years), sex (two female, eight male), as well as previous treatment (surgery, conservative), the significance of the results could not be evaluated by confirmatory statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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4/9. Stress-induced malignant hyperthermia in a head-injured patient. Case report.

    Susceptibility to malignant hyperthermia is a rare inherited myopathy. Hypermetabolic crises accompanied by a rise in body temperature to as high as 44 degrees C are the hallmark of malignant hyperthermia episodes. These are triggered by inhalational anesthetic agents or depolarizing muscle-relaxant drugs. A similar condition exists in pigs; however, in addition to drug-induced attacks, episodes of malignant hyperthermia occur in these animals as a result of stress. It has been proposed that stress-induced malignant hyperthermia occurs in man. The present paper presents a case of stress-induced malignant hyperthermia in a 21-year-old man in whom the inciting stress was a head injury.
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5/9. Trauma and multiple sclerosis. An hypothesis.

    An obligatory event in the pathogenesis of the multiple sclerosis plaque appears to be an increase in the permeability of the blood-brain barrier. Neuropathological observations of the brain of persons suffering from concussion after relatively minor head injury, as well as of animals subjected to experimental brain injury, have shown that alterations of the blood-brain barrier constitute a common result of such trauma. It is postulated that the alterations of the blood-brain barrier secondary to trauma of the brain or spinal cord of patients with already established multiple sclerosis may result in an exacerbation or recurrence of a previously symptomatic plaque, in the appearance of symptoms from a silent lesion, or in the formation of a new plaque in such an area of selected vulnerability. In other persons injury to the nervous system may cause the development of multiple sclerosis plaques in the previously damaged areas when the disease has its onset after the trauma. There is no evidence to support the idea that trauma ever causes multiple sclerosis.
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6/9. The effect of high-frequency jet ventilation on intracranial pressure in patients with closed head injuries.

    Positive pressure ventilation (PPV) can increase intracranial pressure (ICP) in patients with closed head injuries. This adverse effect may be secondary to elevated peak airway pressures. high-frequency jet ventilation (HFJV) has been shown to produce lower peak airway pressures and decrease ICP in experimental animals. This report describes a patient with a head injury who was ventilated with a high-frequency jet ventilator.
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7/9. Cervical fractures and fracture-dislocations sustained without head impact.

    Because of its flexibility and structure, the cervical spine is disposed to various mechanisms of injury: although not so common as injuries caused by head impacts, cervical fractures and/or fracture-dislocations have been reported without direct impact to the head. Some cervical injuries reported have been sustained by wearers of lap and shoulder belts in auto accidents; however, we do not consider belt use a potential hazard because ample evidence has accrued in the medical and engineering literature to document general injury and fatality reduction by use of seatbelts. We believe that in many instances occupants would be more seriously injured or killed were belts not worn. The present paper reviews reports of cervical injuries without head impact found in the literature and case histories of such injuries from the Highway safety research Institute of The University of michigan, as well as experimental studies in animals, cadavers, and volunteer subjects.
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8/9. Partial recovery from visual object agnosia: a 10 year follow-up study.

    We describe a young woman, J.R., who sustained a very severe head injury in 1981 at the age of 17 years. She was assessed in 1982 and found to have visual agnosia. Since then J.R. has been assessed on several occasions over a period of ten years. Her agnosia for real objects has resolved and she has improved on the identification of other classes of stimuli. However, she still has some problems with the identification of line drawings, photographs and model animals. Her drawing from memory remains particularly poor and she has difficulty with visual imagery. We consider her residual deficits in the light of Farah's (1990) theoretical framework; this proposes that associative agnosia could be due to a disconnection syndrome, a loss of stored visual representations or to the loss of knowledge of how to perceive objects. J.R.'s residual impairments appear to be mainly due to a loss of access to visual representations in the absence of visual input.
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9/9. Management of animal bite injuries of the face: experience with 94 patients.

    PURPOSE: Because of the large number of bacteria in the oral cavity, animal bite wounds are generally contaminated, and their treatment is difficult because of the risk of infection, especially in extensive injuries. This report describes the management of a large series of patients and recommends treatment guidelines on the basis of the results. patients AND methods: Ninety-four animal bite wounds on the face and head were analyzed according to the type of animal, location and extent of the soft tissue wound, duration and type of surgical treatment, occurrence of infections and their pathogen spectrum, as well as the choice of antibiotic therapy. RESULTS: dogs caused 91% of the bite wounds. Infections developed in 4 of 53 patients who underwent primary wound closure with minor edge excision and prophylactic administration of oral penicillin. Without antibiotic administration, 2 of 15 patients had infections, which were treated on an outpatient basis. Of 26 patients with initially delayed treatment, 18 showed clinical inflammatory symptoms with a wide spectrum of pathogens (escherichia coli, streptococcus, enterococcus, staphylococcus epidermidis, and proteus) on presentation. CONCLUSION: Extensive animal bite wounds on the face, even with soft tissue defects, should be treated according to the criteria of a esthetic reconstructive facial surgery. In view of the low infection rate, routine antibiotic prophylaxis is not justified.
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