Cases reported "Craniocerebral Trauma"

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1/15. Evaluation of potential closed head injury in patients with known coagulopathy.

    A case report is provided of an elderly "minor" trauma patient in whom an acute subdural hematoma developed. The division of traumatology and surgical critical care worked with other hospital departments to develop and implement a trauma care guideline, promote ongoing communication between departments, and monitor compliance with the guideline.
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2/15. Multi-channel cochlear implantation in patients with a post-traumatic sensorineural hearing loss.

    There are few accounts of cochlear implantation in adults with post-traumatic sensorineural hearing loss. We report our experience with multichannel implantation in three such patients. Two patients experienced no cognitive or communication deficits as a result of their head injury. At nine months post-implant, compared with our experience of non-head-injured implantees, these patients achieved average or above average scores on audiological performance tests. The third patient presented with cognitive, behavioural and communicative deficits. The level of improvement achieved by this patient, when lip-reading was supplemented with electrical stimulation, in both BKB sentence and connected discourse tracking (CDT) tests was comparable with that of the non-head-injured group. However, his absolute performance at nine months post-implant was well below average. Performance at 18 months on BKB sentences and environmental sound recognition showed little change, and was again well below average, however his score on CDT with lip-reading and electrical stimulation improved considerably and was similar to the average achieved by the non-head-injured group. The major difficulties experienced with this patient were increasing depression and low implant use. Considerably more time was spent in the assessment and rehabilitation of this patient and involved liaison with a number of other agencies. When considering such patients for cochlear implantation it is strongly recommended that these additional requirements are taken into account.
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3/15. Changes during long-term management of locked-in syndrome: a case report.

    This paper describes various approaches of treatment to a male client suffering from the locked-in syndrome following closed head injury. During the course of therapy, which started more than 5 years after onset and lasted for as much as 11 years, the client progressed from the so-called classical to the incomplete locked-in state. The different approaches as well as the outcomes are presented in detail, followed by a discussion about interdisciplinary issues, duration of treatment and the impact of a patient's personality on the course and goals of the treatment as well as on the mode of communication.
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4/15. Using the Mead model as a framework for nursing care.

    A model of nursing has no valid purpose unless it serves nurses to help make their nursing better (Fawcett, 1989). The Mead model formed the basis for nursing care of Jason, a young patient who sustained a head injury, a puncture wound and lacerations to his face, in the study presented here. Examination of the Mead Model of nursing is followed by an account of why this model was used in preference to others as a framework for Jason's care. Three components of his nursing care--wound care, communication, involvement of relatives--are discussed in relation to both the model and current knowledge. It was concluded that as a structured way of planning and giving care, the Mead model lacks adequate guidelines. A less experienced nurse using the Mead model may overlook certain aspects of care, an experienced nurse may use his/her knowledge to give high standard care using research-based information. However, models need to be tested so they may be rejected or modified as guidelines for care in this case in the United Kingdom, within a welfare-orientated society.
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5/15. sinus pericranii: radiological and etiopathological considerations. Case report.

    sinus pericranii is a rare vascular anomaly involving an abnormal communication between the extracranial and intracranial circulations. A case of frontal sinus pericranii is presented which appeared to be a posttraumatic sinus because it developed 2 years after a cranial injury. However, the presence of vascular endothelium in the pathological examination and its association with a vascular anomaly (persistent trigeminal artery) suggested a congenital origin. The lesion, pericranial blood sinuses, and bone were totally removed. The computerized tomography, angiography, and magnetic resonance imaging findings are presented. The literature is reviewed and the pathogenesis of sinus pericranii is discussed.
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6/15. Sudden traumatic death in children: "we did everything, but your child didn't survive".

    When caring for children who become suddenly and catastrophically ill, clinicians must simultaneously attend to a complex and rapidly evolving medical situation, as well as to the equally challenging demands of establishing compassionate relationships with family members and communicating well with colleagues. An 18-month-old toddler was brought to the hospital with severe head injury after being struck by a car. Over a period of hours, her condition evolved from prognostic uncertainty to the diagnosis of brain death and considerations of organ donation. Against this medical backdrop, the clinicians successfully established a trusting relationship with family members by careful attention to their emotional, informational, and care needs as they absorbed the devastating prognosis, took in the results of the brain death examination, and considered the option of organ donation. This case illustrates the importance of interdisciplinary communication, the vital role of social workers and other psychosocial providers with expertise in working with families, and the critical significance of mutual care and support for the clinicians who accompany families through these tragic life events.
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7/15. Endovascular treatment of a direct post-traumatic carotid-cavernous fistula with electrolytically detachable coils.

    Carotid-cavernous fistulae are abnormal communications between the internal carotid artery and venous compartments of the cavernous sinus. Fistulae are uncommon but well-documented sequelae of craniofacial trauma. The characteristic clinical presentation includes ocular pain, chemosis, exophthalmus and visual disturbances. We report on a 28-year-old man with a history of severe craniocerebral injury, including multiple craniofacial fractures resulting from a fall from a height of approximately 6 meters, who was surgically treated one year ago. Two months before presentation, the patient began to exhibit progressive chemosis, proptosis, eyelid swelling, diplopia and exophthalmus. Computerized tomography and computerized tomographic angiography revealed findings consistent with a carotid-cavernous fistula of the right side of the cavernous sinus with dilatation of the right ocular vein. Digital subtractional angiography of the right internal carotid artery revealed a fistula between the cavernous part of the artery and the right cavernous sinus. There was only minimal blood flow in the supraclinoid part of the internal carotid artery because of the high pressure within the fistula. Our decision was to try to occlude the fistula by means of endovascular embolization. The origin of the fistula in the internal carotid artery was successfully obliterated with seven electolytically detachable coils. Control digital subtractional angiography at the end of the procedure demonstrated minimal residual flow through the fistula. Two months after the treatment, angiographic control revealed complete obliteration of the fistula. Clinical examination showed total resolution of signs and symptoms of a carotid-cavernous fistula. Endovascular transarterial embolization of carotid cavernous fistulae is a widely accepted, safe and successful treatment option. In the case that we describe we occluded the fistula and right cavernous sinus with electrolytically detachable coils that we could place into the sinus. Other endovascular treatment options include the use of detachable balloons, stent placement, transvenous embolization or surgical ligation of the fistula.
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8/15. Unusual posttraumatic porencephaly--case report.

    An unusual case of posttraumatic porencephaly preceded by neither overt cerebral contusion nor hemorrhage is reported. The cerebral cortex just above the porencephalic cyst was found intra-operatively to be partially herniated into a fracture line, while the cortex elsewhere was completely intact. The porencephalic cyst communicated with the lateral ventricle. Apparently, brain herniation and the cyst-ventricle communication can be causative factors in the occurrence and growth of posttraumatic porencephaly.
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9/15. Extradural haemorrhage: strategies for management in remote places.

    A study of 109 cases of extradural haemorrhage (EDH) treated in south australia over a period of 7 years showed that 35 cases (32.1 per cent) presented in country areas at considerable distances from a neurosurgical service: the mortality in these country cases was 22.9 per cent, comparing unfavourably with a mortality of 12.2 per cent in metropolitan cases. The country series contained a disproportionately large number of cases with multiple intracranial haemorrhages, which are known to have a poorer outcome; when these cases were excluded, the rural mortality (12.5 per cent) was only a little over the metropolitan mortality (9.7 per cent). These data suggest that it is possible to manage extradural haemorrhages successfully even in places remote from a neurosurgical centre, if communications and air transport are used effectively. However, it was found that emergency operations carried out in country hospitals were sometimes inadequate or done too late. Medical retrieval teams based on city hospitals were sent out on 15 occasions, either to assist a general surgeon to complete an emergency operation, or to provide intensive care during transfer to a neurosurgical unit. Osmotherapy (mannitol and/or frusemide) has been useful in gaining time for transfer; the choice between immediate operation and transfer may be difficult, and decisions should take transfer time, clinical state and rate of deterioration into account.
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10/15. Tension pneumocephalus.

    Tension pneumocephalus occurs when intracranial air exists under pressure, resulting in neurologic deterioration. The syndrome is precluded by an extracranial-intracranial communication and a difference in extracranial-intracranial pressure with the latter being greater. Although most frequently associated with head trauma, a variety of situations, including an operative sitting position and use of nitrous oxide anesthesia, have been known to contribute to this potentially life-threatening complication. This article will address pathogenesis, assessment parameters, and medical and nursing approaches utilized to reduce and minimize further entrapment of air. A case report will be presented illustrating this condition.
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