Cases reported "Craniocerebral Trauma"

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1/8. Pediatric family-centered rehabilitation.

    family-centered rehabilitation programs are derived from a philosophy of heath care delivery known as family-centered care. The principles of family-centered care are presented with clinical examples. Its origins are reviewed, and the 10-year process of implementation of family-centered care practice and policy at a children's rehabilitation center are described. Profound changes in behavior are required of the health care professionals as meaningful collaboration with families develops. Key elements of a family-centered rehabilitation program include meaningful participation by families in medical decision making and an institutional culture flexible enough to respond to the ongoing collaboration between families and practitioners.
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2/8. Aerotolerant clostridium tertium brain abscess following a lawn dart injury.

    A young girl developed an intracranial abscess and necrotizing cellulitis following penetrating injury from a lawn dart. Initial identification of a gram-positive rod growing aerobically from clinical specimens was as a bacillus organism, but the observation that the isolate grew poorly in subcultures for susceptibility testing but quite well under standard anaerobic culture techniques led to the identification of the organism as an aerotolerant clostridium tertium. Early management of penetrating head trauma should include cranial imaging studies to detect fractures and intracranial pathology. Clinical microbiologists and clinicians should be aware of the phenomenon of aerotolerance in anaerobic bacteria to avoid errors in choice of antibiotic therapy.
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3/8. Intracranial infection by vibrio alginolyticus following injury in salt water.

    A 20-year-old man presented with an epidural abscess 3 months after a seawater diving accident. Cultures of the abscess cavity obtained by surgical drainage revealed a pure culture of vibrio alginolyticus. Marine vibrios may produce serious intracranial infection after head injury in salt water.
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4/8. osteomyelitis of the skull.

    osteomyelitis of the skull is a direct infection of the bone. It can be an acute or chronic disease. It usually has an insidious initial onset. Complications can be life-threatening and even fatal. The most frequently associated organism responsible for the disease is staphylococcus aureus. Tissue specimens must be obtained for definitive culture and sensitivity reports. It is also important that devitalized bone and sequestra be removed as part of adequate therapy. A typical presentation on skull series is a moth-eaten appearance; however, this may not be recognized radiographically for several months. The antibiotic chosen must be given in high enough doses to assure adequate serum levels to eradicate the organism responsible for causing the disease. Length of treatment depends on the clinical course and the extent of infection but may involve several months or longer. Good nursing care is essential in dealing with osteomyelitis and involves preventive as well as therapeutic management. Patient education and support are important aspects of nursing care in helping the patient cope with the disease.
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5/8. A case of bacterial meningitis complicated by post-traumatic cerebrospinal fluid rhinorrhea.

    This paper reports an 11 year old boy with bacterial meningitis accompanied by post-traumatic cerebrospinal fluid (CSF) rhinorrhea. streptococcus pneumoniae was cultured from CSF. The clinical course was very rapid before admission and his age relatively high for usual bacterial meningitis. Consequently, we examined the cause in detail. Immunological findings were within normal limits. Although routine graphic examinations, such as cranial X-ray photography, horizontal cranial computed tomography (CT) and magnetic resonance imaging, could not demonstrate a bone defect, both coronal thin-section cranial CT scanning and radioactive isotope counting by means of cotton packed into the nasal cavity were useful for detecting CSF rhinorrhea. In a case of atypical meningitis, the past history should be examined with caution and coronal thin-section CT should be performed.
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6/8. Posttraumatic gas-containing brain abscess caused by clostridium perfringens with unique simultaneous fungal suppuration by Myceliophthora thermophila: case report.

    OBJECTIVE AND IMPORTANCE: Gas-containing brain abscesses are rare, and the vast majority are caused by clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature. CLINICAL PRESENTATION: A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure. INTERVENTION: The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin b and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision. CONCLUSION: Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.
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7/8. Use of random amplification of polymorphic dna in a case of pasteurella multocida meningitis that occurred following a cat scratch on the head.

    We cultured pasteurella multocida from the cerebrospinal fluid (CSF) of a 4-month-old infant who presented with meningitis. The patient had been scratched on the head by a cat. Culture of the cat's claws also yielded P. multocida. The isolates had identical biochemical patterns. Analysis of both strains by random amplification of polymorphic dna and comparison of these strains with P. multocida strains isolated from other cats showed that the two strains were identical and completely different from the unrelated isolates. Our patient's meningitis most likely resulted from direct inoculation of P. multocida into the CSF.
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8/8. haemophilus influenzae meningitis in adults.

    haemophilus influenzae meningitis is rare in adults. We reviewed the microbiological records of cerebrospinal fluid (CSF) and blood cultures and the medical records of patients with bacterial meningitis admitted to Chang Gung Memorial Hospital from January 1978 to May 1996. haemophilus influenzae meningitis was found in six adult patients, accounting for 1.8% of 326 bacteriologically proven adult cases of meningitis diagnosed between January 1984 and May 1996. Predisposing conditions included head trauma and/or neurosurgical procedure in four patients and an extracranial extension of a pituitary adenoma in a diabetic patient. None of them had altered consciousness on the day of treatment. A CSF cell count less than 500 x 10(6) leukocytes/liter was noted in three patients. Antibiotic therapy was successful in all patients. Thus, predisposing conditions, particularly head trauma and/or neurosurgical procedure, are commonly present in adult patients with H. influenzae meningitis. patients with the infection may have a low cellular count in the CSF that may be readily misinterpreted as meningitis caused by other pathogens.
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