Cases reported "Craniocerebral Trauma"

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11/157. Fatal carotid dissection after blunt head trauma.

    Occurrence of internal carotid artery injuries associated with skull base fracture has been reported. A. report a case of fatal intracranial carotid dissection related to petrous fracture involving the carotid canal. Identification of carotid lesions may be difficult and generally related to appearance of unexpected neurological deficit. skull base fractures may be considered an indirect sign for detection of vascular injury. Patterns of the fracture are of paramount importance; routine CT scan may fail to detect basilar fractures and high definition fine-cut CT scan should be executed to carefully identify and evaluate fractures. Temporal and sphenoid bone fractures are common in head trauma and involvement of the course of the carotid artery is frequent. The involvement of the intracranial carotid artery course represents a direct risk factor for lesions of the petrous, lacerum and cavernous segments of the carotid artery. early diagnosis of post-traumatic vascular injury may lead to prognosis improvement because of effectiveness of heparin anticoagulant therapy. Then vascular screening is recommendable in cases with complex fractures of the skull base and particularly fracturing along the course of the carotid artery. magnetic resonance angiography may be considered the first line diagnostic tools for vascular screening. Angiography may be reserved for patients with a proven lesion or rapid neurological deterioration taking into account the possibility of interventional treatment.
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keywords = fracture
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12/157. Unusual occipital condyle fracture with multiple nerve palsies and Wallenberg syndrome.

    A 52-year-old male presented with an extremely rare fracture of the occipital condyle involving the jugular foramen with marked medial rostrad displacement of the fragments. He had ipsilateral VII through XII nerves palsies and Wallenberg syndrome. Conservative treatment did not improve the cranial nerve palsies. A high-resolution CT-scan is essential to visualize these fractures.
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ranking = 0.75
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13/157. Type III occipital condylar fracture presenting with hydrocephalus, vertebral artery injury and vasospasm: case report.

    Occipital condylar fractures (OCF) are rare and have a high mortality rate. We report a patient with OCF who presented with acute hydrocephalus and died from diffuse vasospasm secondary to vertebral artery injury. A 45-year-old man fell 20 feet from a deer stand and landed on his head. CT showed a type III OCF continuing to the anterior rim of the foramen magnum on the left, with a bone fragment pushing into the medulla, causing hydrocephalus. The patient was stabilized, and a four-vessel arteriogram showed diffuse vasospasm with complete occlusion of the left vertebral artery at the level of the OCF. To our knowledge, this is the first documented case of the conjunction of OCF, hydrocephalus, and vasospasm.
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ranking = 0.625
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14/157. hypopituitarism following closed head injury.

    We describe four young patients (age 19-34 years) with hypopituitarism following closed head injury. The diagnosis was made by demonstration of low basal pituitary hormone levels and dynamic tests showing low pituitary reserve. The time interval between the injury and diagnosis of hypopituitarism was between three weeks and two months demonstrating the difficulty and complexity of making this diagnosis. Three of our patients (all patients suffering from anterior pituitary hormone deficiency) had ACTH deficiency, a condition which may be life threatening if left undiagnosed; these patients also demonstrated central hypothyroidism. Hypogonadotrophic hypogonadism occurred in three of the patients and was treated with hormonal replacement. diabetes insipidus was the only insult in one of our patients, accompanied other hormonal deficits in two, and did not appear at all in another patient. Information about skull damage was available for three of the patients, and included skull base and facial bone fractures, probably reflecting the extent of injury necessary to cause hypopituitarism. All patients regained normal lives with adequate hormonal replacement therapy.
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ranking = 0.125
keywords = fracture
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15/157. Fracture of the sella turcica.

    A patient with a fracture of the sella turcica, visible on lateral X-ray films of the skull, is described. This fracture, although not diagnosed during life, was present in approximately 20 per cent of a series of consecutive autopsies on patients who died of head injury. The significance of this injury to the hypothalamopituitary axis is discussed and methods of investigation suggested.
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ranking = 0.25
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16/157. An interesting case of arterial trauma after craniocerebral injury.

    A 63-year-old drunken man fell and hit his head on the ground. Apart from symptoms of alcoholisation no signs of severe injuries were found. The man died 2 1/2 days after the accident. The autopsy revealed a huge fracture system in the right parietal region. A branch of the medial cerebral artery was stretched between the cortex and one of the fracture lines, passing through a tear in the dura. Characteristics of this case were that no larger hemorrhage was found and the artery which was torn from the cortex showed no lesions. The case also indicates the immense relative movements between skull and brain which occur during such trauma.
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17/157. The injured coach.

    The patient in this case was diagnosed as having an epidural hematoma (shown in x-ray at right). This results from hemorrhage between the dura mater and the skull. The hemorrhage may result from a traumatic insult to the side of the head, which can fracture the temporal bone and lacerate the middle meningeal artery. Since the hemorrhage is arterial in nature, the patient may deteriorate quickly. These patients may present with what is referred to as a "lucid interval." The patient typically has a significant blow to the head that results in a short period of unconsciousness. They then regain consciousness at a time that frequently coincides with the arrival of EMS. Once conscious, they are in a period known as the lucid interval. They will still have a headache, but may otherwise be acting normally and show no other physical findings on examination. Many such patients refuse treatment and transport. [table: see text] Inside the skull, however, the problem will grow. Broken arterial vessels are bleeding, causing an expanding hematoma. The patient typically will soon complain of a severe headache along with other associated complaints, such as nausea/vomiting, then will lose consciousness again and/or have a seizure. Initial physical findings may include contralateral weakness and a decreased Glasgow coma score. As the hematoma expands, cerebral herniation may occur, compressing the third cranial nerve, which presents as a "blown pupil." EMS providers should have a high suspicion of injuries that affect the side of the head and the base of the skull. It is important to not only assess such injuries, but also the mechanism of injury, and to know the complications or later presentation that can arise from such injuries. Given that this patient was alert, oriented, not obviously intoxicated, and accompanied by his wife, the providers in this case would have had no choice but to abide by a refusal of treatment and transport. However, that could lead to serious complications, such as ongoing minor neurological deficits, later on. If this is the case, contacting medical control should be the priority.
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ranking = 0.125
keywords = fracture
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18/157. Early pin failure following external femoral fracture fixation in a head-injured child.

    External fixation facilitates nursing care and early rehabilitation of head-injured children with femoral shaft fractures. We report an unusual complication of early fatigue failure of the external fixator pins without the patient ever bearing weight.
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ranking = 0.625
keywords = fracture
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19/157. Closed head injury complicated by nonketotic hyperglycemic hyperosmolar coma.

    A case of nonketotic hyperglycemic hyperosmolar coma occurring in a patient with closed head injury and basilar skull fracture is reported. The metabolic abnormality masqueraded as a progression of central transtentorial herniation due to cerebral edema. It is suggested that the development of this complication is related to various predisposing factors normally employed in cases of critically ill, neurologically compromised patients. The anatomic lesions found at autopsy were considered inappropriate as a cause of death; the occurrence of central transtentorial herniation three days before death had been reversed. An awareness of this syndrome is emphasized in considering patients receiving steroids, mannitol, tube feedings, Dilantin, and dehydrative measures as part of their care.
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ranking = 0.125
keywords = fracture
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20/157. Melanotic neuroectodermal tumor of infancy discovered after head trauma.

    Melanotic neuroectodermal tumor of infancy (MNTI) is a rare neoplasm that generally arises in the maxilla during the first year of life. Involvement of bones of the cranial vault or brain is extremely rare. We describe a 7-month-old black female who presented after falling out of bed onto a concrete floor. Subsequently, she developed an anterior frontal mass that enlarged over several days. Radiographs of the skull at her local hospital showed a depressed right frontal skull fracture. However, computerized tomography of the head (reviewed at our institution) revealed a slightly hyperdense extra-axial mass which crossed the anterior frontal midline, widening the metopic suture and extending into the anterior subgaleal scalp. hyperostosis of the adjacent frontal calvarium was also present. A craniotomy revealed a dark, 1.5-cm calcified epidural lesion with some features of an unusual hematoma. Microscopic evaluation revealed a chronic hematoma and MNTI. The tumor recurred within a year. MNTI should be included in the differential diagnosis of epidural and skull lesions in infants.
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ranking = 0.125
keywords = fracture
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