Cases reported "Craniocerebral Trauma"

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1/658. Internuclear ophthalmoplegia following minor head injury: a case report.

    Internuclear ophthalmoplegia (INO) is a common sign of multiple sclerosis in young patients and of vascular diseases in older people. Traumatic bilateral internuclear ophthalmoplegia following severe head injuries may occur. We present the unusual case of a young patient suffered from bilateral INO as an isolated finding after a minor head injury, without other signs of brain stem or cortical injury. The ophthalmoplegia has persisted for 22 months.
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2/658. Technique of removal of an impacted sharp object in a penetrating head injury using the lever principle.

    Penetrating head injuries can be difficult to manage as the extensive surgery which may be required can result in severe morbidity and mortality in some patients. A conservative surgical approach with a "pull and see" policy was adopted successfully in a described case. Extraction can be achieved by using the mechanical advantage of the lever principle. By this method while removing the object any movements of sharp edges which will cause secondary damage can be reduced to a minimum.
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3/658. Successful treatment of traumatic acute posterior fossa subdural hematoma: report of two cases.

    BACKGROUND: Acute traumatic subdural hematoma of the posterior cranial fossa after a closed-head injury, excluding those in newborns, is a very rare clinical event. Generally, the outcome is poor and the overall mortality rate is high. methods: Acute posttraumatic subdural hematomas of the posterior fossa associated with acute hydrocephalus in two patients were removed by standard suboccipital approach. Preoperatively, one patient was in a coma and the Glasgow coma Score was 9 in another. CT scans showed obliterated mesencephalic cisterns in both cases. In the former there was a complex posterior fossa lesion, i.e., combined subdural and intracerebellar hematoma. The surgical decompression was completed 3 and 11 hours after injury, respectively. Intraoperative tapping of the lateral ventricle through a burr hole in the occipital area was performed in the latter case. RESULTS: Both patients survived; one made a good recovery, (i.e., glasgow outcome scale 4 in a patient who was comatose on admission), the other did not do as well (GOS 3). CONCLUSIONS: Our experience justifies the policy of mandatory early operation in cases of traumatic acute subdural hematoma of the posterior fossa associated with poor neurologic condition, even in patients of advanced age. In patients with obliterated mesencephalic cisterns and/or complex posterior fossa lesions the same approach must be followed. These clinical and CT features are not necessarily predictors of a poor outcome.
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4/658. Accidental decapitation: an unusual injury to a passenger in a vehicle.

    A case of decapitation of a vehicle passenger in an accident on a highway is reported. Evaluation of roadside evidence and the deceased's injuries revealed that the victim was partially ejected from a broken passenger-side window as the vehicle spun out of control, decapitation being due to the impact of his head against a barrier stanchion on the shoulder of the road. An unfastened seat-belt, high-speed driving and the construction of the road barrier were contributory factors.
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5/658. Post-traumatic pituitary apoplexy--two case reports.

    A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.
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6/658. Post-traumatic anterior pituitary insufficiency developed in a patient with partial lipodystrophy.

    A case of partial lipodystrophy developing anterior pituitary insufficiency, chronic glomerulonephritis and pulmonary fibrosis was reported. The patient died of respiratory failure secondary to pituitary crisis during the hospital course. From the clinical course in recent several years and the postmortem examination the head injury following car accident in the past history was considered to be the most plausible cause of hypopituitarism. The etiology of pulmonary fibrosis remained unresolved.
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7/658. An unidentified substance.

    AT 5.00 am one Friday morning a 19-year-old woman was brought into the Accident & Emergency (A&E) department following a head on collision with a van. The young woman had sustained severe head injuries, along with a fractured pelvis and a ruptured spleen. Following resuscitative surgery, the patient was taken to the intensive care unit, where she remained unconscious following her head injury. Two patients from the van were admitted to A&E with minor injuries, and were discharged home mid-morning. When staff checked the woman's belongings and listed them in a property book, they discovered white powder in a small twist of white paper, which amounted to about the size of a pea. Staff present listed the substance in the property book and then locked it in the cd cupboard. Six hours later, following discussion with senior staff, two nurses disposed of the substance by flushing it down the toilet and recorded their actions with a witness signature from a senior nurse and pharmacist. Was this the best course of action from the viewpoint of the seriously injured patient and the other two involved in the van? What opinion would a police officer have?
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8/658. Oral clonidine to control hypertension after head injury.

    clonidine, an alpha2 agonist, was administered through a nasogastric tube for the treatment of hypertension in a head-injury patient with elevated plasma catecholamines. Haemodynamic parameters were stabilized with a reduction in sympathetic nervous activity. The plasma clonidine concentration, measured by radioimmunoassay, rapidly increased following the administration. After cessation of oral administration of clonidine, mean arterial blood pressure gradually increased. So clonidine was again administered orally and good blood pressure control was achieved and no change in consciousness level was observed. Oral clonidine was useful and effective for hypertension in this head injury patient.
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9/658. Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports.

    A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as "heading injury." arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts.
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10/658. Extradural haematoma--a preventable cause of death.

    Traumatic extradural haematoma (EDH) complicates 1-4% of all head injuries and is a major factor contributing to morbidity and mortality. Clinical awareness and early diagnosis are the keys to successful management. With the advent of computerised tomographic (CT) scanning a trend towards 'zero mortality' has been reported. We report four adolescent cases presenting with mild head injury (Glascow coma Score 13-15) who subsequently died as a result of EDH. We suggest that excessive delay both in recognising the condition and the subsequent referral and transfer are factors contributing to the mortality of these patients.
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