Cases reported "Craniocerebral Trauma"

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1/92. diabetes insipidus caused by craniofacial trauma.

    A patient is presented with diabetes insipidus secondary to craniofacial trauma. diabetes insipidus can occur in any patient within ten days of craniofacial trauma. Even the masked disease in the unconscious patient can be diagnosed by observation of intake and output, urinary specific gravities, and appropriate chemical studies. The disease can recur following operative reduction of facial fractures. diabetes insipidus can be successfully treated by intramuscular Pitressin and appropriate fluid intake.
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2/92. The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings.

    OBJECTIVE: The aim of this study was to demonstrate the usefulness of cerebral MRI to detect possible child abuse in children with unexplained neurologic findings. METHOD: Between 1990 and 1997, 208 children were referred for suspected physical child abuse to the Child Protection Clinic of Ste-Justine Hospital, a tertiary care pediatric hospital. Among them, 39 children presented initially with neurological findings. For 27 of them, the CT Scan results prompted the diagnosis of child abuse. However, in 12 children, even if a CT-Scan was performed, the diagnosis and/or the mechanisms of the neurologic distress remained obscure. Investigation was completed with MRI study in those 12 cases. RESULTS: MRI findings were diagnostic for physical abuse in eight cases. A diagnosis of child abuse was made in two more cases by a combination of MRI and skeletal survey findings. In one case, MRI was suggestive but the diagnosis of child abuse could not be confirmed. One case was misinterpreted as normal. CONCLUSIONS: MRI is the test of choice to rule out child abuse when faced with a child presenting unexplained neurologic signs lasting for few days. The fact that MRI can better differentiate collections of different ages makes this imaging test particularly useful in identifying cases of child abuse. These results, however, always have to be integrated in a well conducted multidisciplinary clinical approach.
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3/92. 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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4/92. Traumatic ossicular chain discontinuity--report of two cases.

    In addition to hemotympanum and traumatic eardrum perforation, traumatic ossicular chain discontinuity should also be considered in the differential diagnosis of conductive hearing impairment resulting from head injury. The most common form of these ossicular chain lesions following head injury is incudostapedial joint (I-S joint) separation. We successfully managed two patients with I-S joint separation resulting from head injury through exploratory tympanotomy with ossiculoplasty within the recent 2 years. Both were young females who had sustained head injury resulting from traffic accident with the sequelae of persistent hearing impairment. They both gained significant hearing improvement postoperatively.
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5/92. Posttraumatic subgaleal hematoma: a case report and review of the literature.

    INTRODUCTION: A subgaleal hematoma or subaponeurotic hemorrhage occurs infrequently and is usually seen in pediatric patients, especially in the neonatal period. It may be associated with coagulation disorders. CASE REPORT: We report on a previously healthy 19-month-old patient who presented with an extensive subgaleal hematoma and significant anemia secondary to a fall. DISCUSSION: A literature review was conducted, and the etiology, diagnosis, and treatment of the subgaleal hematoma are discussed. CONCLUSION: Conservative treatment, except in select severe cases, is recommended for this condition.
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6/92. cluster analysis of diffusion tensor magnetic resonance images in human head injury.

    OBJECTIVE: Issues surrounding the nature of the edema associated with traumatic brain injury in humans, and its evolution in the acute phase, remain unresolved. This study aimed to characterize the topographical nature of the pathophysiological changes in human traumatic brain injury with diffusion tensor magnetic resonance imaging. methods: Multislice diffusion-weighted magnetic resonance imaging data were acquired from five patients undergoing elective ventilation for management of traumatic focal contusion or hematomas. The diffusion tensor and the T2-weighted intensity were then computed for every voxel in the image data set for each patient. The topographical distribution of abnormalities in the trace of the diffusion tensor and T2-weighted images were characterized by cluster analysis. RESULTS: In four patients with technically satisfactory data, a narrow band of tissue was observed in the periphery of focal lesions, which was characterized by selective reduction in the trace of the diffusion tensor, without any associated increase in the T2-weighted signal intensity. CONCLUSION: This change is interpreted as indicating either a partial redistribution of water from the extra- to intracellular compartment, or a reduction in the diffusivity of water in the intracellular or cytosolic environment. These diffusion and T2-weighted characteristics are also found in early ischemic change, hence, such regions may represent potentially salvageable tissue at risk of permanent damage. The study illustrates the advantage of using information contained within the diffusion tensor in addition to more conventional imaging sequences.
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7/92. Chronic hydrocephalus presenting with bilateral ptosis after minor head injury: case report.

    OBJECTIVE AND IMPORTANCE: Some patients with hydrocephalus may exhibit various signs of oculomotor dysfunction. However, ptosis has not previously been described in chronic hydrocephalus patients. CLINICAL PRESENTATION: We report a 50-year-old woman who was diagnosed with chronic hydrocephalus based on an evaluation for bilateral ptosis after a minor head injury. She exhibited bilateral ptosis and upward gaze paralysis, but other oculomotor functions were normal. Neuroimages revealed chronic hydrocephalus with no traumatic abnormalities. INTERVENTION: The eyelid dysfunction resolved after placement of a right ventriculoperitoneal shunt with a programmable pressure valve. CONCLUSION: The resolution of eyelid dysfunction by cerebrospinal fluid diversion suggests that chronic hydrocephalus was involved in the development of ptosis after the minor head injury. A mild but sudden cerebrospinal fluid pressure change at the time of minor head injury might induce functional impairment at the level of vulnerable periaqueductal structures, which barely withstood the longstanding ventriculomegaly, resulting in the clinical features observed in our patient.
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8/92. Retained intracranial metallic foreign bodies. Report of two cases.

    The authors discuss two examples of extensive migration of retained metallic foreign bodies. The potential for further neurological injury from migration, formation of neurotoxic breakdown products, and the danger of infection are factors to be assessed when considering the removal of retained intracranial metallic foreign bodies.
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9/92. Posttraumatic epidermal inclusion cyst of the deep infratemporal fossa.

    The authors report a case of an epidermal inclusion cyst found in the deep infratemporal fossa 12 years after the patient sustained blunt trauma to that region. Posttraumatic epidermal inclusion cysts are rare and occur mainly in the fingers, palms, and soles. Introduction of the epidermal elements into the dermis during the trauma is thought to be the cause. This case is rare in presentation, with few reports in the English literature that describe an epidermal inclusion cyst in the deep infratemporal fossa. review of the English literature disclosed no other cases of epidermal inclusion cyst after blunt trauma involving the deep infratemporal region.
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10/92. Foreign body in injury--an important evidence.

    In the present paper, a complete case is discussed, that is from the crime upto judgement in the court of law, from the Forensic point of view. The postmortem examination was conducted by the author in which a metallic fragment of size of a mustard seed was found in a incised wound. On chemical analyzers examination, the metal fragment matched with the suspected weapon, in respect of spectrochemical contents. This evidence became an important part in the investigation for conviction of the accused in the court of law. This indicates that when-ever any foreign body, whatever it may be or of whatever size, should not be neglected while examining the injury before death of after death, since it can become an important piece of evidence.
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