Cases reported "Craniocerebral Trauma"

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1/5. Severe papilledema identified 3 weeks after head injury.

    A 62-year-old woman presented with rapidly developed visual disturbance without associated headache or nausea 3 weeks after head injury. Ophthalmologic examination revealed bilateral severe papilledema with retinal hemorrhage, and intracranial pressure (ICP) was 17.5 cmH2O estimated by lumbar puncture. Computed tomography and magnetic resonance (MR) imaging showed no evidence of increased ICP, except dilation of the subarachnoid space around the optic nerves with distortion of the nerves. Her visual acuity remarkably improved after steroid and glycerol treatment, and optic fundus examination revealed bilateral clear optic papillae without atrophic changes. Follow-up MR imaging demonstrated that the bilateral optic nerves had regained the normal appearance. These results indicate that the bilateral papilledema was caused by increased subarachnoid pressure around the bilateral optic nerves. We conclude that papilledema can occur with a mildly increased ICP and trapped subarachnoid cerebrospinal fluid around the optic nerves, and papilledema may progress after the ICP is normalized. papilledema is a warning sign for increased ICP, associated with future visual loss from retinal hemorrhage. Therefore, repeated funduscopic investigation is necessary for the early diagnosis and treatment of papilledema.
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2/5. Percutaneous puncture and pre-operative cyanoacrylate obliteration of a traumatic false aneurysm of an angular artery branch.

    We report a case of traumatic false aneurysm developed in the right glabella in a 5-year-old boy 3 weeks after an innocuous fall. Ultrasound, CT and facial arteriography did not reveal the feeding artery. After direct puncture of the glabellar bulge and rapid aspiration of blood, percutaneous contrast agent infusion revealed that the false aneurysm was supplied by the contralateral angular artery. Intralesional obliteration with cyanoacrylate was subsequently performed smoothly. Succeeding excision was easy and the cosmetic outcome was excellent.
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ranking = 5
keywords = puncture
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3/5. 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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4/5. Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure.

    PURPOSE: To embolize carotid cavernous fistulas (CCFs) by means of transorbital puncture of the cavernous sinus (CS) and the cavernous segment of the internal carotid artery (ICA) through the superior orbital fissure. MATERIALS AND methods: Five patients with CCF were treated with embolization of the CS, and six were treated with embolization of both the CS and the cavernous portion of the ICA after transorbital puncture. All except one had previously undergone occlusion of the ipsilateral proximal ICA before direct transorbital puncture. RESULTS: The fistulas in these cases were all obliterated completely. Only two patients had temporary ptosis. No other remarkable complications were noted. The patent ICA on the side of the fistula in one patient remained patent after embolization. CONCLUSION: Direct transorbital puncture through the superior orbital fissure is an alternate treatment for CCF, especially when the ipsilateral ICA has been occluded.
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ranking = 8
keywords = puncture
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5/5. Acute posterior fossa epidural hematomas in children.

    Epidural hematoma in the posterior fossa is a rare clinical entity requiring immediate surgical intervention to prevent rapid and fatal deterioration. This diagnosis should be considered in children with occipital head trauma who have altered sensorium and evidence of compression of structures within the posterior fossa. Such a clinical setting demands close neurologic observation in a facility where contrast studies and neurosurgical intervention are available. The absence of an occipital skull fracture or the presence of normal pulse rate and blood pressure should not influence the decision. Lumbar puncture is absolutely contraindicated.
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