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1/16. 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. ( info)

2/16. Phenoprocoumon, head trauma and delayed intracerebral haemorrhage.

    Delayed traumatic intracerebral haemorrhage (DTICH) constitutes a serious complication of head injury, and several studies have set out to identify predisposing clinical variables and appropriate management strategies. Here we report a distinct and particularly malignant course of DTICH associated with oral anticoagulant therapy. ( info)

3/16. Antihypertensive treatment for the neurological patient: a nursing challenge.

    The neuroscience nurse's role in hypertensive management for patients with neurological injury can be challenging. This is especially true for patients whose cerebral autoregulation is affected by chronic hypertension or a cerebral insult. Hypertensive management involves more than the mere administration of medications. The nurse is responsible for monitoring the effects of drugs, lowering the blood pressure to a safe level and observing for any neurological deficits which may ensue from cerebral hypoperfusion. The nurse must collaboratively be able to determine if the patient's hypertensive episodes are caused by ineffective antihypertensives or a new cerebral insult. knowledge of hypertension management helps maintain adequate cerebral perfusion and ultimate neurological functioning of the patient. ( info)

4/16. An unusual case of traumatic intracranial hemorrhage caused by wakeboarding.

    Wakeboarding is a relatively new and exciting sporting activity which is similar to water-skiing. While there have been several reports of water-skiing-related injuries, there has been nothing reported in the literature so far concerning injuries in wakeboarding. We present the case of a 14-year-old male who sustained an unusual intracranial subdural hemorrhage while wakeboarding and postulate on the mechanisms which could have resulted in the injury. ( info)

5/16. 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. ( info)

6/16. MRI and CT findings of infected cephalhaematoma complicated by skull vault osteomyelitis, transverse venous sinus thrombosis and cerebellar haemorrhage.

    We present the CT and MRI findings of an 8-day-old infant with an infected cephalhaematoma complicated by skull osteomyelitis, venous sinus thrombosis and left cerebellar haemorrhage. ( info)

7/16. Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies.

    Does an expanded subarachnoid space predispose to subdural bleeding? What does heterogeneity in the appearance of a subdural collection on CT or MRI imaging indicate? Spontaneous rebleeding? Minor re-injury? Major re-injury? In some specific cases, answers to these questions have important forensic implications. To conclude objectively that an infant's intracranial hemorrhage or rebleeding resulted from inflicted injury or re-injury requires an in-depth understanding of the pathogenesis of posttraumatic subdural and subarachnoid collections. The authors present two cases of indoor, accidental, pediatric, closed-head trauma that resulted in intracranial rebleeding. Both accidental cranial impacts occurred in medical settings and were independently witnessed by medical personnel. In addition, the authors summarize the relevant medical literature regarding pediatric intracranial bleeding and rebleeding. ( info)

8/16. Depressed skull fractures: a pattern of abusive head injury in three older children.

    OBJECTIVE: To describe a pattern of abusive head injury in a series of children older than 4 years of age. methods: A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described. RESULTS: An 11-year-old girl and a pair of brothers of ages 7 and 9 were identified. The girl was attacked with a hammer during sleep by her stepmother, who committed suicide shortly afterwards. After craniotomy and intensive care, the child survived her multiple depressed fractures, intracranial bleeding, and brain contusion. Two brothers from a second family were attacked from behind with a hammer by their biological father, who was subsequently found to have undiagnosed schizophrenia. A depressed occipital fracture, without intracranial injury, was found in each child. The elder brother also had metacarpal fractures. Both children recovered without surgical intervention. CONCLUSION: A pattern of abusive head injury was described in older children with depressed skull fractures from blunt injury. The abusing parents were seriously mentally disturbed, and the abusive acts closely resembled child homicide. ( info)

9/16. Retinal hemorrhages in an 8-year-old child: an uncommon presentation of abusive injury.

    OBJECTIVE: Retinal hemorrhages in pediatric patients have been best described as a component of shaken baby syndrome (SBS), which has been described almost exclusively in the infant/toddler population. We describe the occurrence of retinal hemorrhages in the setting of abusive injury in an older child. methods: Case report. RESULTS: An 8-year-old boy was transferred to our institution with coma and respiratory arrest. Evaluation demonstrated intracranial hemorrhage, cerebral edema, and severe bilateral retinal hemorrhages. The patient subsequently died of intractable intracranial hypertension. police investigation confirmed that the injuries were caused by severe abusive injury, including shaking. CONCLUSIONS: This case emphasizes that the diagnosis of SBS is not limited to babies and that the possibility of abusive shaking injury should also be considered in older children presenting with intracranial pathology and retinal hemorrhages. ( info)

10/16. Cerebral venous sinus thrombosis manifesting as bilateral subdural effusion.

    Three patients with bilateral subdural effusion, an exclusive manifestation of cerebral venous sinus thrombosis (CVST), are presented. A possible explanation of this rare occurrence is provided, and the differential therapeutic strategies are discussed. We propose to consider CVST in cases of subdural effusions of obscure origin. Appropriate imaging studies should not be delayed if there is suspicion of sinus thrombosis to enable adequate therapy to be started as soon as possible. ( info)
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