Cases reported "Wounds, Stab"

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11/58. Internal carotid artery pseudoaneurysm masquerading as a peritonsillar abscess.

    Blunt carotid arterial injuries are uncommon. Motor vehicle crashes are the most frequent cause, but this type of vascular injury can be secondary to any direct blow to the neck, intraoral trauma, or strangulation. Types of vascular injuries include dissection, pseudoaneurysm, thrombosis, rupture, and arteriovenous fistula formation. patients with pseudoaneurysm of the internal carotid artery will usually present with neurologic complaints, ranging from the minor to complete stroke. On physical examination, neck hematoma, bruits, pulsatile neck mass, or a palpable thrill may be found. However, in 50% of cases, no external signs of neck trauma are observed. Onset of symptoms may occur within a few hours to several months after the initial injury. angiography is considered the gold standard for diagnosis, but carotid Doppler ultrasound recently has been shown to be very sensitive in detecting these types of injuries. Treatment of pseudoaneurysm is often surgical, with endovascular stenting.
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12/58. Priorities in the management of penetrating maxillofacial trauma in the pediatric patient.

    Penetrating facial trauma is uncommon in children; a large series published by Cooper et al revealed that only 1% to 2% of the total population of infants and children admitted for trauma during their study period had a diagnosis of penetrating trauma to the head or neck. Little has been published specifically addressing these injuries in the pediatric population. The records of 20 patients treated for penetrating facial injuries at Kosair-Children's Hospital in Louisville, kentucky from January 1991 through December 1994 were reviewed. The location, mechanism and extent of injury, as well as the diagnostic and management practices used in patient treatment, were collected. Categorizing the injuries relative to the involvement of one or more facial zones helped guide diagnostic studies and therapeutic intervention and predict associated injuries. This article evaluates the authors' method of management and any differences in management between pediatric and similarly injured adult patients.
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13/58. Covered stent-graft repair of the brachiocephalic arteries: technical note.

    OBJECTIVE: The use of a covered stent-graft to repair disruptions of the cervical carotid and vertebral arteries is described. This device maintains vessel patency while effectively excluding pseudoaneurysms, arteriovenous fistulae, and other breaches in the integrity of the arterial wall. methods: Patient 1 bled from a large rent in the proximal common carotid artery as a result of tumor invasion. Patient 2 developed a vertebral arteriovenous fistula after a stab injury to the neck. Patient 3 developed cerebral infarction and an enlarging pseudoaneurysm of the internal carotid artery, also after a stab wound to the neck. RESULTS: All three patients were treated with the Wallgraft endoprosthesis (boston Scientific, Watertown, MA). In each case, the vessel wall defect was repaired while antegrade flow through the artery was preserved or restored. No neurological complications occurred as a result of stent-graft deployment. CONCLUSION: Covered stent-grafts offer an alternative to endovascular occlusion of the parent vessel, thereby expanding the therapeutic options for patients with extracranial cerebrovascular disease. These three cases highlight the usefulness and versatility of these devices for endoluminal reconstruction of the brachiocephalic vasculature.
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14/58. Traumatic pseudoaneurysm and high flow arteriovenous fistula involving internal jugular vein and common carotid artery. Treatment with covered stent and embolization.

    We describe the case of a 36-year-old man who presented following penetrating trauma to the neck. angiography demonstrated a high-flow arteriovenous fistula and large false aneurysm of the common carotid artery that also had contributions from branches of the external carotid artery and the thyrocervical trunk. This was treated with a combination of a covered endovascular stent placed in the common carotid artery and coil embolization of other small feeding vessels.
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15/58. Self-inflicted blindness and brown-sequard syndrome.

    A 30-year-old paranoid schizophrenic man suffered a psychotic episode while flying on an airplane, locked himself in the bathroom, detached the temples of his sunglasses, and stabbed them deeply into both medial orbits. He then secured one temple into the door hinge and rammed the back of his neck repeatedly against it. The injuries caused no light perception from optic nerve trauma and a Brown-Sequard hemitransection of the spinal cord.
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16/58. Sequential endovascular coil embolization for a traumatic cervical vertebral AV fistula.

    An arteriovenous (AV) fistula involving the cervical vertebral artery is rare. Iatrogenic injury from percutaneous puncture and penetrating wounds are the most common causes. Symptoms include tinnitus and the presence of a pulsatile mass with a thrill. Conservative treatment with coil embolization and preservation of the vertebral artery is an alternative to surgical intervention. We report a patient who developed an AV fistula involving the vertebral artery and internal jugular vein following surgical repair of a stab wound to the neck. The sequential endovascular coil embolism was performed with subsequent successful occlusion of fistula. No neurological deficit developed during or after intervention. This approach appears to be a safe method in the treatment of vertebral AV fistula.
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17/58. How can we approach a left-sided stab wound in the neck, with isolated tracheal laceration?

    Any penetrating trauma to the mediastinum may cause great vessel damage resulting in massive bleeding or even shock. Associated tracheal injury increases morbidity and mortality. We report a case of a penetrating mediastinal injury with isolated tracheal laceration. The stab entered in the left supraclavicular fossa. The patient presented with right-sided pneumothorax, pneumomediastinum and respiratory collapse. bronchoscopy revealed two injuries in the trachea that were repaired by right thoracotomy and left cervicotomy. The patient was discharged on postoperative day 6. Isolated thoracic tracheal injury is very rare in mediastinal stab wounds and operative strategy may change according to bronchoscopic findings.
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18/58. A fatal case of a single stab wound penetrating the small, narrow atlantoaxial interspace.

    A 73-year-old woman was found dead with a small wound on the nape of her neck. The wound was oval in shape, measuring about 0.6 cm in length along the major axis, with a slightly irregular margin. The wound injured the medulla oblongata through the atlantoaxial interspace, and reached the left vertebral artery. This wound was found to be the cause of death. The wound depth was 5 cm in length, with the direction of the wound canal from posterior-lower right to anterior-upper left. The size and appearance of the wound corresponded to those of the horizontal section of a skewer used by the assailant. Such a fatal case due to a single stabbing of the medullar oblongata by the chance gliding of a skewer through the small, narrow atlantoaxial interspace is considered to be exceptional.
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19/58. Unusual stab injury of the spinal cord.

    OBJECTIVE: To report an unusual penetrating stab injury of the spinal cord. DESIGN: Case report of a 13-year-old boy who sustained cervical trauma following an accident while playing. SETTING: spinal cord injuries Unit, Musgrave Park Hospital, Belfast, UK. CASE REPORT: Mechanism of injury was by a spear-like electric fence post entering the neck. Initial neurological examination revealed tetraplegia with C4 sensory level. magnetic resonance imaging (MRI) of spinal cord demonstrates the penetrating injury. CONCLUSION: No ligamentous instability was demonstrated. In the absence of this, the penetrating injury by a short blade thrown at speed was felt to be responsible for the subsequent injury and resulting outcome at discharge of C4 American Spinal Injury association (asia) grade D tetraplegia.
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20/58. Traumatic vertebral artery pseudoaneurysm: a case report.

    A case of traumatic vertebral artery pseudoaneurysm in a 16-year-old Nigerian male following a stab wound is described. Successful surgical treatment by proximal subclavian artery control and excision of the lesion was achieved. The value of Doppler ultrasonography in the diagnosis is highlighted. This case illustrates and re-emphasises that this rare lesion should be considered in patients with neck mass following penetrating posteriorly located neck injuries.
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