1/25. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/25. Intracranial and intraspinal meningeal melanocytosis.We describe a 35-year-old man with a history of remote closed head injury who presented with new neurologic deficits. A noncontrast head CT scan showed hyperattenuation involving both temporal lobes, frontal lobes, basal meninges, and cerebellum. A subsequent contrast-enhanced MR examination of the brain showed enhancement in the basal cisterns extending into the upper cervical spine and throughout the spinal canal. Gross, histologic, and immunohistochemical analysis revealed meningeal melanocytoma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/25. Bone defect associated with middle meningeal arteriovenous fistula treated by embolization--case report.A 57-year-old male presented with a frontal bone defect associated with a middle meningeal arteriovenous fistula (AVF) manifesting as headache. The patient had a history of head injury 19 years previously. skull radiography and computed tomography demonstrated a left frontal bone defect. Left external carotid angiography demonstrated a middle meningeal AVF at the frontal region, at the same location as the bone defect. The AVF was fed by the bilateral middle meningeal and left deep temporal arteries, and drained by the superior sagittal and ipsilateral cavernous sinuses. The minor feeding artery, the left deep temporal artery, was embolized with polyvinyl alcohol particles, then 0.4 ml of a 1:3 mixture of n-butyl cyanoacrylate and lipiodol was injected from the left middle meningeal artery. Follow-up angiography 3 months after the embolization revealed complete obliteration of the fistula. The bone defect may have been caused by erosion of the frontal bone by the pulsating effect of the feeding and draining vessels of the fistula, or by inadequate nutrition to the bone tissue because of the arteriovenous shunt.- - - - - - - - - - ranking = 30.50785711843keywords = headache (Clic here for more details about this article) |
4/25. Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss.Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.- - - - - - - - - - ranking = 30.50785711843keywords = headache (Clic here for more details about this article) |
5/25. A craniocervical injury-induced syringomyelia caused by central canal dilation secondary to acquired tonsillar herniation. Case report.The authors report on a 19-year-old man with an acquired tonsillar herniation caused by a craniocervical junction injury in which serial magnetic resonance (MR) images demonstrated patent and isolated segments of the central canal participating in the dilation and then formation of a cervical syrinx. The patient was involved in a motor vehicle accident; he developed tonsillar herniation as a complication of subarachnoid and epidural hemorrhage, predominantly observed around the cisterna magna and upper cervical canal. Repeated MR images obtained over an 11-month period indicated the for mation and acute enlargement of the syrinx. Ten months after the accident, the patient presented with sensory disturbance in both upper extremities and spasticity due to syringomyelia. He underwent craniocervical decompressive surgery and doraplasty, which reduced the size of syringomyelia. The authors postulate that the patent central canal may play a role in determining the location of a syrinx remote from a focus of cerebrospinal fluid obstruction.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
6/25. Haemorrhage into an arachnoid cyst: a serious complication of minor head trauma.arachnoid cysts are infra-arachnoidal cerebrospinal fluid collections that are usually asymptomatic. However, they can become acutely symptomatic because of haemorrhage and cyst enlargement, which may result from minor head trauma. The range of symptoms is wide and many are "soft" signs. diagnosis is important as cysts causing mass effect require surgery. A case is reported of a child presenting with localised headaches after minor head trauma. Computed tomography demonstrated an arachnoid cyst with evidence of haemorrhage, which required surgical intervention. Other cases of arachnoid cyst presenting to our hospital or reported in the literature are reviewed with respect to presenting symptoms and signs. Localised headaches, behavioural or cognitive changes and ataxia are more commonly associated with this disorder than nausea, vomiting, visual disturbances or seizures. This range of symptomatology following minor head trauma may warrant computed tomography when other criteria for this investigation are not met.- - - - - - - - - - ranking = 61.015714236859keywords = headache (Clic here for more details about this article) |
7/25. Unexpected delayed rupture of the vertebral-posterior inferior cerebellar artery aneurysms following closed head injury.Subarachnoid haemorrhage secondary to closed head injury is rarely associated with traumatic aneurysms of the posterior circulation. We report two cases of ruptured vertebral-posterior inferior cerebellar artery (VA-pica) pseudoaneurysms following closed head injuries. In each case, there was no associated penetrating injury or skull fracture. The first patient was kicked followed by disturbed consciousness. The computerized tomography (CT) scan on admission and cerebral angiography on the 11th day after the trauma revealed a massive subarachnoid haemorrhage (SAH) with pan-ventricular haemorrhage and an aneurysm of the right pica near its origin. Further ruptures occurred on the 12th, 15th, and 66th day, and he died on the 69th day. The second patient complained of persistent headache and nausea following a fight on the previous day. A CT scan and angiography on the 1st day after the trauma showed posterior fossa SAH with fourth ventricular blood and a tiny protrusion of the left VA-pica. On the 14th day, repeated angiography revealed a remarkable growth of the aneurysm, followed by the second rupture. The repair of the VA-pica junction was urgently performed with successful exclusion of the aneurysm. To our knowledge, only eight cases of traumatic aneurysms located at the VA or the pica near its origin have been reported. When intraventricular blood is found with massive subarachnoid blood or with posterior fossa SAH, this ominous complication should be considered. Traumatic VA-pica pseudoaneurysms are curable by refined microsurgical techniques, if diagnosed in time.- - - - - - - - - - ranking = 30.50785711843keywords = headache (Clic here for more details about this article) |
8/25. Posttraumatic cerebrospinal fluid accumulation within the eyelid: a case report and review of the literature.history AND PRESENTATION. A case of a 3-year-old child with a right upper pulsatile eyelid swelling following a falling injury 3 months before is described. Computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a fracture of the orbital roof, a basofrontal dural tear and a direct communication of the cystic cavity with the subarachnoid space. TREATMENT AND OUTCOME. The patient underwent dural repair for cerebrospinal fluid (CSF) leakage and was discharged in good health.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/25. The postconcussion syndrome and the sequelae of mild head injury.The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small minority are malingerers, frauds, or have compensation neurosis, most patients have genuine complaints. Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.- - - - - - - - - - ranking = 61.015714236859keywords = headache (Clic here for more details about this article) |
10/25. Acute on chronic subdural hematoma in a female boxer: a case report.INTRODUCTION: Although the sport of female boxing has a long history, the activity's current popularity is unprecedented. As more women participate, we can expect them to experience many of the serious neurologic injuries observed in their male counterparts. We present the first reported subdural hematoma in a female secondary to boxing and critique management decisions made by the athlete's trainer/coach. CASE REPORT: A 24-yr-old right-handed female boxer developed headaches of increasing intensity, nausea, and emesis after being knocked down while sparring. She was allowed to continue training despite persistent symptoms and participated in a match 2 wk after the incident that was stopped due to intolerable headache. Computed tomography scan of the brain revealed a large heterogeneous subdural fluid collection over the left cerebral hemisphere, causing effacement of the adjacent sulci and a large left-to-right midline shift, consistent with an acute on chronic subdural hematoma. After surgical evacuation, the patient reported persistent memory, concentration, and language problems. Neuropsychological evaluation was performed and revealed deficits in confrontational naming, information retrieval, and concentration difficulty. DISCUSSION: Several factors may increase the female participants' risk for acute neurological injury. The activity's current popularity and high demand with fans results in rapid advancement of inexperienced fighters, which leads to dangerous mismatches. Intergender sparring is common, and return to competition guidelines utilized for male participants are often not adhered to. This report is timely in that female athletes are more often crossing into previously male dominated sports and should serve as a reminder that these participants are vulnerable to similar injuries. Previous safety guidelines should be utilized in this new population of participants.- - - - - - - - - - ranking = 61.015714236859keywords = headache (Clic here for more details about this article) |
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