1/14. Acute traumatic posteroinferior cerebellar artery aneurysms: report of three cases.OBJECTIVE AND IMPORTANCE: Posterior fossa subarachnoid hemorrhage secondary to blunt head trauma is rarely associated with traumatic aneurysms of the posterior circulation. CLINICAL PRESENTATION: We present three cases of posterior fossa subarachnoid hemorrhage from ruptured posteroinferior cerebellar artery (pica) aneurysms after blunt head trauma. In each case, there was no associated penetrating injury or cranial fracture. All three patients presented with acute hydrocephalus requiring ventriculostomy. Two of the three patients had a proximal pica aneurysm visible on emergent angiography. The remaining patient's aneurysm, although not visible on his initial angiogram, was detected on a subsequent angiogram 72 hours later. INTERVENTION: All patients underwent successful surgical clipping of their aneurysms. Two cases required sacrificing of the parent vessels because of the friable nature of the false aneurysms. In each case, severe symptomatic vasospasm occurred, requiring angioplasty. All three patients also required a ventriculoperitoneal shunt for persistent hydrocephalus. CONCLUSION: Features of these three cases and similar cases reported in the literature support the theory that vascular ruptures and traumatic aneurysms of the proximal pica may be related to anatomic variability of the pica as it transverses the brainstem. This variability predisposes individuals to vascular lesions, which occur in a continuum based on the severity of the injury. Posterior fossa subarachnoid hemorrhage after head injury requires a high index of suspicion and warrants aggressive diagnostic and therapeutic interventions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. Episodic coma in a new leukodystrophy.Among the leukodystrophies of a hypomyelinating nature, childhood ataxia with diffuse central nervous system hypomyelination exhibits the unique feature of rapid decrease in mental status after relatively minor head injuries or otherwise noncomplicated febrile illnesses. This article reports the case of a child with progressive spastic quadriparesis in whom unconsciousness developed repeatedly as a result of minor head trauma and required prolonged critical-care nursing. Although cognition is believed to be relatively preserved in this disorder, this child developed progressive cognitive decline. A detailed review of the literature is presented along with discussion of the potential mechanisms of neurologic deterioration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/14. Facial fractures and related injuries: a ten-year retrospective analysis.A retrospective analysis of 828 patients with significant midface or mandibular fractures was undertaken to illustrate the multisystem nature of traumatic injuries associated with fracture of the facial skeleton, covering the period from 1985 to 1994. Special emphasis was placed on determining associated injuries sustained as well as epidemiological information. The experience presented differs from other large series in the literature in that the predominant mechanism of injury is motor vehicle accidents (67%) rather than assaults. Of the patients reviewed, 89% sustained significant associated injuries. Closed head trauma with documented loss of consciousness was noted most frequently (40%), followed by extremity fractures (33%), thoracic trauma (29%), and traumatic brain injuries (25%). Only 11% of patients sustained facial fractures without concomitant injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/14. Chronic extradural haematomas: indications for surgery.Non-invasive neuro-imaging has led to the detection of minimally symptomatic or asymptomatic chronic extradural haematomas. Our experience and review of the literature suggests that, as in the case of chronic subdural haematomas, there is development of membranes and liquifaction of the clot which may permit drainage of such collections through twist drill or burrholes. The time from development and the neuro-imaging chanes on CT and MRI can suggest the age and nature of the clot and thus permit timing of surgery so that drainage may be accomplished with a minor procedure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. The use of discourse analyses for the evaluation of higher level traumatically brain-injured adults.Higher level traumatically brain-injured (TBI) adults often present a challenge in assessment as well as in the measurement of recovery. Traditional clinical measures of language abilities have not been adequate to identify and describe precisely what is deviant about their communication. Assessment has generally consisted of aphasia tests and measures of general cognitive abilities. Although such measures may be sensitive to deficits in lower level TBI patients or those in the early stages of recovery, their usefulness with higher functioning patients is questionable due to the often subtle nature of their residual communication problems. An overview of discourse analyses is presented and recent applications of these procedures with TBI patients reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Neurogenic stuttering as a manifestation of stroke and a mask of dysphonia.R. L. was a 52-year-old man who was referred for an SLP consultation to determine the nature of his fluency disorder, whether or not treatment would be beneficial, and finally whether resumption of pre-trauma vocational status was feasible. The patient was involved in a motor vehicle accident with no resulting detectable trauma. However, shortly after the accident, R. L. developed a severe dysfluency that was later described as cortical stuttering. We reviewed the medical and rehabilitation work-up that attempted to determine whether the communication disorder was functional or organic in origin. Once the fluency disorder was determined to be caused by a suspected small, focal, hemispheric lesion, a five-month treatment program was undertaken that used a noval prosthetic approach to restore fluency. Once fluency was restored with the use of an artificial larynx, a residual anomia was detected and treated. The case of R. L. illustrates a stuttering that appeared to be caused by a combined neurogenic dyspraxic (vocal control), dysarthric (motor control), and dysnomic (word-finding) dysfluency. The literature on this issue was reviewed and the underlying mechanism of recovery was discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/14. fistula of the posterior communicating artery and cavernous sinus.A 24-year-old man was admitted with conjunctival hyperemia of the left eye and progressive chemosis and proptosis 1 month after a head injury. An angiogram showed an arterial-cavernous sinus fistula of the posterior communicating artery, which was treated with minicoils. The atypical configuration, transvenous embolization, and unusual nature of the communication suggested that communication developed through a newly generated vessel in granulation tissue.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. Paramedian thalamic infarction following blunt head injury--case report.A 19-year-old male was admitted following a blow to the face. Computed tomographic (CT) scans 1 hour after injury revealed low-density areas in the bilateral thalami and midbrain, which were enhanced postcontrast except for the core 3 hours later. CT scans 2 days after injury revealed that the size of the low-density areas had increased. CT scans and magnetic resonance images 3 weeks after injury disclosed only small infarcted lesions in the bilateral thalami, the right side of the midbrain, and the left internal capsule. These findings suggest that the injury initially caused thrombus on the basilar arterial wall, leading to occlusion of the perforators, but almost all affected perforators were recanalized. Bilateral thalamic infarction resulting from head injury is unusual, as is the transient nature of the infarction in this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. Injuries produced by judicial hanging. A case report.A judicial hanging occurred in the state of washington. neck injuries were studied by MRI (magnetic resonance imaging) and CT (Computed tomography). In addition, vertebral arteriograms were performed to evaluate the nature of the neck injury. This report details the anatomical changes produced by judicial hanging.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/14. Pragmatic language skills after closed head injury: ability to meet the informational needs of the listener.Two closed-head-injured subjects and 12 non-brain-damaged controls explained a novel procedure to a blindfolded third person. Their productions were transcribed and scored by nine judges on ratings scales based on Grice's maxims of quantity and manner. The two closed-head injury (CHI) productions were significantly inferior to the controls, both being rated as disorganized, confusing, and ineffective. While one subject's production was considered overly repetitive, the other had too little detail. In order to specify, more exactly, the nature of the deficits, a cohesion analysis and an analysis of informational content were performed. The cohesion analysis suggested that the CHI productions were generally similar to the controls. The informational analysis was more revealing. Judgements of detail and repetitiveness were reflected in the number of new and repeated propositions. Errors in sequencing and inclusion of irrelevant propositions contributed to the disorganized and confusing nature of the texts. The results were interpreted within the framework of frontal lobe deficits in monitoring and regulation of performance.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
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