331/859. Unsuspected upper cervical spine fractures associated with significant head trauma: role of CT. Several recent studies report the sensitivity of computed tomography (CT) to be far greater than that of traditional plain film radiographic studies for evaluation of cervical spine fractures and spinal cord pathology. Nevertheless, plain films continue to be the standard screening examination. CT is used only if fractures are demonstrated or suspected on plain film survey. Recently, three patients with significant head and neck trauma (all three patients had intracranial hemorrhage) had cervical spine evaluation by computed tomography and standard plain film views. CT demonstrated significant C1-C2 fractures, while plain films were completely normal in all three cases. Prospectively studying the next 50 patients with significant head trauma, we added a few more slices to the routine head scan protocol to cover the first three cervical vertebrae. This added very little time or cost to the procedure. The additional CT images demonstrated four upper cervical fractures that could not be seen on plain films, even in retrospect. Our findings suggest that routine inclusion of the upper cervical spine with head CT is appropriate in the evaluation of patients with significant head trauma as defined by intracranial hemorrhage or skull fracture. ( info) |
332/859. The traumatic air myelogram. A case of a pneumomyelogram of the cervical spine resulting from blunt trauma to the head is presented. The patient had pneumocephalus and skull fractures. On presentation the patient had no neurological deficits and remained neurologically stable throughout the hospital course. This is the first report of a traumatic pneumomyelogram and pneumocephalus with multiple skull fractures where the patient sustained no neurological sequelae. ( info) |
333/859. Maxillofacial fractures in the elderly: a comparative study. Previous maxillofacial trauma research has dealt primarily with facial bone fractures in the general population. Very few studies have specifically addressed maxillofacial fractures in the elderly. We compared 45 elderly (65 years of age or older) and 201 younger adult (16 to 64 years of age) patients admitted to our hospital with maxillofacial fractures. The percentage of patients admitted with nasal bone fractures was much greater in the elderly population, while mandibular fractures were more common in the adult group. Motor vehicle accidents accounted for over half the injuries in both groups, while falls were more prevalent in the elderly. Management of the elderly patient may be complicated by their associated injuries or underlying medical problems, perhaps partially accounting for their longer median length of hospital stay. The elderly are a unique subpopulation of maxillofacial fracture patients and deserve further study regarding their injuries and optimal methods for treatment. ( info) |
334/859. Zeta waves: a special type of slow delta waves. A special type of delta waves with a duration of 1-3 sec which, because of their saw-tooth or zed shape in the EEG, we have named 'zeta waves' has been described. They occur particularly in cases with rather severe brain lesions, usually with an acute or subacute onset and a space occupying character. In a period of 2 years during which 2500 EEGs have been reported we have seen zeta waves in 20 patients in whom 76 EEGs have been recorded. The characteristics of these waves and the types of lesions with which they occurred are described. The importance of an adequate recording technique for proper presentation of this EEG pattern is emphasized. ( info) |
335/859. Floating petrous bone fracture. Floating petrous bone fracture appears to occur when the elastic pediatric skull is subjected to large compressive forces. Unlike a longitudinal fracture, a floating petrous bone fracture does not involve the ear canal and squamous cortex. Rather, the fracture line runs through the middle ear, separating the petrous apex from its lateral and inferior bony attachments. Characteristic clinical findings include immediate onset of conductive hearing loss, with ipsilateral sixth and seventh cranial nerve paralysis. This article details the third known occurrence of this type of fracture, and includes a discussion of the pathophysiologic mechanism and treatment rationale. ( info) |
336/859. The medical management of retrobulbar haemorrhage complicating facial fractures: a case report. A case of delayed retrobulbar haemorrhage following an orbital floor fracture is reported. Virtual total loss of vision occurred; however, intense medical therapy produced such a dramatic response that surgical decompression was not necessary. On 6 month follow-up the patients visual function was entirely normal in all respects. ( info) |
337/859. Carotico-cavernous fistula presenting as a late complication of facial trauma. A case of carotico-cavernous fistula following facial trauma is reported. Clinical details of the case are described together with a review of the literature. Aetiology and treatment of the condition are discussed. Carotico-cavernous fistula is a rare complication of facial trauma. The case reported is important because the complication presented as a late event some 9 weeks after the initial trauma. ( info) |
338/859. CT evolution of an acute venous epidural hematoma. Acute traumatic epidural hematoma may develop secondary to an arterial or venous bleed. The computed tomography (CT scan) appearance of the hematoma depends on the source and severity of bleeding, the interval between injury and CT scan, and the degree of clot organization or breakdown. We report the emergency evaluation, CT scan evolution, and clinical management of one such acute venous epidural hematoma. ( info) |
339/859. A complex case of cochlear implant electrode placement. cochlear implantation is becoming an increasingly accepted rehabilitative procedure for post lingually deafened adults. The testing, evaluation, and surgery have become standardized procedures. In this case results of two different promontory tests were contradictory. A constant voltage stimulation test was negative, while a later constant current stimulation test indicated good residual function. The CT scan accurately predicted the location of the round window remanent. In order to gain access to the cochlea, a partial labyrinthectomy was performed. Successful implantation was ultimately achieved. This implies that a previous labyrinthectomy may not be an absolute contraindication to cochlear implantation. ( info) |
340/859. A case of subdural hematoma and temporal bone fracture as complications of chiropractic manipulation. We present a case of subdural hematoma and temporal bone fracture as a complication of chiropractic manipulation. Subdural hematoma in the elderly may follow insignificant, often forgotten, trauma and may develop slowly and progress. Our patient presented with a complaint of headache three days after forceful chiropractic manipulation, but denied any history of trauma. Computed tomography confirmed the presence of a subdural hematoma and a temporal bone fracture and the patient underwent successful surgical treatment. Our experience identifies a previously unreported mechanism of injury in patients with subdural hematoma presenting to the emergency department with a complaint of headache. ( info) |