1/38. Lower limb exsanguination and embolism.We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/38. naltrexone: effects on motor function, speech, and activities of daily living in a patient with traumatic brain injury.Evidence from many studies has suggested that endogenous opioid peptides participate in a number of pathophysiological responses to brain injury. This provides the rationale for the use of opioid antagonists for the enhancement of neural recovery after brain injury. A case is presented of an 18-year-old male who had loss of consciousness for 1 month after a severe brain injury. Three months of intensive rehabilitative therapies did not change his functional status. A trial of naltrexone was given while his performance in mobility, speech and overall Functional Independence Measure (FIM) scores were monitored. Results indicate an accelerated improvement in functional status and statistically improved FIM score.- - - - - - - - - - ranking = 277.71762488608keywords = brain injury, traumatic brain, injury, trauma (Clic here for more details about this article) |
3/38. CT scans essential after posttraumatic loss of consciousness.The frequency of "talk and deteriorate" in the emergency department (ED), subsequent deterioration of patients with seemingly "mild" head injury at the time of presentation, is summarized. Among the 1,073 patients with minor head injury treated in the last 5 years, five patients (0.5%) deteriorated in the ED. All of the five patients had experienced transient loss of consciousness (LOC) before presentation. Deterioration had occurred during treatment of trivial associated injuries in four-fifths of the cases. Computed tomography (CT) scans revealed four acute epidural hematomas and one cerebellar contusion. Retrospectively, immediate brain CT shortly after their arrival may have revealed the presence of traumatic intracranial hematomas before deterioration. Although routine use of CT scans in patients with mild head injury has been controversial, the authors conclude that CT scans should be taken if patients have experienced transient LOC to prevent or reduce the occurrence of deterioration in ED.- - - - - - - - - - ranking = 3.134796511522keywords = injury, trauma (Clic here for more details about this article) |
4/38. Fracture of the sella turcica.A patient with a fracture of the sella turcica, visible on lateral X-ray films of the skull, is described. This fracture, although not diagnosed during life, was present in approximately 20 per cent of a series of consecutive autopsies on patients who died of head injury. The significance of this injury to the hypothalamopituitary axis is discussed and methods of investigation suggested.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
5/38. Cerebral aneurysms of traumatic origin.This report reviews 41 cases of traumatic cerebral aneurysms, including four cases of our own which are presented in detail. They may follow penetrating or closed head injury, and are usually associated with significant additional intracranial damage. Almost half of the patients presented with a delayed subarachnoid hemorrhage within three weeks of the initial head injury, defining an important neurological syndrome. Those patients whose post-traumatic aneurysms have been surgically obliterated have an associated mortality which is half that of patients treated by nonsurgical methods.- - - - - - - - - - ranking = 2.1617558138264keywords = injury, trauma (Clic here for more details about this article) |
6/38. Acute rhabdomyolysis and brachial plexopathy following alcohol ingestion.An unusual case of brachial plexopathy following alcohol-induced rhabdomyolysis is presented. The patient's rhabdomyolysis developed during sleep after an acute alcohol binge and there was no history of muscle trauma. It is thought that the brachial plexopathy developed due to direct compression of the plexus from swollen muscles of the shoulder girdle. The lack of similar reported cases despite the common clinical scenario of prolonged unconsciousness following excess alcohol intake suggests that other factors may be important in the development of muscle and nerve damage in susceptible individuals.- - - - - - - - - - ranking = 0.026959302304404keywords = trauma (Clic here for more details about this article) |
7/38. 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 = 8.7066884101211keywords = traumatic brain, injury, trauma (Clic here for more details about this article) |
8/38. Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain.This report identifies evidence of partially functional cerebral regions in catastrophically injured brains. To study five patients in a persistent vegetative state (PVS) with different behavioural features, we employed [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET), MRI and magnetoencephalographic (MEG) responses to sensory stimulation. Each patient's brain expressed a unique metabolic pattern. In three of the five patients, co-registered PET/MRI correlate islands of relatively preserved brain metabolism with isolated fragments of behaviour. Two patients had suffered anoxic injuries and demonstrated marked decreases in overall cerebral metabolism to 30-40% of normal. Two other patients with non-anoxic, multifocal brain injuries demonstrated several isolated brain regions with relatively higher metabolic rates, that ranged up to 50-80% of normal. Nevertheless, their global metabolic rates remained <50% of normal. MEG recordings from three PVS patients provide clear evidence for the absence, abnormality or reduction of evoked responses. Despite major abnormalities, however, these data also provide evidence for localized residual activity at the cortical level. Each patient partially preserved restricted sensory representations, as evidenced by slow evoked magnetic fields and gamma band activity. In two patients, these activations correlate with isolated behavioural patterns and metabolic activity. Remaining active regions identified in the three PVS patients with behavioural fragments appear to consist of segregated corticothalamic networks that retain connectivity and partial functional integrity. A single patient who suffered severe injury to the tegmental mesencephalon and paramedian thalamus showed widely preserved cortical metabolism, and a global average metabolic rate of 65% of normal. The relatively high preservation of cortical metabolism in this patient defines the first functional correlate of clinical- pathological reports associating permanent unconsciousness with structural damage to these regions. The specific patterns of preserved metabolic activity identified in these patients do not appear to represent random survivals of a few neuronal islands; rather they reflect novel evidence of the modular nature of individual functional networks that underlie conscious brain function. The variations in cerebral metabolism in chronic PVS patients indicate that some cerebral regions can retain partial function in catastrophically injured brains.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
9/38. Blunt basal head trauma: aspects of unconsciousness.Two cases of street violence directed to the skull base level and transverse to the cervical axis are described. No skeletal damage. The violence resulted in the so-called "traumatic subarachnoid haemorrhage", an often used, unspecified forensic "diagnosis"; it was here revealed to be due to rupture of the wall of the posterior inferior cerebellar artery (p.i.c.a). However, this was only one of the possible explanations for the acute symptoms of unconsciousness (concussion) and almost immediate death. The careful examination of these two cases and of a series of control cases revealed that at the trauma, stress and strain may have occurred to arterial branches serving as feeding perforant vessels to the medulla oblongata; in these cases they were coursing directly from the p.i.c.a. region.--The type of direct impact has often been regarded as mild! However, its location suboccipitally as in these cases can become dangerous. The resulting direct or indirect deficit of brain stem functions are discussed in these cases as well as "concussion-related symptoms" resulting after other types of head and neck injury.- - - - - - - - - - ranking = 1.1617558138264keywords = injury, trauma (Clic here for more details about this article) |
10/38. Bitemporal head crush injuries: clinical and radiological features of a distinctive type of head injury.OBJECT: Most craniocerebral injuries are caused by mechanisms of acceleration and/or deceleration. Traumatic injuries following progressive compression to the head are certainly unusual. The authors reviewed clinical and radiological features in a series of patients who had sustained a special type of cranial crush injury produced by the bilateral application of rather static forces to the temporal region. Their aim was to define the characteristic clinical features in this group of patients and to assess the mechanisms involved in the production of the cranial injuries and those of the associated cerebral and endocrine lesions found in this peculiar type of head injury. methods: Clinical records of 11 patients were analyzed with regard to the state of consciousness, cranial nerve involvement, findings on neuroimaging studies, endocrine symptoms, and outcome. Furthermore, an experimental model of bitemporal crush injury was developed by compressing a dried skull with a carpenter's vice. Seven of the 11 patients were 16 years old or younger. All patients presented with a characteristic clinical picture consisting of no loss of consciousness (six patients), epistaxis (nine patients), otorrhagia (11 patients), peripheral paralysis of the sixth and/or seventh cranial nerves (10 patients), hearing loss (five patients), skull base fractures (11 patients), pneumocephalus (11 patients), and diabetes insipidus (seven patients). Ten patients survived the injury and most recovered neurological function. CONCLUSIONS: Static forces applied to the head in a transverse axis produce fractures in the skull base that cross the midline structures without producing significant cerebral damage. Stretching of cranial nerves at the skull base explains the nearly universal finding of paralysis of these structures, whereas an increase in the vertical diameter of the skull accounts for the occurrence of diabetes insipidus in the presence of an intact function of the anterior pituitary lobe. The association of clinical, endocrine, and neuroimaging findings encountered in this peculiar type of head injury supports the idea that this subset of injured patients has a distinctive clinical condition, namely the syndrome of bitemporal crush injury to the head.- - - - - - - - - - ranking = 10keywords = injury (Clic here for more details about this article) |
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