1/75. Successful treatment of whiplash-type injury induced severe pain syndrome with epidural stimulation: a case report.Chronic severe cervico-facial pain syndrome associated with a whiplash-type injury was successfully treated with epidural spinal cord stimulation. The patient had been in pain for 9 years, responding temporarily only to stellate ganglion blocks. The patient has now been painless for 18 months. We have been unable to find a similar case reported in the literature to date.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/75. magnetic resonance imaging in acute non-accidental head injury.Making the diagnosis of non-accidental head injury, particularly in the acute illness, can be difficult. The aim of this retrospective study was to evaluate the use of magnetic resonance imaging in the acute presentation of non-accidental head injury. Twelve cases admitted to the Royal Hospital for Sick Children, Edinburgh with a diagnosis of non-accidental head injury, and who had magnetic resonance imaging in the acute illness, were identified. The average age was 5.7 mo (range 1 to 34 mo). The mechanism of the primary injury was whiplash-shaking injury syndrome with impact in four cases and without evidence of impact in seven; in one case there was a compression injury. The magnetic resonance imaging findings reflected the pathological consequences of rotational acceleration-deceleration injury and did not differ between those cases with evidence of impact and those without. Subdural haematomas were identified in all cases; the commonest location for subdural blood was the subtemporal region. It is surprising and important that the most frequent location of subdural blood was in the subtemporal area. This is an area difficult to assess by computerized tomography. Evidence of repeated injuries was found in two cases. These findings confirm the value of magnetic resonance imaging in the acute phase of non-accidental head injury.- - - - - - - - - - ranking = 2.4keywords = injury (Clic here for more details about this article) |
3/75. Treatment of traumatic atlanto-occipital dislocation in chronic phase.We report the case of 27-year-old woman who presented with mild neurological deficits with significant anterior dislocation of the atlanto-occipital junction in a chronic phase after initial conservative treatment in another hospital. The importance of early diagnosis and treatment for atlanto-occipital dislocation is emphasized. The dislocation could not be reduced sufficiently either by halo ring cervical traction or surgical procedure 5 months after the accident. Therefore, transoral odontoidectomy for decompression of the medulla, together with the posterior occipitocervical fusion with a titanium loop brace was performed. The patient's symptoms disappeared completely within a few months after the operation. magnetic resonance imaging findings suggesting soft tissue damage is the key to an early diagnosis and subsequent stabilization of traumatic atlanto-occipital dislocation in the early phase. Transoral decompressive odontoidectomy combined with posterior fusion may be considered for the treatment of irreducible atlanto-occipital dislocation in a chronic phase.- - - - - - - - - - ranking = 0.0030526015246107keywords = trauma (Clic here for more details about this article) |
4/75. Lumbomuscular proprioceptive reflexes in body equilibrium.To evaluate the role of reflexes related to the lumbar proprioceptors in maintenance of body equilibrium, changes in equilibrium function of the eyes and body were observed after unilateral procainization of the lumbar erector muscles. Observations were made on normal subjects and vertigo cases with lumbar pain after whiplash injury using various equilibrium tests. The results obtained were as follows: (1) On unilateral procainization of the lumbar erector muscles of normal subjects, eye nystagmus and disturbances of the righting reflex developed. Simultaneously, changes in drift reactions of the lower limbs were detected by the stepping test. Namely, in many of the subjects examined the direction of stepping deviation became quite different from that before procainization, and stepping after procainization tended to show slight or moderate ataxic features, associated with a sensation of unsteadiness. (2) When procaine was injected unilaterally into tender spots in the lumbar erector muscles of traumatic vertigo cases, spontaneous eye nystagmus and disturbances of the righting reflex decreased. Simultaneously, significant changes in the drift reactions of the lower limbs were observed in many of the cases examined. Namely, the direction of deviation became the opposite of that before procainization and ataxia in walking almost disappeared with reduction in vertigo. The following conclusions were drawn from these findings: (1) The effects of procaine on equilibrium of normal subjects are in sharp contrast to its effects on equilibrium of traumatic vertigo cases. Findings in the former might be due to increased imbalance between the activities of the right and left lumbar proprioceptors, while those in the latter might be due to decreased imbalance between the two. (2) These findings support the view that from the standpoint of body equilibrium, there are two phases of the proprioceptive reflex, and that Fukuda's concept of "two phases of the labyrinthine reflex, i.e., a stage of disturbance and a stage of coordination", can be applied to interpretation of the proprioceptive reflex of lumbar origin.- - - - - - - - - - ranking = 0.20122104060984keywords = injury, trauma (Clic here for more details about this article) |
5/75. pneumocephalus associated with aqueductal stenosis: three-dimensional computed tomographic demonstration of skull-base defects.Ventriculoperitoneal (VP) shunt placement in patients with aqueductal stenosis has recently been reported as a cause of pneumocephalus. We report on a patient with pneumocephalus associated with aqueductal stenosis treated by VP shunting. A 29-year-old woman who had undergone a shunt operation for aqueductal stenosis 7 years previously sustained a whiplash injury in a minor traffic accident. Computed tomography (CT) revealed massive subdural pneumocephalus, and three-dimensional reconstructions of CT images clearly demonstrated defects in the skull base overlying the ethmoid sinuses. Both endoscopic III ventriculostomy and placement of external ventricular drainage were came free of symptoms and rhinorrhea ceased. Three-dimensionally reconstructed CT images were useful in detecting the extent of the patient's skull base defect. III ventriculostomy was not effective in this case. Direct closure of the skull base by craniotomy was not necessary, and a programmable valve system was effective in preventing recurrence of either pneumocephalus or rhinorrhea.- - - - - - - - - - ranking = 0.2keywords = injury (Clic here for more details about this article) |
6/75. 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 = 0.20426928587669keywords = injury, trauma, brain (Clic here for more details about this article) |
7/75. Perspectives on posttraumatic fibromyalgia: a random survey of Canadian general practitioners, orthopedists, physiatrists, and rheumatologists.OBJECTIVE: To determine which factors physicians consider important in patients with chronic generalized posttraumatic pain. methods: Using physician membership directories, random samples of 287 Canadian general practitioners, 160 orthopedists, 160 physiatrists, and 160 rheumatologists were surveyed. Each subject was mailed a case scenario describing a 45-year-old woman who sustained a whiplash injury and subsequently developed chronic, generalized pain, fatigue, sleep difficulties, and diffuse muscle tenderness. Respondents were asked whether they agreed with a diagnosis of fibromyalgia (FM), and what factors they considered to be important in the development of chronic, generalized posttraumatic pain. RESULTS: More-recent medical school graduates were more likely to agree with the FM diagnosis. Orthopedists (28.8%) were least likely to agree, while rheumatologists (83.0%) were most likely to agree. On multivariate analysis, 5 factors predicted agreement or disagreement with the diagnosis of FM: (1) number of FM cases diagnosed by the respondent per week (p < 0.0001); (2) patient's sex (p < 0.0001); (3) force of initial impact (p = 0.003); (4) patient's pre-collision psychiatric history (p = 0.03); and (5) severity of initial injuries (p = 0.03). The force of initial impact and the patient's pre-collision psychiatric history were both negatively correlated with agreement in diagnosis. Patient related factors (personality, emotional stress, pre-collision physical, mental health) were considered more important than trauma related factors in the development of chronic, widespread pain. CONCLUSION: Future studies of the association between trauma and FM should identify potential cases outside of specialty clinics, and baseline assessments should include some measurement of personality, stress, and pre-collision physical and mental health.- - - - - - - - - - ranking = 0.20488416243938keywords = injury, trauma (Clic here for more details about this article) |
8/75. Concomitant post-traumatic craniocervical junction epidural hematoma and pontomedullary junction infarction: clinical, neurophysiologic, and neuroradiologic features.STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of post-traumatic epidural hematoma of the craniocervical junction with concomitant brain stem infarction. SUMMARY OF BACKGROUND DATA: Post-traumatic epidural hematoma of the cervical spine and brain stem post-traumatic infarction are very rare disorders. Post-traumatic epidural hematoma is usually located dorsally in the epidural space. methods: The clinical, neuroradiologic, and neurophysiologic findings in one patient with post-traumatic epidural hematoma located ventrally at the cervicomedullary junction and associated with medial infarction at the pontomedullary junction are reported. RESULTS: The main clinical finding in this patient was bilateral corticospinal and corticobulbar tract involvement. A magnetic resonance image showed displacement and flattening of the medulla oblongata and of the most cranial portion of cervical cord, which were caused by the epidural hematoma associated with an ischemic lesion of the pontomedullary junction. Results of central motor conduction studies indicated that the abnormality of the central motor pathways was localized at brain stem level, and that there was normal conduction from the cervicomedullary junction to spinal cord. CONCLUSION: This is the first reported case of spinal epidural hematoma located ventrally in the cervical spine at the cervicomedullary junction level and concomitant infarction at the pontomedullary junction resulting from whiplash injury.- - - - - - - - - - ranking = 0.20731317488578keywords = injury, trauma, brain (Clic here for more details about this article) |
9/75. Case study: acceleration/deceleration injury with angular kyphosis.OBJECTIVE: To discuss the case of a patient who received upper cervical chiropractic care after trauma-induced arcual kyphosis in the cervical spine. A practical application of conservative management for posttrauma cervical spine injury in the private office setting is described. Clinical Features: A 17-year-old female patient suffered an unstable C3/C4 motor segment after a lateral-impact motor vehicle collision. Additional symptoms on presentation included vertigo, tinnitus, neck and shoulder pain, and confusion. Intervention and Outcome: Conservative management consisted exclusively of upper cervical-specific adjustments guided by radiographic analysis and paraspinal bilateral skin temperature differential analysis of the cervical spine. During 10 weeks of care and 22 office visits, all symptoms subsided and the instability of C3/C4 motor segment appeared to be completely resolved. CONCLUSION: This study provides support for the use of upper cervical chiropractic management in cervical spine trauma cases. The clinical work-up consisted of physical examination, radiographic analysis, computer-administered and scored cognitive function testing, and audiometric examination. After conservative care, these examinations were repeated and demonstrated that the objective findings concurred with the subjective improvements reported by the patient.- - - - - - - - - - ranking = 1.0018315609148keywords = injury, trauma (Clic here for more details about this article) |
10/75. Bilateral vocal cord paralysis after anterior cervical discoidectomy and fusion in a case of whiplash cervical spine injury: a case report.BACKGROUND: Bilateral vocal cord paralysis is a risk of anterior cervical discoidectomy and fusion. We discuss the mechanism of vocal cord paralysis and the precautions necessary to avoid this catastrophic complication. A rare case of bilateral vocal cord paralysis after anterior cervical discoidectomy and fusion (ACD/F) is reported. CASE DESCRIPTION: The patient, a 37-year-old male, was paraplegic, had bilateral intrinsic hand muscle weakness and sphincter involvement following a whiplash cervical spinal injury. A C5-C6 ACD/F for traumatic C5-C6 disc prolapse was performed. On the third postoperative day, he developed difficulty in coughing and a husky voice. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy that partially alleviated his major symptoms. CONCLUSION: In patients undergoing ACD/F, a mandatory preoperative evaluation of the vocal cords should be performed. An appropriate modification in surgical planning should be made if vocal cord palsy is diagnosed preoperatively to prevent bilateral vocal cord paralysis. Proper and judicious use of Cloward retractors is advocated.- - - - - - - - - - ranking = 1.0006105203049keywords = injury, trauma (Clic here for more details about this article) |
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