11/75. Roller coaster migraine: an underreported injury?A 28-year-old woman presented with severe headache, sleep problems, memory problems, and irritability 2 months after a violent roller coaster ride. She was diagnosed with posttraumatic migraine, and intravenous dihydroergotamine resolved her symptoms. Imaging studies, electroencephalogram, and visual and auditory evoked responses were normal. imipramine, divalproex sodium, and propranolol were prescribed to prevent the headaches from recurring and dihydroergotamine nasal spray was prescribed for breakthrough headaches. We consider the many short but significant brain insults delivered during the roller coaster ride a critical factor in triggering this instance of posttraumatic migraine, which while unmanaged was a source of significant disability for the patient.- - - - - - - - - - ranking = 1keywords = injury, trauma, brain (Clic here for more details about this article) |
12/75. Post-traumatic pseudoaneurysm of the common carotid artery. Importance of echo-Doppler evaluation of the intimal damage.Nonpenetrating traumas of the extracranial carotid artery are uncommon and frequently involve the carotid bifurcation. We report a case of asymptomatic post-traumatic pseudoaneurysm of the common carotid artery in a 32-year-old woman, detected by chance 12 years after a cervical injury. Of all the investigations, only echo-Doppler permitted the detection of an intimal tear at the level of the aneurysmatic dilatation. After aneurysmectomy, 8 mm PTFE graft replacement was carried out. We believe that routine use of echo-Doppler ultrasonography in all asymptomatic patients with a definite history of contusive cervical trauma should be recommended. In our opinion, the absolute surgical indication resulted from the local and neurological complications potentially stemming from the pseudoaneurysmatic dilatation.- - - - - - - - - - ranking = 0.25476017893635keywords = injury, trauma (Clic here for more details about this article) |
13/75. Traumatic bilateral ECCA injury in a roller coaster enthusiast.Vascular and trauma surgeons have seen a marked increase in the incidence of traumatic injury of the ECCA. Making the diagnosis is straightforward, but requires a high index of suspicion. This patient's injury is from hyperextension/flexion trauma that occurred from repetitive rides on roller coasters.- - - - - - - - - - ranking = 1.4988660324002keywords = injury, trauma (Clic here for more details about this article) |
14/75. ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.OBJECTIVE: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy. methods: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer. In addition, we performed ultrasonography in 3 cadaveric specimens to show the feasibility of detecting the accessory nerve. RESULT: Nerve transection (n = 2), scar tissue (n = 1), and atrophy of the trapezius muscle (n = 4) were confirmed by electroneurographic testing and surgical nerve inspection. In 1 case in which a patient had a whiplash injury with accessory nerve palsy, ultrasonography showed atrophy of the trapezius muscle with a normal nerve appearance. CONCLUSIONS: ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy.- - - - - - - - - - ranking = 0.24943029974339keywords = injury (Clic here for more details about this article) |
15/75. Acute peripheral vestibular deficits after whiplash injuries.We report 3 patients who had acute peripheral vestibular dysfunction minutes to hours after a car collision with whiplash injury without head trauma. The accident was a frontal collision in 1 case, a rear impact in the second, and lateral in the third. All patients complained immediately of cervicalgia, headache, acute vertigo with a sensation of erroneous body movements, and slipping of image with head movements. A sudden sensation of tilting of the environment when driving, tinnitus, and hyperacusis were also described. The otoneurologic findings showed bilateral canalolithiasis in 1 patient and an acute peripheral vestibular deficit in 2 patients. Tilt of the subjective visual vertical was measured in all patients. Cerebral magnetic resonance imaging yielded normal findings. As angular and linear accelerometers, the vestibular organs are directly exposed to high forces generated by whiplash mechanisms. vertigo generated by peripheral vestibular lesions is probably underestimated in whiplash injuries and may often be incorrectly attributed to cervical or cerebral lesions.- - - - - - - - - - ranking = 0.25019171105667keywords = injury, trauma (Clic here for more details about this article) |
16/75. Esophageal disruption from blunt and penetrating external trauma.Eleven patients suffered esophageal perforations from external trauma. This series includes the first report of esophageal perforation that resulted from a cervical flexion-hyperextension injury. The other ten patient had penetrating trauma. Early signs were subtle. Small amounts of mediastinal and cervical air tended to be overlooked or erroneously attributed to other causes, such as associated pneumothorax. Once suspected, the possibility of esophageal disruption was not always pursued with optimum vigor. There was undue reliance on contrast media radiography. There were two patients with falsely normal esophagograms. All patients healed well when treated witreatment of choice.- - - - - - - - - - ranking = 0.25399876762307keywords = injury, trauma (Clic here for more details about this article) |
17/75. Functional recovery after near complete traumatic deficit of the cervical cord lasting more than 24 h.Two young men presented with a complete cervical cord deficit associated with bilateral C4-C5 dislocation and 11 mm encroachment (sagittal narrowing) of the spinal canal in one case and near complete cervical cord deficit due to a crush fracture of the C7 vertebral body with 9 mm axial compression and 50% antero-posterior encroachment of the canal in the other case. There was no improvement within the first 24 h. Both patients left the hospital walking after open surgical realignment and complete cord decompression.- - - - - - - - - - ranking = 0.0030456452531231keywords = trauma (Clic here for more details about this article) |
18/75. Primary traumatic benign midbrain haematoma in hyperextension injuries of the head.Primary traumatic brain stem injury occurring in isolation is not universally recognized as a distinct pathological entity which may follow a head injury. We describe two patients with clinical and radiological evidence of primary posttraumatic midbrain haemorrhage occurring in isolation associated with good recoveries. It is suggested that paramedian midbrain syndromes associated with midbrain haemorrhages should be recognized as a distinct, although unusual, complication of hyperextension injury to the head which may have a benign course.- - - - - - - - - - ranking = 0.78276301967522keywords = injury, traumatic brain, trauma, brain (Clic here for more details about this article) |
19/75. Isolated amnesia following a bilateral paramedian thalamic infarct. Possible etiologic role of a whiplash injury.A previously healthy 45 years old carpenter suffered a whiplash injury in a road accident on July, 18th, 1990. He continued to work in spite of occipital headache, episodic sweatening and slight hypersomnia. On August, 8th, 1990 while parking his car into the deck of a ferry-boat he was found slightly confuse and markedly amnestic. A post-traumatic subdural haematoma was suspected. As a CT-scan of the brain was normal, a toxic encephalopathy or an hysterical amnesia were proposed. However, a MRI performed on August, 22th, 1990, apart from a small infarct in the white matter of the left occipital lobe, showed two small bilateral paramedian thalamic infarcts. The last lesions usually follow a thrombotic or embolic occlusion of the "basilar communicating artery" (BCA) belonging to the vertebro-basilar system. The possible etiologic relationship between this syndrome and the previous whiplash injury has been considered. Six months later, while a control MRI showed a reduction of the brain lesions, a neuropsychological examination revealed a slight improvement of memory dysfunction evident also at a distance of further 6 months. This case is interesting because it tests the high sensitivity of MRI in amnestic syndromes and because of the possible role of a whiplash injury in the etiology of BPTI.- - - - - - - - - - ranking = 1.7482854663168keywords = injury, trauma, brain (Clic here for more details about this article) |
20/75. MRI-pathological correlations in acute traumatic central cord syndrome: case report.Ante- and post-mortem MRI and detailed pathological examination were performed in a patient with a typical acute traumatic central cord syndrome (ATCCS) after a minor hyperextension injury to the neck who died 60 h later from heart failure. T2-weighted MRI showed a central hyperintense area at C3-4. There were disc protrusions, but no vertebral fracture or displacement. Histopathology disclosed severe axonal swelling and oedema in the dorsolateral fasciculi and, to a lesser degree, in the dorsal columns. In addition, an area of recent necrosis was found in the right anterior horn at C4-5. These findings suggest that the pathological hallmark of typical ATCCS is mechanical axonal disruption at a segmental level, but that more severe trauma may be accompanied by tissue destruction.- - - - - - - - - - ranking = 0.25399876762307keywords = injury, trauma (Clic here for more details about this article) |
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