1/11. The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings.OBJECTIVE: The aim of this study was to demonstrate the usefulness of cerebral MRI to detect possible child abuse in children with unexplained neurologic findings. METHOD: Between 1990 and 1997, 208 children were referred for suspected physical child abuse to the Child Protection Clinic of Ste-Justine Hospital, a tertiary care pediatric hospital. Among them, 39 children presented initially with neurological findings. For 27 of them, the CT Scan results prompted the diagnosis of child abuse. However, in 12 children, even if a CT-Scan was performed, the diagnosis and/or the mechanisms of the neurologic distress remained obscure. Investigation was completed with MRI study in those 12 cases. RESULTS: MRI findings were diagnostic for physical abuse in eight cases. A diagnosis of child abuse was made in two more cases by a combination of MRI and skeletal survey findings. In one case, MRI was suggestive but the diagnosis of child abuse could not be confirmed. One case was misinterpreted as normal. CONCLUSIONS: MRI is the test of choice to rule out child abuse when faced with a child presenting unexplained neurologic signs lasting for few days. The fact that MRI can better differentiate collections of different ages makes this imaging test particularly useful in identifying cases of child abuse. These results, however, always have to be integrated in a well conducted multidisciplinary clinical approach.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. New-onset psychogenic seizures after intracranial neurosurgery.BACKGROUND: patients with physical brain abnormalities have an increased risk of developing psychogenic nonepileptic seizures (PNES). Here we describe patients who developed PNES after intracranial neurosurgery for indications other than the control of refractory epileptic seizures and explore whether neurosurgical intervention is at risk factor for PNES. METHOD: We searched the database of 372 patients diagnosed with PNES at our department over the last 10 years and identified 17 patients (4.6%) in whom PNES first started after intracranial neurosurgery. Surgical procedures included the complete or partial resection of a meningioma, AV malformation, cavernoma, plexus papilloma, neurinoma, astrocytoma, oligodendroglioma, dysontogenetic cyst, the drainage of a brain abscess and removal of a subdural hematoma. PNES were documented by ictal video-EEG, ictal EEG, or ictal observation and examination in all cases. The diagnosis of additional epileptic seizures were confirmed by ictal EEG/video-EEG, or made on the basis of a clinical assessment by an experienced epileptologist. FINDINGS: Five patients had purely psychogenic postoperative seizure disorders, twelve had epileptic and psychogenic attacks. Median age at neurosurgery was 32 years (range 5-54), median latency between surgery and onset of PNES was 1 year (range 0-17 years). INTERPRETATION: PNES may develop after intracranial neurosurgery undertaken for other indications than the control of refractory epileptic seizures. Younger patients with a history of pre-operative psychiatric problems or epileptic seizures and surgical complications may be at higher risk. A diagnosis of PNES should be considered in patients who develop refractory seizures after neurosurgery.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/11. Transdural metastasis from adenocarcinoma of the prostate mimicking subdural hematoma: case report.BACKGROUND: Metastasis of prostatic adenocarcinoma to the nervous system is extremely rare and has been infrequently reported over the last several years. We describe the presentation, evaluation, and surgical intervention of a case of metastatic prostate carcinoma to the dura. CASE DESCRIPTION: This patient presented with symptoms and physical findings consistent with a subacute subdural hematoma in the setting of recently diagnosed adenocarcinoma of the prostate. He underwent a craniotomy for presumed subdural hematoma. The pathologic diagnosis was consistent with metastatic prostatic carcinoma. CONCLUSION: This case report demonstrates the need for broad differential diagnosis in the evaluation and treatment of patients presenting with seemingly straightforward subacute subdural hematomas.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/11. Minor head injury.The evaluation and treatment of minor head injuries are reviewed, with particular emphasis on those problems of head injury commonly seen by family physicians. Clinical history, physical examination, and radiologic studies that are of value in diagnosing minor head injuries are highlighted.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/11. Hemorrhagic retinopathy in infancy: a clinicopathologic report.The clinical and pathological findings of an infant with severe, bilateral hemorrhagic retinopathy and unilateral retinal detachment are presented. acceleration-deceleration forces may have caused the ocular damage in the absence of significant direct trauma to the head or eyes. This mechanism may account for injuries inflicted by physical child abuse, but without the usual associated findings of this syndrome.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/11. New observations in scintigraphy of subdural and extradural hematomas.Static radionuclide images of subacute subdural hematomas demonstrate significant variations in findings over a 3-hr period in the same patient. The lesion can appear, disappear, and reconstitute in an entirely different pattern. This transformation has not appeared in extradural hematomas, and may provide a differential diagnostic sign. In patients with a clinical history or physical findings suspicious for these intracranial hematomas, immediate and sequential delayed static imaging is recommended.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/11. Unsuspected subdural hematoma as a differential diagnosis in elderly patients.Subdural hematomas are among the most common forms of intracranial hemorrhage encountered in clinical practice and are a surgically remediable cause of dementia. When the symptom presentation is subtle or diffuse, a subdural hematoma can be overlooked. This is especially true among elderly people who may exhibit unrelated, preexisting dementia or delirium. Particularly confusing is that such declines in intellectual capacity can also result from subdural hematoma. It is therefore essential that a thorough physical and neurologic assessment be done on all patients with cognitive deficiencies. This always includes brain imaging. Early recognition of a subdural hematoma is important, given its treatability and potential reversibility. We describe an elderly woman with new-onset cognitive deficit and gait dyspraxia. There was no evidence of trauma. physical examination was otherwise unremarkable. Initially, she refused evaluation, but once a subdural hematoma was identified by a tomographic scan, a satisfactory outcome followed surgical intervention.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/11. A case of interhemispheric subdural hematoma.The interhemispheric subdural hematoma is a rare condition. We present a case of interhemispheric subdural hematoma in a patient aged 65 years. A day prior to admission he was struck with a water-pipe on the head. He went to sleep the same evening complaining of a slight headache. At about two o'clock in the morning the headache increased in intensity. By the morning he lost consciousness. On examination by a neurosurgeon the patient was found to be comatose. The physical examination revealed blue eyelids of the left eye, paraplegia of the right leg, paresis of the left leg and arms. Bilateral Babinski's reflex was present, the abdominal reflexes were absent, the tendon and periosteal reflexes were hyperactive. The pupils were equal in size and slowly reactive to light. The patient exhibited symptoms of meningoradicular irritation. An emergency CT scan revealed high-density area in the interhemispheric sulcus extending frontally to parietally. The patients was operated on in an emergency. At operation, extensive rupture of the sagittal sinus was identified. Later the patient died. The presented case was interesting with the extensive rupture of the sagittal sinus and the relatively long lucid interval until clear manifestation of the clinical picture becomes evident.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
9/11. shaken baby syndrome: identification and prevention for nurse practitioners.shaken baby syndrome is a less widely recognized form of physical child abuse. It is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma; often identifying shaken baby syndrome is difficult because of the lack of obvious external signs. shaken baby syndrome should be considered in infants with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, respiratory irregularities, coma, or death. With the increased awareness of child abuse, more attention has been focused on morbidity and death caused by the violent shaking of infants. This article describes the clinical findings of shaken baby syndrome, explores the characteristics of families at risk for abuse, and discusses implications for nurse practitioners.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/11. Nutrition management in a pregnant comatose patient.Major intracranial injury or disease during pregnancy resulting in a comatose state presents unique and complex management challenges. Our patient is a 34-year-old woman who suffered a closed-head injury associated with spousal abuse at 22 weeks' gestation. This injury resulted in a large right frontoparietal hematoma that was subsequently evacuated via a right frontotemporal craniotomy 5 days after the injury. She remained in a vegetative state postoperatively. Aggressive nutrition support was provided with enteral feedings through a nasoduodenal feeding tube. Mild oligohydramnios was detected at 30 weeks' gestation and was subsequently determined to be due to preterm premature rupture of membranes. She was managed until 33 weeks' gestation, when signs of chorioamnionitis were noted. She then underwent a primary cesarean delivery and was delivered of an appropriate-for-gestational-age 2150-g viable male infant. The patient had progressive improvement in her mental status with occupational and physical therapy and was discharged on the 29th postpartum day. This case presents the nutrition and medical challenges of maintaining adequate maternal and fetal health in a pregnant comatose patient.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
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