1/24. Traumatic dissection of the common carotid artery after blunt injury to the neck.BACKGROUND: Occlusive lesions of the common carotid artery (CCA) resulting from blunt injury are extremely rare, and their clinicopathologic and therapeutic features have not yet been clarified. OBJECTIVES AND RESULTS: Five patients with occlusive lesions of the CCA developed neurologic deficits at 1.5 hours to 10 years after blunt neck injury. Lesions included two complete occlusions, one severe stenosis, and two segmental intimal dissections of the CCA. In the two patients with CCA occlusion, bypass surgery was performed using a Dacron graft between the ipsilateral subclavian artery and the carotid bifurcation. In the remaining three patients, the involved segments were replaced with a Dacron graft. Surgical specimens from the early posttraumatic period revealed intimal tears with mural thrombosis and/or subintimal hematomas and those from the later period showed myointimal hyperplasia or fibrotic organization. CONCLUSION: Traumatic occlusive lesions of the CCA tend to evolve from intimal dissections to severe stenoses or occlusion, compromising cerebral circulation. The involved CCA can be diagnosed early by B-mode Doppler sonography and successfully reconstructed using a Dacron graft.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/24. Delayed post-traumatic cervical instability.BACKGROUND: Cervical spine instability is a clinical entity whose biomechanical and radiological features have been widely discussed by many authors. On the other hand, the subject of delayed post-traumatic cervical instability is often surrounded by confusion due to its difficult nosologic framing; the aim of this study is to contribute to the matter. methods: A cooperative study was organized by the Study Group for Spinal Surgery of the Italian Society of neurosurgery to evaluate cervical trauma patients surgically treated more than 20 days after the traumatic event. From a total number of 172 patients, twenty-five were admitted to the study, because neuroradiological investigations performed during the acute phase had shown either an absence of traumatic lesions or only minimal lesions judged to be stable. For this reason these 25 patients had not been treated by either surgery or immobilization in a halo vest. Some time after trauma, this group of patients clearly demonstrated evidence of unstable lesions requiring surgical treatment, following the appearance of new clinical signs or on neuroradiological follow-up. RESULTS: Re-examination of the neuroradiological investigations performed during the acute phase made it possible to identify elements that might have led us to suspect the presence of ligamental lesions: microfractures, dislocations less than 3 mm, and inversion of physiological lordosis. CONCLUSIONS: This review clearly indicates that patients with even mild cervical trauma must be scrupulously evaluated during the acute phase and that in some cases it is advisable to perform a more detailed neuroradiological investigation.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/24. Latissimus dorsi myocutaneous flap reconstruction of neck and axillary burn contractures.Neck and axillary burn contractures are both a devastating functional and cosmetic deformity for patients and a challenging problem for reconstructive surgeons. Severe contractures are more commonly seen in the developing world, a result of both the widespread use of open fires and the inadequacy of primary and secondary burn care in these vicinities. When deep burns are allowed to heal spontaneously, patients develop hypertrophic scarring of the neck and axillary areas. The back is typically spared, however, remaining a suitable donor site. We have used nine latissimus dorsi myocutaneous flaps in a total of six patients, finding the flaps effective in resurfacing both the neck and the axillary regions after wide release of burn contractures. Before flap mobilization, surgical neck release is often necessary to ensure safe, effective control of the airway in patients with significant neck contractures. Flap bulkiness in the anterior neck region can eventually be reduced by dividing the thoracodorsal nerve. Anchoring the skin paddle to its recipient site through the placement of tacking sutures will also help achieve a more normal anterior neck contour.- - - - - - - - - - ranking = 14.080028823478keywords = nerve (Clic here for more details about this article) |
4/24. Cervicogenic headache: long-term postoperative follow-up.The patient, a 50-year old female had been suffering from right-sided head- and neck pain since she was 31 years of age. It started in connection with an indirect neck trauma. analgesics were of little or no avail and operative procedures, including liberation of the greater occipital nerve (GON) (n = 2) and decompression of the C2 ganglion/root, had only a transitory effect. At 42, a magnetic resonance scan of the cervical spine demonstrated a degenerated disk C5-C6, with encroachment on the foramina and the cord. At 42 years of age, a stabilization operation at C5-C6 (Robinson-Smith) alleviated her discomfort--only some motor complaints in the ipsilateral upper extremity remaining and only in the first 12-18 months.- - - - - - - - - - ranking = 14.080028823478keywords = nerve (Clic here for more details about this article) |
5/24. Blunt carotid artery injury after accidental neck compression: report of a case.Almost all cases of carotid artery injury are precipitated by a high-energy impact such as motor vehicle accidents or gunshot wounds, and are usually diagnosed using angiography. We report herein a case of carotid artery injury induced by a low-energy insult with rare clinical signs which was diagnosed using ultrasonography as well as angiography. A 37-year-old man sustained an accidental compression of the neck and was transferred to our emergency room. Horner's syndrome and phrenic nerve palsy were detected on the left side. ultrasonography demonstrated two sites of injury with an intimal flap of the distal left common carotid artery as well as angiography. The patient was placed on anticoagulants and was discharged on the 10th hospital day with both Horner's syndrome and phrenic nerve palsy. This case suggests that surgeons should investigate any possible carotid artery injury, even after low-velocity injuries such as compression of the neck, and therefore an ultrasonic examination should be performed at the initial evaluation and at follow-up studies. In addition, further investigations are also called for to investigate the utility of anticoagulation in the treatment of carotid artery injury.- - - - - - - - - - ranking = 28.160057646956keywords = nerve (Clic here for more details about this article) |
6/24. neck pain after minor neck trauma--is it always neck sprain?We report a patient who had headache and neck pain after whiplash injury and subsequently developed cerebellar infarction due to vertebral artery dissection. This patient's pain was out of proportion to his apparent injury and it was a clue to the final diagnosis. Gross motor examination for cord injury may not be adequate for patients with minor neck trauma. Detailed cranial nerve and cerebellar examination should be performed for detection of circulatory insufficiency. Discharge advice for patients should also include that of stroke or transient ischaemic attack.- - - - - - - - - - ranking = 14.080028823478keywords = nerve (Clic here for more details about this article) |
7/24. Peripheral mechanisms in tremor after traumatic neck injury.tremor is a rare manifestation after neck injury, and its physiological mechanism has not been elucidated. We studied the effects of torque loading and ischaemic nerve block on coarse postural tremor in the right upper extremity, which had developed in association with a C7-C8 radiculopathy after traumatic neck injury in a 55 year old man. Loading reduced the tremor frequency from 6.1 Hz to 4.2 Hz with corresponding electromyography (EMG) bursts at the same frequencies as the tremor. Ischaemic nerve block also reduced the tremor frequency from 6.2 Hz to 2.8 Hz, and the time course of the frequency was not in parallel with that of the size of the maximal M wave. A significant reduction of the tremor frequency by loading and ischaemic nerve block indicates a mechanical reflex mechanism underlying the tremor, and association of synchronous EMG bursts suggests an increase in gain in the stretch reflex loop. The stretch reflex loop plays an important role in generation of oscillation in tremor after neck injury.- - - - - - - - - - ranking = 42.240086470434keywords = nerve (Clic here for more details about this article) |
8/24. survival with intact cerebral function after gunshot injury to both internal carotid arteries.A 24-year-old man was admitted after sustaining a single gunshot wound to the neck with an expanding hematoma on the left. Computed tomography angiography demonstrated bilateral internal carotid artery pseudoaneurysms, with disruption of flow on the left and a carotid-jugular fistula on the right. At operation, transection of the left internal carotid artery necessitated ligation of the artery. No injuries to the trachea or larynx were found, but the pharynx was lacerated and was repaired. The patient was transferred to the angiography suite where a stent graft was placed in the right internal carotid artery. This served to close the pseudoaneurysm and the arteriovenous fistula while preserving distal flow. The patient recovered with intact cerebral function and with mild paresis of the tongue related to hypoglossal nerve injury. He was discharged home after 7 days.- - - - - - - - - - ranking = 14.080028823478keywords = nerve (Clic here for more details about this article) |
9/24. Penetrating zone II neck injury by broken windshield.All penetrating neck wounds are potentially dangerous and require emergency treatment because there are important vessels, nerves and organs in the neck. We present the case of a patient who had an unusual penetrating neck injury caused by a broken windshield, noticed accidentally. Because fragments of windshield glass consist of sharp material, and the neck contains vital structures, such penetrating neck injury may cause life-threatening complications. Radiological examinations should be offered before the management of all neck wounds. The risk of retained foreign bodies and related complications can be prevented by using fluoroscopy during surgical exploration of the neck.- - - - - - - - - - ranking = 15.080028823478keywords = nerve, organ (Clic here for more details about this article) |
10/24. Unusual form of accidental mechanical asphyxia.This brief case report shows an unusual form of accidental atypical strangulation. A 46-year-old male became trapped between the rims of an automatically closing door during his hopeless effort to enter a supermarket at night. The victim's neck was violently pressed by the edges of the automatic door. From external observation we found an incomplete ligature mark and numerous small abrasions in the neck. On autopsy we found typical signs of asphyxia and fractures of the hyoid-laryngeal complex and bruising of the soft tissues of the neck. The subsequent toxicology was negative with the exception of alcohol level. We came to the common conclusion of a double form of mechanical asphyxia - atypical violent strangulation and atypical hanging. The third highly likely contributory factor of death was direct stimulation of the baroreceptor nerve endings in the left carotid sinus and left carotid sheath. In recent literature, there have been presented only a few cases describing this manner of asphyxia and death.- - - - - - - - - - ranking = 14.080028823478keywords = nerve (Clic here for more details about this article) |
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