1/128. Post-traumatic pituitary apoplexy--two case reports.A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. Skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/128. acinetobacter meningitis: four nosocomial cases.We report the clinical features and therapeutic outcomes of four patients with multiantibiotic-resistant acinetobacter meningitis. There were three males and one female, aged from 17 to 49 years. Three of them had suffered from head injuries with skull fractures, and the other suffered from an intracerebral hemorrhage and underwent a craniotomy. All four patients acquired nosocomial acinetobacter meningitis, and multiantibiotic resistance developed. After treatment with imipenem/cilastatin, three of the four patients survived; one died of multiorgan failure. Because the clinical manifestations of acinetobacter meningitis are similar to those of other gram-negative bacillary meningitis, the diagnosis can only be confirmed by bacterial culture. Resistance to multiple antibiotics, including third-generation cephalosporins, is frequently seen in patients with nosocomial acinetobacter meningitis, and imipenem/cilastatin seems to be the antibiotic of choice for this potentially fatal central nervous system infection.- - - - - - - - - - ranking = 0.048045734016485keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/128. Recurrent bacterial meningitis: report of two cases from Riyadh, saudi arabia.We report two cases of recurrent bacterial meningitis after head injury in two Saudi boys. The brain CT scan showed bony defects in both despite normal otolaryngeal clinical findings. One child remained well after surgical repair but the other was lost to follow-up.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
4/128. Head injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors.INTRODUCTION: Following head injury complex pathophysiological changes occur in brain metabolism. The objective of the study was to monitor brain metabolism using the Paratrend multiparameter sensor and microdialysis catheters. patients, MATERIAL AND methods: Following approval by the Local ethics Committee and consent from the relatives, patients with severe head injury were studied using a triple bolt inserted into the frontal region, transmitting an intracranial pressure monitor, microdialysis (10 mm or 30 mm membrane; glucose, lactate, pyruvate, glutamate) catheter and Paratrend multiparameter (oxygen, carbon dioxide, pH and temperature) sensor. A Paratrend sensor was also inserted into the femoral artery for continuous blood gas analysis. RESULTS: 21 patients were studied with cerebral microdialysis for a total of 91 monitoring days (range 19 hours to 12 days). Of these, 14 patients were also studied with cerebral and arterial Paratrend sensors. The mean ( /- 95% confidence intervals) arterial and cerebral oxygen levels were 123 /- 10.9 mmHg and 27.9 /- 5.71 mmHg respectively. The arterial and cerebral carbon dioxide levels were 34.3 /- 2.35 mmHg and 45.3 /- 3.07 mmHg respectively. Episodes of systemic hypoxia and hypotension resulting in falls in cerebral oxygen and rises in cerebral carbon dioxide were rapidly detected by the arterial and cerebral Paratrend sensors. Systemic pyrexia was reflected in the brain with the cerebral Paratrend sensor reading 0.17 degree C (mean) higher than the arterial sensor. Elevations of cerebral glucose were detected, but the overall cerebral glucose was low (mean 1.57 /- 0.53 mM 10 mm membrane; mean 1.95 /- 0.68 mM 30 mm membrane) with periods of undetectable glucose in 6 patients. Lactate concentrations (mean 5.08 /- 0.73 mM 10 mm membrane; mean 8.27 /- 1.31 mM 30 mm membrane) were higher than glucose concentrations in all patients. The lactate/pyruvate ratio was 32.1 /- 5.16 for the 10 mm membrane and 30.6 /- 2.17 for the 30 mm membrane. Glutamate concentrations varied between patients (mean 15.0 /- 10.5 microM 10 mm membrane; mean 28.8 /- 17.8 microM 30 mm membrane). CONCLUSION: The combination of microdialysis catheters and Paratrend sensors enabling the monitoring of substrate delivery and brain metabolism, and the detection of secondary metabolic insults has the potential to assist in the management of head-injured patients.- - - - - - - - - - ranking = 4keywords = brain (Clic here for more details about this article) |
5/128. Traumatic occipital condyle fractures.Trauma to the brain or calvaria may cause some cranial nerve damage. This may be transitory or permanent. Occipital condyle fracture (OCF) is a rarely encountered pathology not easily diagnosed by routine clinical and radiological evaluation and one of the causes of lower cranial nerve disability. Frequently, the hypoglossal nerve is involved. Here we present two cases of OCF caused by motor vehicle accidents. Both of the patients complained of dysphagia and voice disturbance. After detailed neurologic and radiologic evaluation, they were diagnosed with OCF. They were both treated conservatively. OCF as a cause of lower cranial nerve damage is rarely reported. Since it is hard to diagnose OCF by routine cranial and cervical evaluation, detailed radiological study in suspected cases is a must. Since one of our patients was admitted 6 years after the trauma, this article is also noteworthy as a report on radiological changes of the OCF.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
6/128. Multiple growing fractures and cerebral venous anomaly after penetrating injuries: delayed diagnosis in a battered child.A growing fracture usually results from a skull fracture with dural tear after blunt head trauma during infancy. We present a case of child abuse with multiple growing fractures resulting from penetrating head trauma by scissors. MR imaging confirmed the presence of growing fractures and revealed a presumably post-traumatic venous anomaly (occluded left cavernous sinus and aberrant posterior venous drainage via the internal cerebral veins). Diagnosis of the growing fractures and venous anomaly was delayed until the age of 15 years. Medical expertise should be more readily available to battered children, and MR imaging is advocated in growing skull fracture to exclude associated post-traumatic brain lesions.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
7/128. titanium mesh repair of the severely comminuted frontal sinus fracture.BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. methods: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
8/128. A high-speed hydroplane accident.This report records the investigation into a high-speed hydroplane accident in which the driver died. He was ejected head first into the water at 117 to 126 ft/sec (80 to 85 mph), suffering brain damage and a fractured skull. Suggestions are made to minimize the effects of these inevitable crashes.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
9/128. The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma.Computed tomography (CT) has revolutionized the diagnosis and management of head-injured patients, and its increasing availability has led to its liberal use. CT scanning provides excellent anatomic detail of the brain as fixed static images, but the dynamic nature of human physiology means that many injury patterns will evolve in time. We describe an 8-year-old child who had fallen 8 feet from a tree. He had a brief loss of consciousness but a normal neurologic evaluation on arrival to the emergency department (ED). He underwent expedited cranial CT scanning, which revealed no acute brain injury. Two and one half hours later, the patient had a mild depression in consciousness, prompting a second CT scan in the ED, which revealed an acute epidural hematoma. He had acute surgical evacuation of the hematoma and made a full neurologic recovery. This case illustrates that a single early CT examination may at times provide a false sense of security and underscores the importance of serial neurologic examinations.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
10/128. An interesting case of arterial trauma after craniocerebral injury.A 63-year-old drunken man fell and hit his head on the ground. Apart from symptoms of alcoholisation no signs of severe injuries were found. The man died 2 1/2 days after the accident. The autopsy revealed a huge fracture system in the right parietal region. A branch of the medial cerebral artery was stretched between the cortex and one of the fracture lines, passing through a tear in the dura. Characteristics of this case were that no larger hemorrhage was found and the artery which was torn from the cortex showed no lesions. The case also indicates the immense relative movements between skull and brain which occur during such trauma.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
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