Computed tomography findings in patients with mild head trauma

To determine the frequency of computed tomography [CT] findings in patients with mild head trauma. In this cross-sectional study conducted between September 2005 and April 2006, 708 patients with mild head trauma as defined by a Glasgow Coma Score [GCS] of 13-15, were underwent standard clinical examination and cranial CT. The mean +/- SD age of our patients was 26.8 +/- 19.03 years [range: 1 month to 89 years]. 489 [68.9%] patients were male and 219 [30.8%] were female. GSC was 13 in 1%, 14 in 4.6% and 15 in 94.4% of patients. The most common mechanism of trauma was car accident and falling down, each of which happened for 132 patients [18.6%].The most common findings on CT were subgaleal hematomas in 213[30%] and intracranial lesions were seen in 41 patients[5.8%] ;among them 37 were male. Among intracranial lesions, the most common finding was epidural hematoma in 18 patients followed by hemorrhagic contusion in 13 patients. Intracranial lesions were observed in 28.6% of patients with GCS of 13; in 15.2% with GCS of 14 and in 5.1% with GCS of 15 [P=0.002]. Many of patients with GCS equal to 15 after head trauma have considerable intracranial lesions and minor focal neurologic signs revealed by careful physical examination could be a good marker of these lesions

Cervical spondyloticmyelopathy: the pattern of neurologic deficits and improvement following anterior cervical decompression

We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy [CSM] to determine findings which had a predictive value for surgical outcome. Consecutive patients with CSM caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in Loghman Hakim Hospital from 1999-2003 were prospectively enrolled. Patients were evaluated postoperatively by office visit. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. Forty - three patients [30 male, 13 female] with a mean age of 48.8 years fulfilled our inclusion criteria. The most common preoperative symptoms were sensory deficit in distal upper limbs [88.4%], gait disturbance [69.8%] and sensory deficit of distal lower limbs [58.1%]. The most common signs were hyperreflexia [95.3%], Hoffman's sign [93%] and Babinski's sign [83.7%]. Vertebral osteophyte and soft disc herniation were found in 86% and 14% of the patients, respectively. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale was noted in 79.7% of the patients who had an abnormal scale preoperatively. Strength improved considerably and significantly after operation. However, less than half of the patients experienced functional improvement in the lower limbs, a discrepancy that was probably caused by persistent spasticity. Atrophy of the hand muscles, preoperative spastic gait and cord atrophy as shown in MRI were poor prognostic factors