ABSTRACT
Minor head injury is the most common type of head injury. Despite its high prevalence and a lot of studies, there is much controversies about the management of these patients. We performed this study to find indications for brain CT scan according to clinical signs and symptoms. We did this prospective cohort study in two university hospitals [Alzahra and Kashani] for one year enrolling 682 consecutive patients with minor head injury [GCS = 15] and recording all clinical signs and symptoms to find which could be used as predictors for brain injuries. X[2] and logistic regression with 95% confidence interval were used for analysis. Of 682 patients, 46 [6.7%] had brain injuries in CT scan. All patients with abnormal CT scans had at least one of the following risk factors: post traumatic amnesia, post traumatic unconsciousness, post traumatic seizure, headache, confusion, vomiting, focal neurological deficit, skull fracture, coagulopathy or history of taking anticoagulants and age more then 60 years. We didn't find any abnormality in brain CT scan of patients who did not have any of these factors on admission. Confusion, Vomiting, skull fracture and age > 60 years had significant correlation with brain injuries. We also found those patients who had more than one risk factor had more abnormalities in CT scan. Not all patients with minor head injury need brain CT scan. Clinical factors can be used as indications for brain CT scan in these patients
Subject(s)
Humans , Male , Female , Craniocerebral Trauma/diagnosis , Tomography, X-Ray Computed , BrainABSTRACT
Background: annually, millions of people are affected by traumatic brain injuries which cause long - lasting sequels such as cognitive or motor system dysfunctions. Methylphenidate, a neurostimulant drug, has been proposed as a therapeutic agent in brain injuries. Unlike previous reports, new studies have shown more benefits from its use in traumatic brain injuries. This clinical trial was going to define the value of methylphenidate use in the treatment of traumatic brain injuries
Methods: a double blind, randomized clinical trial was implemented. 60 patients, hospitalized in Intensive Care Units, were randomly put into treatment and control groups. In the treatment group, methylphenidate was administered 5 mg daily, from day 5 to 9 of their hospitalization and 10 mg daily thereafter. Normal Saline was administered as placebo to control patients. All the patients were followed by monitoring these parameters: vital signs, Glasgow Coma Scale [GCS] and brain function. Physicians, who were responsible for patients' monitoring, did not know patients' status of drug reception [drug or placebo]
Results: during the first day GCS in the treated group was 5.43 +/-1.52 and in the control patients was 5.37+/-1.30 [P = 0.87]. After 14 days, GCS was 14 +/- 0.66 and 10.37 +/- 2.13 in treated and control patients, respectively [P < 0.05]
Conclusion: this study confirmed the results of similar recent studies done during the past 5 years. They found improved brain functions using methylphenidate in traumatic brain injuries
ABSTRACT
Background: the aim of this study is to determine sensitivity and specificity of 3D- Time-Of-Flight and Phase Contrast Magnetic resonance angiography [MRA] in comparison with intra-arterial digital subtraction angiography [IA- DSA] in detection of intracranial aneurysms
Methods: 54 patients with 22 aneurysms underwent MRA and then IA-DSA prospectively from October 2002 till December 2003
Results: MRA detected 20 aneurysm where as IA- DSA scored 22 [90.9%]. false positive in MRA was 18.1% [4 cases] and no false positive was in IA- DSA. So sensitivity of MRA in detection of intracranial aneurysms is 90.9%, and specificity is 88.8%. Positive predictive value of 83.3% and negative predictive value of 94.1% is also calculated
Conclusion: MRA is a valuable non- invasive technique in the detection of intracranial aneurysms that can be a proper screening test for this purpose