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OBJETIVO: Os autores apresentam uma série de casos de hematoma extradural da fossa posterior (HEDFP) com expansão supratentorial. MÉTODOS: O presente trabalho é retrospectivo e descritivo. Foram analisados 14 pacientes com HEDFP de apresentação mista. RESULTADOS: Dos 14 pacientes, 12 são do gênero masculino e dois, do feminino. A média das idades foi de 26,2 anos. Acidente de trânsito foi a principal causa, seguida de queda acidental e agressão física. Escore na escala de coma de Glasgow variou entre 8 e 14. Cefaleia e vômitos foram os principais achados clínicos. Exame de RX simples de crânio demonstrou traço de fratura em 80% (8/10) dos casos. Tomografia de crânio demonstrou traço de fratura e hematoma extradural mista em todos os pacientes e ressonância magnética em um caso. Cirurgia foi realizada em 12 e tratamento conservador em dois. Dois pacientes foram a óbito. CONCLUSÃO: Na presença de fratura no osso occipital, deve-se suspeitar de HEDFP de forma mista. Exames de imagens são importantes no diagnóstico e conduta.
OBJECTIVE: The authors present a case series of HEDFP with supratentorial expansion. METHODS: This study is retrospective and descriptive. We analyzed 14 patients with HEDFP presentation mixed. RESULTS: Of 14 patients, 12 males and two females. Mean age was 26.2 years. Traffic accidents were the leading cause, followed by accidental fall and assault. Score on the Glasgow coma scale ranged between 8 and 14. Headache and vomiting were the main clinical findings. Examination showed RX plain skull fracture line in 80% (8/10) of cases. Cranial CT scan showed the fracture line and epidural hematoma mixed in all patients and magnetic resonance one case. Surgery was performed in 12 and conservative in two. Two patients died. CONCLUSION: In the presence of occipital bone fracture should be suspected HEDFP mixed basis. Imaging techniques are important for diagnosis and management.
Subject(s)
Humans , Male , Female , Adult , Cranial Fossa, Posterior , Craniocerebral Trauma/surgery , Craniocerebral Trauma/therapy , Hematoma, Epidural, Cranial , Hematoma, SubduralABSTRACT
Objective To explore the clinic application value of ultrasonography examination of optic nerve sheath diameter(ONSD) in brain injury.Methods From July 2008-June 2011,90 cases of brain injured patients were chosen as experimental group including light (A group),medium (B group),and heavy (C group) brain injured patients according to the admission GCS score ;50 cases of conventional physical examination and 90 cases of volunteers 50 in neurosurgical outpatient were chosen as control group.The ONSD of both groups were measured 3 mm behind the globe through orbital using color sonographic with different time after admission.3 times measurements were carried out for every optic nerve sheath.All client's ONSD mean and standard deviation were calculated.In 0.5 h after color dopplar ultrasound examination,lumbar vertebra puncturing measured intracranial pressure in different groups.Results After admission (1d,3 d,7 d,14 d),the ONSD of A group was (4.54 ±0.32)mm,(4.42 ±0.30)mm,(4.44 ±0.32) m,and (4.43 ± 0.25) mm,respectively; The ONSD of B groups was (4.48 ± 0.28) mm,(4.52 ± 0.24) mm,(4.46 ±0.28)mm,and (4.38 ±0.22)mm,respectively; The ONSD of C group was (5.67 ±0.35)mm,(6.36 ± 0.42) mm,(5.65 ± 0.23) mm,and (4.76 ± 0.35) mm,respectively.After admission (1 d,3 d,7 d,14 d),the intracranial pressure (IP) of A group was (82 ± 11) mmH2O,(79 ± 12) mmH2O,(90 ±15) mmH2O,and (86 ± 14) mmH2O,respectively; The IP of B group was (78 ± 15) mmH2O,(85 ± 10)mmH2O,(78 ± 16) mmH2O,(80 ± 11) mmH2O,The IP of C group was (225 ± 26) mmH2 O,(288 ± 23)mmH2O,(256 ± 23) mmH2O,(122 ± 18) mmH2O,respectively.Group D had the ONSD average of (4.58± 0.41)mm and IP of (88 ± 10)mmH2O after eyeball 3-mm place.No difference was found between A and B,A and D,or B and D (P＞0.05) ; A difference was found between A and C,B and C,or D and C (t =12.24～24.67,P＜0.01).Conclusions The ONSD and IP in light medium brain injured patients had no change.In patients with severe brain injury,IP changed with the time after injury,the ONSD increased with the IP,the ultrasonography examination of ONSD with the important value in the diagnosis and treatment can respond the IP increase,which is a non-invasion,convenient,fast,and feasible method for evaluation of cranial high pressure.
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Objective To observe the energy expenditure in severe traumatic brain injury patients,and to assess the impact of cumulative energy balance on clinical outcomes.Methods Using prospective self-controlled study,the changes of energy expenditure in 56 patients with severe traumatic brain injury were measured.Daily energy intake was recorded.Afterwards,energy balance was calculated.The relationship between cumulative energy balance and clinical outcomes was analyzed.Results Mean practical energy intake of all patients was (5966 ± 1973)kJ/d,and mean negative energy balance was (822 ± 314) kJ/d.The negative energy balance was most crucial in first 3 days after administration.Meanwhile,practical energy intake was significantly lower than target energy intake [(3258±1280)kJ vs (5977±976)kJ,P ＜0.05].The practical energy intake was increased with time,and the first 14 days were crucial for development of negative energy balance.On the 7th day after administration,the level of plasma albumin was significantly lower compared with that on 3 rd [(28.0 ±5.5)g/L vs (36.5 ±4.2)g/L,P ＜0.05],and then increased gradually and returned to normal level on 28 days [(36.2 ± 3.2)g/L].Three days after administration,prealbumin[122.8 ± 18.8)mg] was significantly lower than normal level,but elevated rapidly on the 7 th day[(209.8 ±33.6) mg/L,P ＜0.05] and continuously increased till 28 th day[(281.2 ±24.3)mg/L].On the 3 rd day after administration,C-reactive protein [(135.9 ±44.4) mg/L] was significantly higher than normal level; however,it significantly decreased on the 7 th day[(110.2 ± 36.7)mg/L,P ＜0.05],and continuously decreased.Logistic regression analysis showed a strong association of cumulative negative energy balance with infection and upper gastrointestinal bleeding [odds ratio [(OR) of infection was 2.129,95 ％ confidence interval (95％ CI 1.528 to 29.886,P =0.023 ; OR of upper gastrointestinal bleeding was 0.091,95％ CI0.013 to 0.545,P =0.009].Conclusions Cumulative negative energy balance may be correlated with the occurrence of complications of patients with severe traumatic brain injury,early supply of sufficient energy may improve the outcome of patients.