Morphological Patterns of Traumatic Head Injury in Medicolegal Autopsies at Muhimbili National Hospital, Dar ESSalaam Tanzania

Introduction: Head injury is predicted to surpass many diseases as a major cause of death and disability by the year 2020. There is a limited documentations on morphological patterns of traumatic Head Injury and its prevalence specifically in Medical legal Autopsy in Tanzania population. The aim of this study was to determine the morphological patterns of Traumatic Head Injury (TBI) in Medical legal autopsies seen at Muhimbili National Hospital (MNH). Subjects and Methods : This was a hospital based cross -sectional study conducted at MNH mortuary. The postmortem examination was performed under Virchow method on 170 cases of TBI in which morphological patterns of TBI was recorded. Proportional of TBI frequencies on various morphological patterns in medical legal autopsies were recorded. Association between cause of death and etiology of TBI were established by Fisher - exact test.Results:The proportion of TBI among the medico - legal autopsy at MNH was 38.5%. All cases of TBI had scalp abrasion, and the majority had linear fra cture 67(39.3%) and the commonest the parietal bone was commonly affected 85(55.6%). In closed TBI, majority had subarachnoid hemorrhage130 (84.9%). All cases of T BI had brain edema, with one coincidental finding of metastatic adenocarcinoma. A total of 42 cases of TBI had brain herniation, 51 brain laceration and 52, had brain contusion. The association between etiology of injury, wearing helmets among motor cycle user and cause of death was statistically significance (p<0.05). Conclusion:The higher pro portion of TBI among medicolegal autopsies at MNH reflects the burden of head injury in our settings.

Prognostication in Traumatic Brain Injury- A Prospective Study of 100 Patients in Tertiary Care Hospital in Rural Area.

Traumatic brain injury is a major health issue responsible for considerable mortality and morbidity worldwide especially in subjects under the age of 40 yrs. It is important to assess and grade the TBI as soon as possible to guide management and decrease the comorbidities. Various guidelines have been issued by the neurosurgical societies to immediately assess and intervene when ever required. In this study, we have tried to assess the role of basal cisternal effacement in the management and prognosis of RTA patients, and hence tried to simplify the prognostication process and improve the patient management.METHODS100 subjects were studied who were having history of traumatic head injury. NCCT was done for all the patients using 128 slice Multidetector CT- Ingenuity (Philips Medical Systems, USA). Other parameters like pupillary reaction, GCS at the time of presentation, midline shift and associated fractures and bleed were assessed. All the patients were followed up till the time of discharge. The data so obtained was analysed.RESULTSParameters like age, pupillary reflex, GCS at presentation, associated intracranial bleed, associated cranial vault fractures and presence or absence of midline shift correlated well with the final outcome with p value consistently <0.05. We analysed that the degree of obliteration of perimesencephalic cistern was a good prognostic marker in traumatic head injury patients. 36% of patients had favourable outcome out of which none of the patients had obliterated perimesencephalic cistern or interpeduncular cisterns. 64% patients had unfavourable outcome out of which 60% and 48% had obliterated or partially obliterated perimesencephalic cisterns and interpeduncular cisterns respectively, and only 4% and 16% had normal perimesencephalic cisterns and interpeduncular cisterns respectively.CONCLUSIONSIt is important to investigate, grade and prognosticate traumatic head injury patients at the earliest. Our study and various other studies prove that various clinical predictors including age, Glasgow coma scale, and pupil reactivity correlate with outcome of patient. Presence of midline shift, intraventricular haemorrhage, and obliteration of cisterns in patients of traumatic brain injury also correlate with the outcome and can be used; thus, making the prognostication process much easier. These findings can be used on the first day of admission itself.

A study on correlation of degree of midline shift on CT scan and Glasgow coma scale in patients of acute traumatic head injury.

Background: The present study is undertaken to analyses the patients of craniocerebral injury with special reference to correlation between Glasgow coma scale score and CT scan findings at the time of admission. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. In Glasgow coma scale it was found that confident prediction could be made only after 24 hours. Results: Cerebral contusion was the most common CT scan finding followed by depressed fracture), subdural hematoma (15.3%) than extradural hematoma. Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusion: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome.

Advance in evolution and biomechanical mechanism for finite element model of human brain / 医用生物力学

Brain and neck injury has become the most severe injury during vehicle collision accident due to its high fatality rate. Finite element (FE) model has been widely used in the study on biomechanical mechanism of traumatic brain injury (TBI). In this paper, recent literatures on biomechanics of skull-brain-neck FE model were reviewed, advance in the evolution and biomechanical studies of TBI in road traffic accidents was elaborated, and protection methods of head and neck injury were explored, so as to provide a theoretical basis for biomechanical research and development of appropriate car safety devices for TBI in the event of vehicle collision accident.

Characteristics of Statistical Imaging Analysis in Morphological and Functional Brain Imaging of Neuropsychological Impairments and Nonorganic Mental Disorder after Traumatic Head Injury / The Japanese Journal of Rehabilitation Medicine

Objective : The objective of the present study was to clarify the differences in statistical imaging analysis of functional and morphologic imaging between neuropsychological impairments (NPI) and nonorganic mental disorder (MD) after traumatic head injury. Methods : Six depressive patients after head injury without abnormal findings on conventional MRI (MD group), six nondepressive patients with NPI after diffuse axonal injury (NPI group), and six healthy subjects with a history of head injury (control group) were enrolled in this study. For all subjects, ^99mTc-ethylcysteinate dimmer (Tc-ECD) SPECT and MRI 3D volumetry were performed. Imaging data were analyzed using statistical parametric mapping, and then, the analyzed data were compared among the three groups (2 sample t test, uncorrected <i>p</i><0.01). Results : Compared to the Control group, significant low Tc-ECD uptake and regional grey matter volume reduction were noticed bilaterally in the anterior medial brain aspects such as the anterior cingulate cortex in both the MD group and the NPI group. These findings were significantly greater in the NPI group than in the MD group. Moreover, these functional and morphologic abnormalities were also spread to more medial and deep aspects such as the posterior limbic and the brain stem in the NPI group. Conversely, in the MD group without morphologic abnormalities, only functional abnormalities spread above the common lesions to the dorsolateral brain aspects such as the superior frontal lobe. Conclusion : Our results revealed some characteristics of statistical imaging analysis in functional and morphologic imaging of MD and NPI patients after head injury. These findings seem to be novel and can serve as useful information for future investigation of neural correlates with both NPI and MD after head injury.

Acute Therapy for Traumatic Head Injury / The Japanese Journal of Rehabilitation Medicine

The most important factors in determining the outcomes of patients with traumatic brain injury (TBI) is the degree of severity and types of primary brain damage, and the secondary damage to the brain such as low-oxygen and low-blood pressure et al. For severe TBI patients, prompt and appropriate decompression to reduce intracranial pressure (ICP) and ICU management are commonly required. The second edition of "Guidelines for the Management of Severe Head Injury" was published by the Japan Society of Neurotraumatology (JSNT) in 2006. These guidelines include a wide range of topics in the management for severe TBI, from prehospital care, primary care, ICU management and surgical treatment. The essence of extended decompression and neuroprotection for TBI is also focused in the JNST Guidelines. The pathophysiological event in the acute stage of severe TBI is quite variable ; therefore, an appropriate individual based approach in ICU management is necessary under experienced medical teams.

Observation on the effect of rice water on prevention of diarrhea in patients with traumatic head injury undergoing enternal nutrition / 中国实用护理杂志

Objective To investigate the effect of rice water on prevention of diarrhea in patients with traumatic head injury undergoing enternal nutrition. Methods 110 patients with traumatic head injury in neurosurgery department were selected and randomly divided into the observation group and the control group.The observation group was fed with rice water in the early two days of entemal nutrition and then begun with nutrient solution on the third day, as to the control group,patients were fed with nutrient solution at the beginning of enternal nutrition. Incidence of diarrhea in these two groups were viewed and underwent χ2 test. Results The number of samples with diarrhea in the observation group(3 cases) was significantly less than that of the control group (12 cases). Conclusions Feeding with rice water can clean the intestine, regulate the function of gastrointestinal tract and reduce the incidence of diarrhea obviously in patients with traumatic head injury during the early period of enternal nutrition.

Traumatismo craneoencefálico en niños: Mecanismos de la lesión primaria / Traumatic head injury: Mechanisms of primary injury

El traumatismo craneoencefálico se origina de la energía mecánica ejercida sobre la cabeza; los cambios iniciales causados por esta energía se conocen como lesión primaria o mecánica, mientras que los eventos que le siguen y continúan causando más daño constituyen la lesión secundaria o no mecánica, ambas dan por resultado el daño final. Dos tipos de condiciones conducen a la mayoría de las lesiones primarias, el fenómeno de contacto y la inercia. La única forma de evitar los mecanismos de la lesión primaria es fomentar, entre la comunidad, la cultura de prevención, con la concientización acerca de las medidas de seguridad. Así como promover programas que permitan identificar el maltrato infantil, y disminuir los factores de riesgo que lo favorecen. En este trabajo se hace una revisión de los mecanismos de la lesión primaria.

Traumatic brain injury results from the application of mechanical input to the head. The initial damage occurring at the very injury moment is considered the primary or mechanical injury. Secondary or non-mechanical injury results from complications which can produce additional and delayed damage. Two mechanical phenomena constitute the most common causes of primary brain injury: contact effect and inertial load. The only way to avoid the primary injury is to promote a culture of prevention and recognition of risk factors in child abuse. This article makes reviews mechanisms of primary head injury.

The Comparison of MMPI and Neuropsychological Tests according to Degree of Subjective Symptom Complaints in Patients with Traumatic Head Injury / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics of "fake bad" and "fake good" patients with traumatic head injury in neuropsychological tests. METHODS: We measured subjective symptoms by SCL-90-R and objective symptoms by McBride obstacle-valuation measure. The patient was divided into three groups according to differences between subjective and objective symptoms. We also examined their intelligence, memory, clinical characteristics, using K-WAIS, K-MAS, MMPI. RESULTS: The group who overly expressed their subjective symptoms has its psychotic symptom exaggeratingly measured, so it will be helpful to be careful to such over-expressed symptoms in those who present a psychotic symptom in a clinical view-point. An K-WAIS measurement among those who exaggerated their subjective symptoms showed less value than the actual one, which weakens the reliability of this intelligent test. Rather, for that group, the result of K-MAS can be used with a confidence in the estimation of their severity of symptoms. CONCLUSION: MMPI and neuropsychological tests are helpful to understand characteristics between subjective symptoms and objective disabilities of patients with traumatic head injury.

Efficacy analysis of nimodipine in the treatment of acute severe brain injuries / 中国临床药理学与治疗学

AIM: To observe the effect of nimodipine on the severe brain injury. METHODS: Nimodipine was ccsed for acute severe brain injury patients early in 6 hours after wounded. The effect and safety were observed in an open trial. RESULTS: The mortality and morbidity of 20 patients decreased significantly by the use of nimodipine in comparisom with another 20 patients treated normally. CONCLUSION: Nimodipine is benefit to severe brain injury patients.

Changes of Immunoreactive TRH in Cerebrospinal Fluid and Plasma after Acute Traumatic Head Injury in Cats / 第二军医大学学报

The changes of immunoreactive TRH (TRH-ir) in cerebrospinal fluid (CSF) and plasma before and after acute traumatic head injury were determined with radioimmunoassay (RIA) on a feline model of acute experimental head trauma. The results showed that the concentrations of TRH-ir in experimental animals pre- and 2, 4, and 6h post-injury were 119.48?51.77, 460.71 ?178.72, 377.27? 139.33, and 280.17?110.46pmol/L in CSF, and 122.58?28.87,1158.89?163.18, 909.69?160.55, and 545.38?132.80pmol/L in plasma, respectively, while those in control animals measured at the corresponding time were 112.22?53.42, 105.36?49.64, 100.63?52.89, and 104.52?52.42pmol/L in CSF, and 113.57 ?25.79, 107.32?26.60, 119.84?31.53, and 117.21?28.95pmol/L in plasma, respectively. The contents of TRH-ir in CSF and plasma in the experimental group after traumatic head injury were significantly higher than those, in the control group (P