Clinical analysis and treatment strategy of cerebral contusion in children / 天津医药

Objective To study the clinical characteristics of brain contusion in children and discuss the corresponding treatment strategies.Methods From February 2013 to December 2017,the clinical data of 32 patients(aged 1-14 years)with cerebral contusion and treated in the department of brain of the affiliated hospital of armed police logistics college were collected,including 22 males and 10 females.The age of patients ranged from 1 to 13.5 years,with the average of(6.03 ± 3.96)years.Patients were divided into low age group(1-4 years old,n=14)and high age group(5-14 years old,n=18)according to their age.Data of the brain damage location and distribution,Glasgow Coma Scale(GCS)/Children's Coma Scale (CCS), intracranial pressure (ICP), cerebral edema, airway condition, traumatic epilepsy and electroencephalogram (EEG) were summarized and analyzed. Results The duration of hospitalization was 17-57 d, with the average of (34.2 ± 11.5)d.All the children were treated with hyperbaric oxygen for 14-51 d,with an average of(36.1±5.1)d.There were no significant differences in the depth of brain damage and the location of brain injury between the two age groups(P>0.05). The coma scores at the admission and the discharge were significantly lower in low age group than those of the high age group (P<0.05). The duration of ICP monitoring was 6-15 d, with the average of (7.5±2.0) d. The ICP level and the resonance index(RI)value of cerebral edema monitoring at the admission was higher in the low age group than those in the high age group(P<0.05).The abnormal time of RI was less in the low age group than that in the high age group(P<0.05).There were no significant differences in seizures and EEG classification between two groups (P>0.05). There were 10 cases in each group received the transnasal intubation,and the average days with intubation were longer in the low age group than those of the high age group(P<0.05).Conclusion The clinical manifestations,imaging features,ICP,the degree of brain edema, seizures and airway management in children of different ages are different. The treatment should be carried out as soon as possible,actively and comprehensively,especially in the clinical management for the children of low age.

Value of stepwise therapy of dehydration drugs on aged people with cerebral contusion / 中国综合临床

Objective To explore the advantage of stepwise therapy of dehydration drugs on aged people with cerebral contusion for reduce the incidence of delayed traumatic intracranial hematoma and improve neurological function.Methods One hundred and twenty standard patients were divided into stepwise therapy group(n =60,group A) and regular therapy group(n =60,group B) by randomly.In group A,according to the developing regularity of cerebral edema,we use less dehydration drugs on early stage,and increase the dose step by step with the disease developed.In group B,we use dehydration drugs regularly,then compare the incidence rate of delayed traumatic intracranial hematoma and the cure rate of the disease between this two groups.Results The incidence of delayed traumatic intracranial hematoma was 8％ (5/60) in A group,and 30％ (18/60) in B group.Compared with B group,the stepwise therapy of dehydration drugs on cerebral contusion can reduce the incidence of delayed traumatic intracranial hematoma obviously,there was significant difference between two groups(x2 =6.21,P ＜0.05) ;The recovering rate was 70％ (42/60) in B group,and 30％ (28/60) in B group,there was significant difference between two groups (x2 =6.72,P ＜ 0.05).Conclusion The treatment of stepwise therapy is more reasonable on aged people with cerebral contusion,the incidence of delayed traumatic intracranial hematoma can be reduced obviously compared with regular therapy of dehydration drugs.

Safety of Intrathecal Baclofen Therapy in a Patient with Sleep Apnea Syndrome / The Japanese Journal of Rehabilitation Medicine

We report a 30-year-old man with an extensive cerebral contusion. He presented with severe left upper and lower limb paralysis and mild right lower limb palsy. He was diagnosed with severe sleep apnea syndrome and was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). Four years after the injury, he was able to walk with Lofstrand crutches. However, he gradually began to have difficulty standing, walking and driving his wheelchair because his spasticity developed markedly. He received ITB (intrathecal baclofen) therapy and noted a reduction in spasticity. He was once again able to drive his wheelchair and to walk with support. In addition, his respiratory function didn't show any deterioration. Spasticity is a common complication after cerebral or spinal cord injury, for which treatment has been difficult. ITB therapy can dramatically reduce spasticity, but has been demonstrated that it may also depress respiratory function in patients with respiratory insufficiency. This case suggests that ITB therapy may reduce spasticity without affecting respiratory function even in patients with a respiratory disorder.

An experimental study on the relationship between the expression of GFAP and iNOS and the post-traumatic intervals after brain contusion in rats / 中国法医学杂志

Objective To observe the relationship between the expression of GFAP and iNOS the post-traumatic intervals after experimental cerebral contusion,in order to attempt to find out a method of timing wound age of brain contusion in the forensic prediction of injury time.Methods After setting up an model of experimental focal cerebral contusion in rats,immunohistochemical method was applied to observing the changes of inducible nitric oxide synthase (iNOS) and glial fibrillary acidic protein (GFAP) staining combined with histology method in rats.The immunostaining results were measured quantitatively with computer imaging analysis system.Results (1) At 3h after injury,GFAP-positive astrocytes around the wounded area were definitely detected.The intensity and the area of GFAP-positive cells increased following the post-traumatic intervals.The intensity peaked dually at 1d and 5d,respectively,followed by reduction at 3d,which revealed two-peak waveforms,The area of GFAP positive cells enhanced significantly at 3h and gradually increased with prolonging survival time,and reached a peak at 7d after injury.(2) At 12h after injury,the iNOS isoform was present and iNOS positive staining cells were noted.The intensity and the area of iNOS positive cells increased following the post-traumatic intervals.The area of positive reached maximal level at 1-3days,gradually subsided after 5d,and maintain a higher lever up to 7d post-injury;but the intensity of individual positive cell gradually increased with prolonging survival time,reached a peak at 5d and gradually subsided after 5d,but the level was still higher than the initial interval.Conclusions Expression of GFAP and iNOS is correlated with post-traumatic intervals after cerebral contusion in rats,suggesting that the expression of iNOS and GFAP may be served as the markers for timing of brain contusion in forensic practice.

Magnetic Resonance Imaging in Severe Head Injury: Comparison with Computed Tomography

Magnetic resonance imaging(MRI) and computed tomography(CT) in 30 patients with severe head trauma were compared. MRI was superior to CT in detection of intracerebral and extracerebral traumatic lesions. The results obtained were as follows : 1) 27 intracerebral(18 cerebral contusions, 5 diffuse axonal injuries & 4 intracerebral hematomas) and 13 extracerebral traumatic lesions(4 acute epidural hematomas, 4 subdural hygromas, 2 subarachnoid hemorrhages, 1 acute subdural hematoma, 1 chronic subdural hematoma & 1 pneumocephalus) in 30 patients were seen on CT and/or MRI. 2) Group I lesions which seen on MRI and not seen on CT were 5 diffuse axonal injuries(100%), & 8 cerebral contusions(44%), and group II lesions which seen on CT and MRI with better visualization on MRI were 6 cerebral contusions(33%), 2 intracerebral hematomas(50%), & 3 subdural hygromas(75%). 3) Group III lesions which seen on CT and MRI equally well were 4 cerebral contusions(22%), 2 intracerebral hematomas(50%), 2 acute epidural hematomas(50%), 2 subarachnoid hemorrhages(100%), 1 chronic subdural hematoma(100%), 1 subdural hygroma(25%) & 1 pneumocephalus(100%). 4) Group IV lesions which seen on CT and MRI with better visualization on CT were 2 acute epidural hematomas(50%), & 1 acute subdural hematoma(100%), and lesion which seen on CT and not seen on MRI was not. 5) 21 intracerebral lesions of group I and II were located on temporal(11), parietal(3), frontal(2) and occipital lobes(2), basal ganglia(1), brain stem(1) and cerebellum(1). 6) We recommended MRI in the acute stage of severe head trauma for accurate diagnosis and evaluation of intracerebral traumatic lesions, especially diffuse axonal injuries and cerebral contusions, which were not visualized clearly on CT.

Morphologic study of the post-traumatic cerebral infarction / 中国法医学杂志

Objective To observe the morphologic characteristics of the post-traumatic cerebral infarction and discriminate it from brain contusion. Methods From 81 severe brain injury samples 15 were selected which met the criteria of the secondary necrosis and hemorrhage of brain. Another 15 simple brain contusion samples were selected as control. They were cut according to various requirements either coronary or saggittally or horizontally and observed grossly and histologically. Results The post-traumatic cerebral infarctions were found mainly in 5 localities: basal ganglia (3 cases), cingulate gyrus (2 cases), both cuneus of the occipital lobes (2 cases), lateral occipito-temporal gyrus (6 cases, 5 of them complicated with hemorrhage in the midbrain and pons), and occipital gyrus (2 cases). All of the infarctions were located not at the point of coup or contrecoup. They were localized and had clear boundaries. All of the lesions could be traced back to be related to brain hernia. Microscopically, there were extravasation of blood, and necrosis in the infarction, and usually severe congestion and edema with white blood cells infiltration and glia cell reaction. If the lesion was in the cerebrum, it was usually located at the junction of cortex and medulla, in severe cases extended to whole thickness of the cortex and the subarachnoid space, but the pia mater was not ruptured. There were marked ischemic and hypoxia changes in the neurons. The lesions of brain contusion, on the contrary, were always ruptured. The contused brain tissue may be necrotic. Conclusion The Post-traumatic cerebral infarction is synonymous with secondary necrosis and hemorrhage of the brain. The mechanism of the infarction is compression of intra-cerebral blood vessels due to cerebral hernia. It could be differentiated from cerebral contusion by the relation with cerebral hernia, the location of the lesion, the in-tactness of the pia mater, as well as other related histological changes.

The timing expression of apo E following experimental traumatic brain injury in the rat / 中国法医学杂志

Objective To Study the expression of apo E protein changed in different wound age and position of the experimental traumatic brain injury(TBI) in rat. Methods The animal model of cerebral contusion was established by impact to the parietal lobe with a free fall weight,observed the changes of apo E in different wound age (0.5h、2h、6h、12h、24h、3d、7d、14d). The results were measured quantitatively with computer imaging analysis system. Results In cortex apo E-positive neurons definitely detected in 0.5h after brain injury, reaching the peak in 3d, then it shows the gradual decrease from 3d to 14d; In hippocampus apo E-positive neurons definitely detected in 0.5h after brain injury, reaching the peak in 3d in CA1 section and 24h in CA2～CA4. Then it shows the gradual decrease. We found the expression of apo E protein in CA1 section is stronger than others. Conclusion The location and intersity of the immunoreactivity of apo E protein changed at the different stages after TBI. These changes observed in the present study might be used for determination of injury time,early diagnosis and distinguish antemortem and postmortem brain injury in forensic medicine.

A preliminary study on expression of caspase-3 in experimental brain contusion in rats / 中国法医学杂志

Objective To investigate the expression of caspase-3 in different post-traumatic intervals and severity of traumatic brain injury (TBI). Method Brain tissue samples of slight (n =24), moderate (n = 24) brain injury and control (n = 10) groups of rat were examined by immunohistochemical staining. Results Up-regulation of caspase-3 expression was found in tissues from traumatic brain injury as compared with controls in 1h after TBI, and lasted for 2 weeks. In tissues taken Ih, 12h, 24h, 72h, lweek and 2weeks after TBI there were different amount of positive celis in brain injuries of different severity. Con-clusion The expression of caspase-3 is different in brain injuries of different severity . These findings are valuable in appraising the severity of injuries.

Study on the expression of nitric oxide synthase 1(NOS1)and mRNA after rat cerebral contusion / 中国法医学杂志

The experimental right cerebral contusion model was established in rats.To observe the relationship between the expression of Nitric oxide synthase 1(NOS1)and time elapsed after cerebral contusion,the expression of Nitric oxide synthase 1(NOS1)and mRNA was studied by immunohistochemistry and in situ hybridization at different intervals after cerebral injury.The results indicated that a positive relationship existed between the expression of NOS1 and NOS1 mRNA and the intervals elapsed after brain injury.This method also can be used to distinguish antemortem and postmortem injury rat′s cerebral contusion.So that,the expression of NOS1 and NOS1 mRNA is of great value for timing of brain injury.

CT Evalution and Clinical Course in Cerebral Contusion

This study includes 398 cases of cerebral contusion among 1137 cases of craniocerebral injury diagnosed by neurological finding and CT brain scan, who were admitted from January 1983 to June 1985 in our neurological department. 68 cases showed abnormalities on CT scanning, among these 48 cases were heterogenous hyperdensity with surrounding irregular marginated hypodensity, 26 cases midline shift, 13 cases local increased density, 9 cases recurrence of new lesion. The authors studied comparison and correlation of clinical course and CT finding of cerebral contusion.

Early Prognostic Evaluation with C-T Scan in Cerebral Contusion

The cerebral contusion(necrotic brain tissue infiltrated with blood) is common post-traumatic lesion, In 851 consecutive C-T scan performed by 48 hours from injury, the contusion were present in 193(22.%) of the case. Comparing the midline shift, area, number, size of the lesions and their etiopathogenesis with the clinical course(assessed by Glasgow coma scale), it is possible to evaluate the early prognosis. The patient who showed 1) midline shift over 15mm, 2) the contusional lesion in basal ganglia, brain stem or corpus callosum, 3) multiple or large sized lesion took poor prognosis. Cortical contusion especially in the frontal region had relatively good prognosis. The pathogenetic mechanisms(angular acceleration of the brain) is the same in basal ganglia, brain stem and corpus callosum, but a direct impact of the In conclusion, the etiopathogenetic mechanism and consequent site of the cerebral contusion are the most important factors on the evaluation of the severity of the brain damage and their prognosis.