Disability identification for cases with clinical diagnosis of diffuse axonal injury due to traffic accidents: a study of 89 cases / 法医学杂志

OBJECTIVE@#To study the disability identification for cases with clinical diagnosis of diffuse axonal injury (DAI) due to traffic accidents, and to explore the possible effects of DAI on identification results.@*METHODS@#Five hundred and fifty-six cases of cerebral injury due to traffic accidents were collected, including 467 cases diagnosed with cerebral contusion or laceration and 89 cases diagnosed with DAI. The identification results of different groups with diagnosis of DAI diagnosis, diagnosis of DAI with cerebral contusion (laceration), and diagnosis of cerebral contusion or laceration without DAI were compared and statistically analyzed, based on the results of CT and MRI re-review.@*RESULTS@#The disability identification levels in DAI group (20 cases), DAI group (69 cases) with cerebral contusion (laceration) and DAI group (467 cases) not complicated by cerebral contusion (laceration) were 7.72 +/- 1.09, 7.78 +/- 1.11, and 8.86 +/- 0.66, respectively. The disability levels of the two groups diagnosed with DAI were higher than those of the group without DAI diagnosis (P < 0.05).@*CONCLUSION@#Patients with DAI diagnosis might have more severe cerebral injury. In the identification process, one should pay attention to the possible missed diagnosis and misdiagnosis, and meanwhile avoid relying on those evidences provided only by CT and MRI.

Effects of nimodipine on cerebral hemodynamics, and prognosis of diffuse axonal injury patients

To evaluate the effects of nimodipine on hemodynamic state, vasospasm, and short time prognosis of diffuse axonal injury [DAI] patients. In a prospective, clinical trial double blind study, 40 DAI patients with Glasgow coma scale of 5-8 were selected and randomly divided into 2 equal groups. The first group was treated with 60 mg of nimodipine every 4 hours immediately after admission, and the control group did not receive this treatment. Mean blood flow velocity [MFV] and pulsatility index of both middle cerebral arteries were measured using transcranial Doppler on the 1st, 3rd, and 10th days of admission. Glasgow outcome scale was evaluated one month after admission. This study was performed from June 2003 to June 2004 at Imam Medical Center, Tabriz, Iran. There were significant differences in MFV among the 3 transcranial Doppler, which demonstrated hemodynamic changes in these patients. Nimodipine did not have any significant difference on MFV between the treatment and control groups. In the nimodipine group, 45% had good prognosis [30% in the control group] and nobody had vasospasm on the 10th day Doppler study [15% in the control group], although it did not show any statistical significant difference between them. Nimodipine improved the prognosis and decreased vasospasm, however, there was no statistical difference. Therefore, we suggest further studies in a larger number of DAI patients

Tormenta simpatica paroxistica siguiendo a injuria axonal difusa / Paroxysmal sympathetic storm after diffuse axonal head injury

El término tormenta simpática paroxística se utiliza como sinónimo de alteraciones episódicas de la temperatura corporal, la presión arterial, la frecuencia respiratoria y cardíaca, el tamaño pupilary el nivel de conciencia, que coinciden con hiperhidrosis, salivación excesiva y postura extensora. Esto siempreen el contexto de una injuria axonal difusa grave que sigue a un traumatismo encéfalo-craneano (TEC) grave.Presentamos dos pacientes jóvenes con injuria axonal difusa secundaria a TEC grave, que desarrollan en suevolución cuadros de hipertensión arterial, taquicardia y fiebre, sin evidencia durante los episodios de actividad epileptiforme y habiéndose descartado la causa infecciosa, que responden favorablemente al tratamiento con beta-bloqueantes y morfina. Consideramos que el correcto diagnóstico de esta entidad minimiza la solicitud de estudios innecesarios permitiendo iniciar un tratamiento adecuadoc

The term paroxysmal sympatheticstorms is used to define episodic alterations in body temperature, blood pressure, heart and respiratoryrate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during theepisodes of epileptiform activity and without any infectious cause with excellent answer to the treatment withbeta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application ofunnecessary studies allowing an appropriate treatment