Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Aspects épidémiologiques et thérapeutiques des pathologies neurochirurgicales chez l'enfant de moins de 5 ans à Libreville (Gabon) de 2019 à 2021 / Epidemiology and management of neurosurgical diseases of children aged 5 years or less in Libreville (Gabon) from 2019 to 2021

Introduction. Les pathologies neurochirurgicales sont un ensemble d'affections qui touche le cerveau, la moelle épinière, et les paires crâniennes nécessitant une prise en charge médico-chirurgicale. Leur incidence en Afrique sub-saharienne et plus particulièrement au Gabon est mal connue. Objectif. Décrire les aspects épidémiologiques et évolutifs des pathologies neurochirurgicales chez l'enfant de moins 5 ans à Libreville. Patients et méthodes. Il s'agit d'une étude rétrospective descriptive et analytique, multicentrique portant sur des patients de moins de 5ans pris en charge pour une affection neurochirurgicale de Janvier 2019 à Décembre 2021 à Libreville. Résultats. Sur 4811 enfants hospitalisés, 130 répondaient aux critères d'inclusion (prévalence : 2,7%). L'âge moyen était de 13,1 mois. Le sex-ratio était de 1,3. Les grossesses étaient mal suivies dans 72,2% des cas. Les pathologies neurochirurgicales malformatives représentaient 63,5%. L'hydrocéphalie était la plus observée dans 71,2%. Sur les 115 enfants, 71 ont bénéficié d'un traitement chirurgical, soit un taux de 61,7% et le taux de mortalité globale était de 6,1%. Dans le groupe des enfants présentant une malformation congénitale, 8,2% n'avaient pas été traités, le taux de mortalité était de 8,2%. Les complications à court termes étaient dominées par les infections. Conclusion. Les pathologies neurochirurgicales sont en fréquentes dans notre contexte. Une prise en charge immédiate reste de mise, nécessitant donc un plateau technique de pointe pour améliorer l'évolution à court terme voire à moyen et long terme de ces affections.

Introduction. Neurosurgical pathologies are a set of conditions that affect the brain, spinal cord, and cranial pairs requiring medical and surgical management. Their incidence in subSaharan Africa and more particularly in Gabon is poorly known. Objective. To describe the epidemiological and evolutionary aspects of neurosurgical pathologies in children under 5 years old in Libreville. Patients and methods. This is a retrospective descriptive and analytical, multicenter study of patients under 5 years of age treated for a neurosurgical condition from January 2019 to December 2021 in Libreville. Results. Of the 4811 hospitalized children, 130 met the inclusion criteria (prevalence of 2.7%) and 15 were excluded for incomplete records. The average age was 13.1 months. The age group of 28 days-1 year was the most observed. The sex ratio was 1.3. Pregnancies were poorly followed in 72.2% of cases. Malformative neurosurgical pathologies accounted for 63.5% of cases. Hydrocephalus was the most observed in 71.2%. Of the 115 children, 71 received surgical treatment, a rate of 61.7% and the overall mortality rate was 6.1%. In the group of children with congenital malformation, 8.2% had not been treated, the mortality rate was 8.2%. Short-term complications were dominated by infections. Conclusion. Neurosurgical pathologies are frequent in our context. Immediate care remains essential, therefore requiring a cutting-edge technical platform to improve the short-term or even medium- and long-term evolution of these conditions.

Characteristics of injuries resulting from falls from height in the construction industry

INTRODUCTION@#Falls from heights contribute to 34% of fatal accidents in Singapore. Of these, 51% of the accidents occur in the construction industry. This retrospective review, of all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital, analysed injury patterns and related them to mechanisms and contributory factors.@*METHODS@#Information collected included injury and casualty characteristics, safety measures, pre-existing medical conditions and clinical outcomes.@*RESULTS@#Of 1,085 patients, 951 were male with a mean age of 39.8 years, mean height of 165.9 cm and mean weight of 69.7 kg. Most of the casualties fell between 0800 and 2000 hours. Among the severely injured patients, 2.4% had head injuries, 54.9% had chest injuries and 39.2% had abdominal and pelvic injuries. For these casualties, the mortality rate was 60.8%. For patients with less than major trauma, the commonest injuries were in the lower limbs (41.8%), upper limbs (40.8%) and spine (22.2%). All the casualties survived. Falls from scaffolding, formwork and platforms were the most common causes of severe injuries (41.1%). Safety helmets and harnesses were reported to be used in 1.8% and 4.1% of instances of falls, respectively.@*CONCLUSION@#Studying the patterns of injuries following falls at construction sites has the potential for injury prevention through safe practices, use of safety equipment and targeted training.

Development and global validation of a 1-week-old piglet head finite element model for impact simulations / 中华创伤杂志(英文版)

PURPOSE@#Child head injury under impact scenarios (e.g. falls, vehicle crashes, etc.) is an important topic in the field of injury biomechanics. The head of piglet was commonly used as the surrogate to investigate the biomechanical response and mechanisms of pediatric head injuries because of the similar cellular structures and material properties. However, up to date, piglet head models with accurate geometry and material properties, which have been validated by impact experiments, are seldom. We aim to develop such a model for future research.@*METHODS@#In this study, first, the detailed anatomical structures of the piglet head, including the skull, suture, brain, pia mater, dura mater, cerebrospinal fluid, scalp and soft tissue, were constructed based on CT scans. Then, a structured butterfly method was adopted to mesh the complex geometries of the piglet head to generate high-quality elements and each component was assigned corresponding constitutive material models. Finally, the guided drop tower tests were conducted and the force-time histories were ectracted to validate the piglet head finite element model.@*RESULTS@#Simulations were conducted on the developed finite element model under impact conditions and the simulation results were compared with the experimental data from the guided drop tower tests and the published literature. The average peak force and duration of the guide drop tower test were similar to that of the simulation, with an error below 10%. The inaccuracy was below 20%. The average peak force and duration reported in the literature were comparable to those of the simulation, with the exception of the duration for an impact energy of 11 J. The results showed that the model was capable to capture the response of the pig head.@*CONCLUSION@#This study can provide an effective tool for investigating child head injury mechanisms and protection strategies under impact loading conditions.

Proteína precursora del beta-amiloide (ß-App) y daño axonal difuso tras un traumatismo craneoencefálico: un punto de vista forense / Beta-amiloid precursos protein (ß-App) and diffuse axonal damage after head injuries: a forensic point of view

Resumen La proteína precursora del β- Amiloide (β-APP) es una glicoproteína de membrana y un componente habitual de las neuronas. Tiene funciones en el crecimiento y la adhesión celular tras un traumatismo. Es transportada mediante transporte rápido axonal anterógrado y se acumula dentro de las neuronas cuando se daña citoesqueleto. Este proceso es activo, es decir consume energía. El β-APP no es específico de los traumatismos. Se acumula en cualquier circunstancia en la que se dañen los axones, tal como la hipoxia, alteraciones metabólicas, y cualquier otra causa de edema cerebral y aumento de la presión intracraneal que puedan conducir a un daño axonal difuso (DAI) En el presente estudio estudiamos la expresión de esta proteína en casos de traumatismo cráneo-encefálico con diferente evolución cronológica El daño del citoesqueleto producido por la proteólisis, junto con la alteración de las quinasas y las fosfatasas, aumentan la permeabilidad de la membrana, lo que provoca la entrada de calcio en la célula que, a su vez, activa la calmodulina que hace que los neurofilamentos se compacten, los microtúbulos desaparezcan y se rompa la espectrina. Esta disrupción del citoesqueleto tiene como consecuencia que las sustancias que se transportan a su través, se acumulen, sobre todo en las zonas afectadas por el DAI. Al final de todo este proceso, los axones se rompen, lo que se conoce como axotomía secundaria. El estudio de la acumulación del β-APP es útil para valorar la extensión del DAI y para determinar el tiempo de supervivencia tras el traumatismo o cualquier otro daño cerebral.

Abstract β-Amyloid Precursor Protein (β-APP) is a membrane glycoprotein and a common component of neurons. It is involved in adhesion and cell growth processes after traumatic events. It is carried by anterograde fast axonal transport, and it accumulates inside neurons when the cytoskeleton is damaged. This is a vital biochemical process that consumes energy. β-APP is not specific of traumatic events. It accumulates in any case of axonal damage, whatever its cause may be, like hypoxia, metabolic disorders, and any other circumstances that lead to brain swelling and intracranial pressure rising and in consequence to Diffuse Axonal Injury (DAI). In this study we review the expression of this protein in cases of traumatic brain injury with different chronological evolution. The damage of cytoskeleton due to proteolysis in addition to the disturbance of kinases and phosphatases increase the permeability of the membrane. Calcium gets into the cell and activates calmodulin, thus neurofilaments compact, microtubules disappear and spectrin breaks. This disruption of the cytoskeleton has as consequence that the transported substances accumulate in the most affected areas by DAI. At the end of this process axon breaks, which is known as secondary axotomy. The study of the accumulation of β-APP is useful to assess the extent of DAI and to determine the time elapsed after trauma or another insult to CNS.

Contribuições práticas do processo de enfermagem relacionado ao traumatismo cranioencefálico: Uma revisão integrativa / Practical contributions of the nursing process in traumatic brain injury: An integrative review

Introdução: O traumatismo cranioencefálico é um evento incapacitante e de importância mundial com expressiva morbimortalidade mundial. Objetivo: analisar as evidências científicas internacionais sobre o processo de enfermagem no cuidado ao adulto com traumatismo cranioencefálico. Método: Revisão integrativa, realizada em seis bases de dados de fevereiro a março de 2020. Os descritores ''pacientes internados'', ''cuidados críticos'', ''cuidados de enfermagem'', ''processo de enfermagem'', ''traumatismos craniocerebrais'' e ''traumatismo múltiplo'' foram cruzados por meio de operadores booleanos AND e OR. Os estudos foram analisados pelo método de redução de dados, contrapondo-se, o que gerou a síntese. Resultados: Ressalta-se o monitoramento hemodinâmico, a aplicação da escala de coma de Glasgow e a atualização de um plano de cuidados como parte do processo de enfermagem. Além disso, cabe-se destaque a necessidade de elaboração dos diagnósticos e intervenções de enfermagem. Conclusão: Existe uma lacuna com relação a formulação de diagnósticos de enfermagem e intervenções ligadas ao processo de enfermagem, como também a descrição dos parâmetros ideais a serem verificados na monitorização das pessoas.

Introducción: El traumatismo craneoencefálico es un acontecimiento incapacitante de importancia mundial, con una importante morbilidad y mortalidad en todo el mundo. Objetivo: Analizar las evidencias científicas internacionales sobre el proceso de enfermería en el cuidado de personas adultas con lesión cerebral traumática. Método: Revisión integradora, realizada en seis bases de datos, de febrero a marzo de 2020. Los descriptores fueron "pacientes hospitalizados", "cuidados críticos", "cuidados de enfermería", "proceso de enfermería", "lesión cerebral traumática" y "lesión cerebral traumática múltiple". Se cruzaron mediante los operadores booleanos AND y OR. Los estudios se analizaron mediante el método de reducción de datos y la contrastación generó la síntesis. Resultados: Se destaca la monitorización hemodinámica, la aplicación de la escala de coma de Glasgow y la actualización de un paquete de cuidados como parte del proceso de enfermería. Además, hay que destacar la necesidad de elaborar diagnósticos e intervenciones de enfermería. Conclusión: Existe un vacío en cuanto a la formulación de diagnósticos e intervenciones vinculado al proceso de enfermería, así como en la descripción de los parámetros ideales que deben verificarse en el seguimiento de personas.

Introduction: Traumatic brain injury is a disabling event of worldwide importance with significant morbidity and mortality worldwide. Objective: The aim was to analyze the international scientific evidence on the nursing process of caring for adult patients with traumatic brain injury. Method: This was an integrative review conducted from February to March 2020 in six databases. The descriptors "hospitalized patients", "critical care", "nursing care", "nursing process", "traumatic brain injury" and "multiple traumatic brain injury" were matched through the Boolean operators AND/OR. The studies were analyzed through a data reduction method: they were contrasted with each other. This in turn generated the synthesis. Results: The results highlight the hemodynamic monitoring, the application of the Glasgow coma scale, and the update of a care package as part of the nursing process. Furthermore, the results also highlight the need to develop nursing diagnoses and interventions. Conclusion: There is a gap regarding the formulation of nursing diagnoses and interventions linked to the nursing process, as well as the description of the ideal parameters to be checked when monitoring patients.

Impacto da aplicação de diretrizes na solicitação de tomografia computadorizada de crânio em traumatismo cranioencefálico leve: revisão sistemática / Impact of application of guidelines on the utilization of head computed tomography in minor head injury: systematic review

A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.

Computed tomography (CT) is the exam of choice for tracking injuries in traumatic brain injury (TBI). Despite this, its routine use in mild TBI is controversial. The objective of this review was to evaluate the impact of applying guidelines for the management and conduct of mild TBI on the request for CT of the head. A search was carried out in the LILACS, Medline, PubMed, SciELO databases, using MeSH and DeCS descriptors. The initial search identified 30,191 articles. After removal of duplicate publications, selection by title, selection by abstract, 25 publications remained, which were read in full and five were included in this systematic review. In conclusion, the articles analyzed showed, on average, a 25.8% reduction in the request for cranial CT when the guidelines were applied, and guide that protocols for mild TBI are efficient tools to assist medical practice, positively impacting when applied to the population. , and clinical evaluation should always be taken into account.

Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

Reconstruction and Quantitative Evaluation of Blunt Injury Cases by Finite Element Method / 法医学杂志

OBJECTIVES@#To reconstruct the cases of acceleration craniocerebral injury caused by blunt in forensic cases by finite element method (FEM), and to study the biomechanical mechanism and quantitative evaluation method of blunt craniocerebral injury.@*METHODS@#Based on the established and validated finite element head model of Chinese people, the finite element model of common injury tool was established with reference to practical cases in the forensic identification, and the blunt craniocerebral injury cases were reconstructed by simulation software. The cases were evaluated quantitatively by analyzing the biomechanical parameters such as intracranial pressure, von Mises stress and the maximum principal strain of brain tissue.@*RESULTS@#In case 1, when the left temporal parietal was hit with a round wooden stick for the first time, the maximum intracranial pressure was 359 kPa; the maximum von Mises stress of brain tissue was 3.03 kPa at the left temporal parietal; the maximum principal strain of brain tissue was 0.016 at the left temporal parietal. When the right temporal was hit with a square wooden stick for the second time, the maximum intracranial pressure was 890 kPa; the maximum von Mises stress of brain tissue was 14.79 kPa at the bottom of right temporal lobe; the maximum principal strain of brain tissue was 0.103 at the bottom of the right temporal lobe. The linear fractures occurred at the right temporal parietal skull and the right middle cranial fossa. In case 2, when the forehead and left temporal parietal were hit with a round wooden stick, the maximum intracranial pressure was 370 kPa and 1 241 kPa respectively, the maximum von Mises stress of brain tissue was 3.66 kPa and 26.73 kPa respectively at the frontal lobe and left temporal parietal lobe, and the maximum principal strain of brain tissue was 0.021 and 0.116 respectively at the frontal lobe and left temporal parietal lobe. The linear fracture occurred at the left posterior skull of the coronary suture. The damage evaluation indicators of the simulation results of the two cases exceeded their damage threshold, and the predicted craniocerebral injury sites and fractures were basically consistent with the results of the autopsy.@*CONCLUSIONS@#The FEM can quantitatively evaluate the degree of blunt craniocerebral injury. The FEM combined with traditional method will become a powerful tool in forensic craniocerebral injury identification and will also become an effective means to realize the visualization of forensic evidence in court.

Factors related to healthcare costs of road traffic accidents in Bucaramanga, Colombia / Factores relacionados con costos por atención médica de siniestros de tránsito en Bucaramanga, Colombia

ABSTRACT OBJECTIVE To determine the factors related to overall healthcare costs of road traffic accidents in Bucaramanga, Colombia. METHODS A descriptive cross-sectional study was conducted through the analysis of road traffic accident records that took place in 2019 in Bucaramanga, Colombia. Cost quartiles in dollars were compared using Pearson's chi-squared and Fisher's exact tests. Odds ratios were also calculated in logistic regression. RESULTS 3,150 road accidents were reported in 2019 involving 7,038 people, of which 812 had information related to healthcare costs in health care institutions. The median cost was 56.59 USD (RI = 29.35-140.15), average cost of 290.11 USD ± 731.22 (95%CI: 239.74-340.48). A higher possibility to be in the 4th quartile was found when persons were under 18 years of age (OR = 4.88; 95%CI: 1.30-18.32) or 46-60 years (OR = 3.66; 95%CI: 1.01-13.30), the type of vehicle involved is motorcycle (OR = 2.79; 95%CI: 1.25-6.24), bicycle (OR = 7.66; 95%CI: 2.70-21.68), having a head injury (OR = 4.50; 95%CI: 2.61-7.76) and hypothetical drunk driving (OR = 12.44; 95%CI: 2.01-76.87). CONCLUSIONS Relevant factors in healthcare costs were riding a motorcycle or bicycle, having a head injury, being under 18 years of age or 46 to 60 years of age and hypothetical drunk driving. It is important to implement prevention measures based on identified factors to reduce road accident rate and therefore, its socioeconomic costs.

RESUMEN OBJETIVO Determinar los factores relacionados con los costos generales durante la atención en salud de siniestros de tránsito en Bucaramanga, Colombia. MÉTODOS Estudio descriptivo, transversal, con análisis de registros de siniestros de tránsito durante 2019 en Bucaramanga, Colombia. Se realizó una comparación entre cuartiles de los costos en dólares con pruebas estadísticas de Chi-cuadrado de Pearson y exacta de Fisher. También, se calcularon odds ratio en regresión logística. RESULTADOS En 2019 se registraron 3.150 siniestros, con 7.038 personas involucradas, de los cuales 812 tenían información de costos generados por atención en instituciones de salud. La mediana de costos fue US$ 56,59 (RI = 29,35-140,15), promedio de US$ 290,11 ± 731,22 (IC95% 239,74-340,48). Se observó mayor posibilidad para estar en cuartil 4 de los costos si la persona tenía menos de 18 años (OR = 4,88; IC95% 1,30-18,32) o entre los 46-60 años de edad (OR = 3,66; IC95% 1,01-13,30), cuando el tipo de vehículo es la motocicleta (OR = 2,79; IC95% 1,25-6,24) y la bicicleta (OR = 7,66; IC95% 2,70-21,68), si la lesión ocurre en la cabeza (OR = 4,50; IC95% 2,61-7,76) y si la hipótesis está relacionada con embriaguez (OR = 12,44; IC95% 2,01-76,87). CONCLUSIÓN Los factores relevantes en los costos fueron la motocicleta, bicicleta, lesión en la cabeza, ser menor de 18 años o tener entre los 46 años y los 60 años y embriaguez como hipótesis. Es relevante implementar medidas de prevención según los factores identificados para disminuir la accidentalidad y, por ende, sus costos socioeconómicos.

Epidemiological Pattern of Traumatic Brain Injury in Brazil between 2008 and 2019

Introduction Traumatic brain injuries (TBIs) are a public health problem with high economic impact, as well as an important cause of death and sequela in polytrauma patients, affecting mainly young adults. Objective To analyze the temporal trend of TBI incidence in Brazil between 2008 and 2019, according to age group and gender. Methods An ecological study, based on secondary data from hospital admissions for TBI in all Brazilian states between 2008 and 2019. The numbers were collected using the hospital information systemof the Unified Health System in Brazil.We performed a descriptive analysis using the data obtained. Linear regression models were used to measure the incidence trend of TBI in the period adopted. Results The state of Piauí had the highest increase in the incidence of TBI in the country in the last 10 years (coefficient ß»63.43 e p»0.002). The main concern, though, is the increase in the incidence of TBI amongst children (0­4 years old) in the states of Ceará (ß»31.22 and p<0.001 for boys; ß»42.20 and p<0.001 for girls), Paraná (ß»37.26 and p»0.011 for boys; ß»25.90 and p»0.015 for girls), Pernambuco (ß»20.08 and p»0.016 for girls), Mato Grosso (ß»18.76 and p»0.005 for boys; ß»16.11 and p»0.035 for girls), and Distrito Federal (ß»48.87 and p»0.004 for girls; ß»48.28 and p»0.006 for boys). Conclusion The analysis of the results is able to point out improvements that can be made. Besides that, it is remarkably important to redirect public polices to preventive medicine sincemany of the TBI causes are avoidable through awareness and education of the population.

Anatomy of the Middle Meningeal Artery

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Ultrasonografía del diámetro de la vaina del nervio óptico en el monitoreo de la presión intracraneal / Ultrasound of optic nerve sheath diameter for monitoring intracranial pressure

Introducción: El neuromonitoreo no invasivo en pacientes críticos representa una opción de primera línea para el manejo de complicaciones fatales derivadas del aumento de la presión intracraneal. En esta modalidad se incluye la ultrasonografía del diámetro de la vaina del nervio óptico, la cual representa una técnica rápida, fácil de realizar y disponible a la cabecera del paciente. Objetivos: Describir aspectos fundamentales y actualizados sobre el uso de la ultrasonografía en el monitoreo de la presión intracraneal a través de la medición del diámetro de la vaina del nervio óptico en los diferentes escenarios neuroclínicos. Métodos: Se realizó una revisión de la literatura publicada en bases de datos como: PubMed/Medline, SciELO y Google académico entre los meses mayo y julio de 2020. Se revisaron publicaciones en inglés y español. Se seleccionaron 46 bibliografías que cumplieron con los criterios de inclusión. Se describen aspectos fundamentales como la anatomía ecográfica del nervio óptico, descripción de la técnica y su uso en entidades neurocríticas como el traumatismo craneoencefálico, ictus, muerte encefálica, entre otros. Conclusiones: La ecografía de la vaina del nervio óptico representa una alternativa no invasiva ampliamente aceptada para la medición del incremento de la presión intracranial. Con un diámetro de 5,0 hasta 5,9 mm o más se puede asumir el diagnóstico de hipertensión intracraneal con alta sensibilidad y especificidad, aunque debe individualizarse su uso en cada patología neurocrítica. La curva de aprendizaje para la realización del proceder es de breve tiempo y satisface las habilidades necesarias(AU)

Introduction: Noninvasive neuromonitoring in critically ill patients is a first-line option for the management of fatal complications derived from increased intracranial pressure. This modality includes ultrasound of optic nerve sheath diameter, which is a quick technique, easy to perform and available at the bedside. Objectives: To describe significant and state-of-the-art aspects regarding the use of ultrasound for monitoring intracranial pressure through measurement of the optic nerve sheath diameter in different neuroclinical settings. Methods: A review was carried out, between May and July 2020, of the literature published in databases such as PubMed/Medline, SciELO and Google Scholar. Publications in English and Spanish were reviewed. Forty-six bibliographic sources were chosen, as long as they met the inclusion criteria. Fundamental aspects are described, such as the ultrasound anatomy of the optic nerve, the technique procedures and its use in neurocritical entities such as head trauma, stroke and brain death, among others. Conclusions: Ultrasound of the optic nerve sheath is a widely accepted noninvasive choice for measurement of increased intracranial pressure. With a diameter of 5.0 to 5.9 mm or more, the diagnosis of intracranial hypertension can be assumed with high sensitivity and specificity, although its use should be individualized in each neurocritical pathology. The learning curve for carrying out the procedure is short and satisfies the necessary skills(AU)

Implementación de telerradiología en neurotrauma en áreas de difícil acceso-revisión sistemática / Implementation of teleradiology in neurotrauma in areas of difficult access - systematic review

ABSTRACT: Introduction: According to the world health organization, injuries represent more than 20% of health problems in the world. Head trauma and the absence of neurosurgery and radiology services in less populated areas make it difficult to assess and manage patients with brain injury. Objective: To describe the clinical findings and benefits derived from the implementation of teleradiology in neurotrauma in areas of difficult geographic access. Materials and methods: A systematic search was carried out in Pubmed, Scopus, Ebsco host, Sciencedirect, and Embase, with the thesauri "Teleradiology" and "Craniocerebral Trauma". Results: The decision to intervene in a patient with brain trauma and the period of time until surgery are essential for the clinical outcome. Those centers that use teleradiology require transfers to specialized hospitals, for which portable technological devices contribute to the response time of neurosurgery care. Conclusion: Teleradiology has a positive impact on patients with traumatic brain injury in geographical areas of difficult access, facilitating communication with specialists; providing timely care and optimizing transfers to high complexity centers.

RESUMEN: Introducción: Según la organización mundial de la saludlos traumatismos representan más del 20% de los pro-blemas en salud en el mundo. El trauma craneoencefálico y la ausencia de servicios de neurocirugía y radiología en zonas menos pobladas dificultan la valoración y manejo de pacientes con lesión cerebral. Objetivo: Describir los hallazgos clínicos y beneficios derivados de la implementación de la telerradiología en neurotrauma en áreas de difícil acceso geográfico. Materiales y métodos: Se realizó una búsqueda sistemática en Pubmed, Scopus, Ebsco host, Sciencedirect, y Embase, con los tesauros "Teleradiology" y "Craniocerebral Trauma". Resultados: La decisi-ón de intervenir a un paciente con traumatismo cerebral y el periodo de tiempo hasta la cirugía son fundamentales para el desenlace clínico. Aquellos centros que usan la telerradiología, precisan los traslados a los hospitales espe-cializados, por lo cual los dispositivos tecnológicos portátiles contribuyen en el tiempo de respuesta de la atención en neurocirugía. Conclusión: La telerradiología impacta positivamente en pacientes con trauma craneoencefálico en zonas geográficas de difícil acceso, facilitando la comunicación con especialistas; brindando atención oportuna y optimizando los traslados a centros de alta complejidad. (AU)

The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma / Associação entre a pressão intracraniana e o diâmetro da bainha do nervo óptico em pacientes com traumatismo cranioencefálico

Abstract Background: Although intracranial pressure (ICP) monitoring is the gold standard method for measuring intracranial pressure after traumatic brain injury, optic nerve sheath diameter (ONSD) measurement with ultrasound (US) is also used in the evaluation of ICP. Objective: To investigate the association between a series of OSND measurements by US and changes in clinical presentation of the patient. Methods: Prospective study including 162 patients with traumatic brain injury. Age, sex, cerebral CT findings, ONSD levels by US at minutes 0, 60, and 120, Glasgow Coma Scale (GCS) within same period, change of consciousness, treatment, and mortality data were reviewed. The association of ONSD levels with GCS, change of consciousness, treatment, and mortality was evaluated. Results: There was no difference in ONSD changes in the patients' sample within the period (p=0.326). ONSD significantly increased in patients who died (p<0.001), but not in those who survived (p=0.938). There was no significant change in ONSD of the patients who received anti-edema therapy (p=801), but significantly increased ONSD values were found in those who received anti-edema therapy (p=0.03). Patients without change of consciousness did not have any significant change in ONSD (p=0.672), but ONSD values increased in patients who consciousness became worse, and decreased in those who presented a recovery (respectively, p<0.001, p=0.002). A negative correlation was detected between ONSD values and GSC values measured at primary, secondary, and tertiary time periods (for all p<0.001). Conclusions: ONSD follow-up may be useful to monitor ICP increase in patients with acute traumatic brain injury.

RESUMO Antecedentes: Embora o monitoramento da pressão intracraniana (PIC) seja o método padrão-ouro para medir a pressão intracraniana após lesão encefálica traumática, a medição do diâmetro da bainha do nervo óptico (DBNO) com ultrassom (US) também é usada na avaliação da PIC. Objetivo: Investigar a associação entre uma série de medidas de DBNO por US e mudanças na apresentação clínica do paciente. Métodos: Estudo prospectivo incluindo 162 pacientes com traumatismo cranioencefálico. Idade, sexo, achados de TC cerebral, níveis de DBNO por US nos minutos 0, 60 e 120, Escala de Coma de Glasgow (GCS) no mesmo período, mudança de consciência, tratamento e dados de mortalidade foram revisados. A associação dos níveis de DBNO com GCS, mudança de consciência, tratamento e mortalidade foi avaliada. Resultados: Não houve diferença nas mudanças de DBNO na amostra de pacientes no período (p=0,326). O DBNO aumentou significativamente em pacientes que morreram (p<0,001), mas não naqueles que sobreviveram (p=0,938). Não houve mudança significativa no DBNO dos pacientes que receberam terapia antiedema (p=801), mas valores significativamente aumentados de DBNO foram encontrados naqueles que receberam terapia antiedema (p=0,03). Pacientes sem alteração da consciência não tiveram alteração significativa no DBNO (p=0,672), mas os valores do DBNO aumentaram nos pacientes que pioraram a consciência e diminuíram naqueles que apresentaram recuperação (respectivamente, p<0,001, p=0,002). Detectou-se correlação negativa entre os valores de DBNO e os valores de GSC medidos nos períodos primário, secundário e terciário (para todos, p<0,001). Conclusões: O acompanhamento do DBNO pode ser útil para monitorar o aumento da PIC em pacientes com lesão cerebral traumática aguda.

Vigilancia epidemiológica del Traumatismo Encéfalo Craneano (TEC) en el Hospital San Bernardo de la Provincia de Salta, Argentina / Epidemiological surveillance of Cranial Brain Injury (TEC) at the San Bernardo Hospital in the Province of Salta, Argentina

Introducción: El TEC es una de las principales causas de discapacidad y muerte en nuestra sociedad. Tiene una mortalidad que ronda el 30% y una morbilidad cercana al 60%1, 2, 3, 4, 5.No hay un estudio estadístico epidemiológico exhaustivo sobre TEC en Argentina, por tal motivo la finalidad de este trabajo es conocer la epidemiología de esta patología en el Hospital San Bernardo (HSB) de Salta. Materiales y métodos: Se realizó un trabajo observacional transversal prospectivo. Se incluyeron todos aquellos pacientes que ingresaban al HSB desde agosto de 2014 hasta agosto de 2015 por el servicio de guardia con diagnóstico de TEC asociado o no a politraumatismo. Para el análisis estadístico se utilizó la versión 3.3.3. del Software R para Windows. Resultados: Se estudiaron un total de 1.496 pacientes de los cuales 76% fueron de sexo masculino y 24% femenino. El 84% de los TEC son leve, el 13% moderado y el 4% grave. Según el mecanismo del trauma, el 39% fue por accidente de tránsito, el 32% fue por agresión física y el 22% por caídas. El 19% de los pacientes fue internado. Los días promedio de internación son 10,27. De los pacientes internados, el 27% requirió cirugía de urgencia. Evaluado el GOS, el 19% tuvo GOS 1, 46% GOS 2 ­ 4 y 35% GOS 5. Conclusión: El TEC es una patología que afecta principalmente a adultos varones jóvenes. Las causas más frecuentes en nuestro medio son los accidentes de tránsito y la agresión física. El TEC en nuestro medio presenta una mortalidad global del 19%, con una morbilidad del 47%. Los datos estadísticos de nuestro Hospital referentes al TEC son concordantes con la bibliografía mundial

Introduction: Head Trauma (TBI) is one of the main causes of disability, death and economic loss in our society. It has a mortality of around 30% and a morbidity close to 60%1, 2, 3, 4, 5.There is no exhaustive statistical study on TBI in Argentina, for this reason the purpose of this project is to know the San Bernardo Hospital epidemiology of this pathology. Materials and methods: A prospective cross-sectional observational study was carried out. Patients who were admitted to the San Bernardo Hospital emergency department from August 2014 to August 2015 with a diagnosis of TBI associated or not with multiple trauma were included. Version 3.3.3 was used for statistical analysis of the R Software for Windows. Results: A total of 1.496 patients were studied, of which 76% were male and 24% female, with range of 14 ­ 97 years old (Table 4). 84% of TBI were mild, 13% moderate, and 4% severe. According to the mechanism of trauma, 39% was due to a traffic accident, 32% was due to physical aggression and 22% due to falls. 19% of the patients were hospitalized. The average days of hospitalization are 10.27. Of the hospitalized patients, 27% required emergency surgery. The patients GOS was 19% GOS 1, 46% GOS 2 ­ 4 and 35% GOS 5. Conclusion: TBI is a prevalent pathology that affects mainly young male adults. The most frequent cause in our environment are traffic accidents and physical aggression. TBI in our setting presents an overall mortality of 19% with a morbidity of 47%. Statistics of diagnosis and treatment of patients with TBI in our Hospital are similar to those published in the world bibliography and guidelines

Surgical Treatment of Carotid-cavernous Fistula Performed through the Brazilian Unified Health System

Introduction The carotid-cavernous fistula (CCF) is an abnormal communication between the arterial carotid system and the cavernous sinus. In most cases, spontaneous fistulas are due to the rupture of intracavernous carotid artery aneurisms. Traumatic fistulas occur in 0.2% of head injuries, and 75% of all CCFs are caused by automobile accidents or penetrating traumas. Objective To identify the data regarding the number of annual procedures, hospital expenses, length of hospital stay, and the number of deaths of patients admitted by the Brazilian Unified Health System (SUS, in the Portuguese acronym), in the period between 2007 and 2017, using the surgical code of the surgical treatment for CCF. Methods The present was an ecological study whose data were obtained by consulting the database provided by the Department of Computer Sciences of the Brazilian Unified Health System (Datasus, in Portuguese). Results A total of 85 surgical procedures were performed for the treatment of CCFs from January 2007 to October 2017 through the Unified Health System (SUS, in Portuguese), and there was a reduction of 71.42% in this period. The annual incidence of patients undergoing this surgical treatment during the period observed remained low, with 1 case per 13,135,714 in 2007, and 1 case per 51,925,000 in 2017. Conclusion Despite the low annual incidence of the surgical treatment of CCFs performed by the SUS in Brazil in the period of 2007­2017, based on the data obtained on the average length of stay and expenditures in hospital services, it is necessary that we develop an adequate health planning.

Glaucoma de células fantasmas secundario a Síndrome de Terson en un ojo fáquico / Secondary ghost cell glaucoma a Terson syndrome in a phakic eye

Paciente masculino con antecedente de trauma craneoencefálico severo recibido en la unidad de emergencia con una puntuación en la escala de Glasgow de 3 puntos; se describió en la tomografía computarizada un hematoma frontal epidural y una hemorragia subdural aguda; fue intervenido quirúrgicamente por neurocirugía en la Unidad de Emergencias y posteriormente fue llevado a la unidad de cuidados intensivos donde durante la recuperación (2 meses) refirió disminución de la agudeza visual en ojo izquierdo; fue evaluado en el servicio de Oftalmología donde la agudeza visual del ojo derecho fue de 20/40 y en ojo izquierdo no percibe la luz, en la evaluación oftalmológica se evidencia la presión intraocular en ojo izquierdo de 44mmHg, abundante celularidad en cámara anterior y a la evaluación ultrasonografía de cámara vítrea se describe una imagen que se correlaciona con una aparente hemorragia vítrea. Se diagnostica con Glaucoma de células fantasmas y síndrome de Terson; se inicia tratamiento médico con antiglaucomatoso para el glaucoma de células fantasmas y expectante para el síndrome de Terson, a la semana debido a la pobre respuesta se realizó trabeculectomia y vitrectomía vía Pars plana, posterior al tratamiento oftalmológico, se describió una visión de ojo izquierdo de 20/200

Male patient with a history of severe head trauma received in the emergency unit with a Glasgow coma score of 3; radiologically, an epidural frontal hematoma and an acute subdural hemorrhage are described in the computed tomography; the patient underwent surgery in the Emergency Unit and was later admitted to the intensive care unit where during recovery (2 months) he reported decreased visual acuity in the left eye; is evaluated in the ophthalmology service where is found a visual acuity of the right eye with correction of 20/40 and the left eye does not perceive light, the ophthalmology evaluation shows an intraocular pressure of the left eye of 44mmHg, abundant cellularity in the anterior chamber and in the ultrasound evaluation of the vitreous chamber describes an image that correlates with an apparent vitreous hemorrhage. He is diagnosed with Ghost Cell Glaucoma and Terson Syndrome; Medical treatment with antiglaucoma treatment for Ghost cell glaucoma and expectant for Terson syndrome is started. After a week due to the poor response, a trabeculectomy and vitrectomy via pars plana was performed, after ophthalmological treatment, a vision of the left eye of 20/200 was described

Hematoma subdural crónico / Chronic subdural hematoma

El hematoma subdural crónico (HSC) es una patología neuroquirúrgica frecuente, que se reconoce como consecuencia de traumatismos craneoencefálicos de poca magnitud que habitualmente se diagnostican en pacientes seniles, aunque puede presentarse en pacientes jóvenes y sin antecedentes de traumas.El objetivo que persigue este trabajo es la presentación de una paciente con un HSC bilateral, con características poco usuales.Caso clínico: se presenta una paciente del sexo femenino, de 46 años de edad, sin antecedente de traumatismo craneal ni de otra patología concomitante, que consulta por una cefalea de 15 días de evolución. El examen físico constató midriasis, pupila de Hutchinson, papiledema bilateral y exoforia del ojo derecho, parálisis del tercer par craneal y ataxia de tronco, fue catalogada con Glasgow 13. Se realizó tratamiento anti edema cerebral temprano y las manifestaciones desaparecieron en gran medida. En la Tomografía axial computarizada se diagnosticó un hematoma subdural frontotemporal bilateral con desplazamiento de las estructuras de la línea media a la izquierda. Fue operada de urgencia y dada de alta completamente recuperada tres días después.Conclusión: el HSC puede presentarse con distintas formas clínicas, simulando procesos expansivos tumorales, ataques cerebrovasculares, demencias o entidades neurológicas de otra índole. El manejo del caso por clínicos y neurocirujanos fue rápido y efectivo, lo que explica que la paciente tuvo una recuperación temprana y total. En estos casos la actuación médica es decisiva en el éxito del tratamiento.

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma.The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics.Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson's pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.