Resultados del manejo no operatorio en trauma hepático de los pacientes que se presentaron al servicio de urgencias del Hospital San Vicente Fundación, Medellín / Outcomes of non-operative management of liver trauma in patients who presented to the Emergency Department of Hospital San Vicente Fundación, Medellín

Introducción. El hígado continúa siendo uno de los órganos más afectados en los pacientes con trauma. Su evaluación y manejo han cambiado sustancialmente con los avances tecnológicos en cuanto a diagnóstico y las técnicas de manejo menos invasivas. El objetivo de este estudio fue realizar un análisis de los resultados del manejo no operatorio del trauma hepático en cuanto a incidencia, eficacia, morbimortalidad, necesidad de intervención quirúrgica, tasa y factores relacionados con el fallo del manejo no operatorio. Métodos. Se realizó un estudio descriptivo observacional retrospectivo, analizando pacientes con trauma hepático confirmado con tomografía o cirugía, durante un periodo de 72 meses, en el Hospital Universitario San Vicente Fundación, un centro de IV nivel de atención, en Medellín, Colombia. Resultados. Se incluyeron 341 pacientes con trauma hepático, 224 por trauma penetrante y 117 por trauma cerrado. En trauma penetrante, 208 pacientes fueron llevados a cirugía inmediatamente, el resto fueron manejados de manera no operatoria, con una falla en el manejo en 20 pacientes. En trauma cerrado, 22 fueron llevados a cirugía inmediata y 95 sometidos a manejo no operatorio, con una falla en 9 pacientes. La mortalidad global fue de 9,7 % y la mortalidad relacionada al trauma hepático fue de 4,4 %. El grado del trauma, el índice de severidad del trauma y las lesiones abdominales no hepáticas no se consideraron factores de riesgo para la falla del manejo no operatorio. Conclusiones. El manejo no operatorio continúa siendo una alternativa segura y efectiva para pacientes con trauma hepático, sobretodo en trauma cerrado. En trauma penetrante se debe realizar una adecuada selección de los pacientes.

Introduction. The liver continues to be one of the most affected organs in trauma patients. Its evaluation and management have changed substantially with technological advances in diagnosis and less invasive techniques. The objective of this study was to perform an analysis of the results of non-operative management of liver trauma in terms of incidence, efficacy, morbidity and mortality, need for surgical intervention, rate and factors related to the failure of non-operative management.Methods. A retrospective observational descriptive study was performed, analyzing patients with hepatic trauma confirmed by tomography or surgery, during a period of 72 months at the Hospital Universitario San Vicente Fundación level 4 medical center, in Medellín, Colombia.Results. 341 patients with liver trauma were analyzed, 224 with penetrating trauma and 117 with blunt trauma. In the penetrating trauma group, 208 patients were taken to surgery immediately, the rest were managed nonoperatively with a failure in 20 patients. In the blunt trauma group, 22 were taken to immediate surgery and 95 underwent nonoperative management, with failure in nine patients. Overall mortality was 9.7% and mortality related to liver trauma was 4.4%. Trauma grade, trauma severity index, and non-hepatic abdominal injuries were not considered risk factors for failure of nonoperative managementConclusions. Nonoperative management continues to be a safe and effective alternative for patients with liver trauma, especially in blunt trauma. In penetrating trauma, an adequate selection of patients must be made.

Head injury burden in a major referral hospital emergency centre in Botswana

Introduction:This study describes the demographics, aetiology, emergency centre diagnosis and severity indicators of patients with head injuries presenting to the largest referral hospital emergency centre in Botswana.Methods:Cross-sectional retrospective data was collected from July 2015 to September 2015 for all emergency centre head injury presentations at Princess Marina Hospital. Information was extracted from emergency centre records regarding patient demographics, mechanism of injury, clinical observations, diagnosis, and treatment.Results:Three-hundred and sixty head injury patients presented to the emergency centre in the three months, averaging four per day. 80% were less than 40 years of age and males accounted for 69% of all presentations. 58% of injuries were listed as being accidental, 39% recorded from assaults and 38% from road traffic accidents. The most common emergency centre clinical diagnosis was concussion and the most common radiological diagnosis skull fracture. The median Glasgow Coma Scale was 15 with a range from 3 to 15; and, among patients for whom Revised Trauma Score could be calculated, 79% scored the lowest probability of death in the Revised Trauma Score.Discussion:Head injury disproportionately overburdened males in this study, and head injury aetiology and demographic picture was similar to regional data. Severity scoring using the Glasgow Coma Scale was only available among 66% of patients and Revised Trauma Score calculable in half of presentations. Only 55% of head injury patients were discharged from the emergency centre, despite the preponderance of low severity scores. Head CTs appear to have been over-utilised and implementation of a Traumatic Head CT guideline for our setting is proposed. This study improves understanding of the burden of head injury in Botswana and advocates for national referral guidelines for patients with head injury in Botswana

Generalidades de trauma cráneo encefálico en medicina legal / Generalities of traumatic brain injury in legal medicine

Resumen:El Trauma Cráneo Encefálico (TCE) tiene hoy en día una incidencia muy alta de morbilidad y mortalidad en nuestra población, por lo que es de suma importancia esclarecer los conceptos básicos de las lesiones producidas por el TCE, su cronología y el pronóstico de dichos traumas. Este artículo se basa en identificar las lesiones primarias y secundarias más frecuentes y las características más importantes de cada una de ellas, así como describir los mecanismos de trauma frecuentemente implicados.

Abstract:The Brain Trauma (TCE) has a very high incidence of morbidity and mortality in its population today, so it is very important to clarify the basic concepts of the injuries produced by the TCE, its timing and the prognosis of these traumas. This article is based on identifying the most frequent primary and secondary lesions and the most important characteristics of each, as well as describing the mechanisms of trauma frequently involved

Clinical Features of Patients with Labyrinthine Concussion after Head Trauma

OBJECTIVE: Blunt head injury can lead to isolated damage of the inner ear (cochlear labyrinthine concussion) or damage of the otolith organ (vestibular labyrinthine concussion) due to a bone conduction pressure. We evaluated the clinical characteristics of hearing impairment in patients who suffered from a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. METHODS: This retrospective study examined 9 patients presenting with hearing impairment after blunt head trauma within recent 5 years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients complained of associated auditory symptoms including tinnitus, dizziness, earfullness, and otalgia. Twelve ears of 9 patients showed sensorineural hearing loss; mild (1 ear), moderate (3 ears), moderate-severe (4 ears), severe (2 ears), and profound (2 ears). After high-dose steroid therapy, 2 ears had a significant hearing gain, but 10 ears showed no improvement of hearing. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head trauma, we performed a CT angiogram to exclude any vascular abnormalities. The CT angiogram showed no vascular abnormality. She was discharged after conservative treatment. One day after discharge, she returned to the emergency department because of mental deterioration. Brain CT showed diffuse SAH, which was dominant in the right Sylvian fissure. The CT angiogram revealed a right middle cerebral artery bifurcation aneurysm. During operation, a non-traumatic true saccular aneurysm was found. The patient recovered fully after successful clipping of the aneurysm and was discharged without neurologic deficit. Normal findings on a CT angiogram do not always exclude aneurysmal SAH. Follow-up vascular study should be considered in trauma patients who are highly suspicious of aneurysmal rupture.

Traumatic arteriovenous fistula associated to pseudoaneurysm of the superficial temporal artery in a child: case report and literature review / Fístula arteriovenosa traumática associada a pseudoaneurisma da artéria temporal superficial em uma criança: relato de caso e revisão da literatura

As fístulas arteriovenosas (FAVs) e os pseudoaneurismas traumáticos extracranianos são malformações incomuns e, em sua maioria, estão associadas a traumatismo craniano fechado com lesão contusa de forte intensidade. O diagnóstico em geral é clínico, porém o exame de escolha para o diagnóstico definitivo é a angiografia. Nos casos em que a lesão é pequena, é possível abordá-la com embolização via endovascular com sucesso. A excisão cirúrgica, no entanto, ainda é o método de escolha para o tratamento. É relatado um caso de um paciente do sexo masculino, com 9 anos de idade, diagnosticado com FAV, acometendo o ramo frontal da artéria temporal superficial, secundária a trauma craniano contundente ocorrido três anos antes do diagnóstico.

The arteriovenous fistulae (AVFs) and the extracranial traumatic pseudoaneurysms are uncommon malformations and in the majority of the cases are associated to closed head trauma with high intensity blunt lesion. The diagnosis is generally clinical, though the exam of choice for definitive diagnosis is an angiography. In minor lesion cases it's possible to successfully approach it with endovas-cular embolization. The surgical excision though, is the method of choice for the treatment. Here is reported a case of a 9-year-old male patient, diagnosed with AVF involving the frontal branch of the superficial temporal artery, secondary to blunt head trauma occurred three years before diagnosis.

Cerebellar mutism following closed head injury in a child

Cerebellar mutism is a rare occurrence following paediatric trauma. Although it is quite common after posterior fossa surgery in children, this phenomenon has rarely been reported following other insults, such as trauma, and its pathophysiology remains poorly understood. We report a seven-year-old child who presented to the casualty department of Sultan Qaboos University Hospital in Muscat, Oman, in May 2013 with a traumatic right cerebellar contusion. The child presented with clinical features of cerebellar mutism but underwent a rapid and spontaneous recovery. The possible mechanism of this occurrence is discussed

Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

Lesiones de múltiples nervios craneales luego de traumatismo craneal cerrado: reporte de caso y revisión del tema / Multiple cranial nerve injuries following closed head trauma: case report and review

La lesión de los nervios craneales es un acompañamiento común de un trauma en la cabeza. Lesiones de los nervios craneales asociados con la lesión cerrada de la cabeza ha sido encontrado para ser asociado con una mayor gravedad de la lesión. Los objetivos de este estudio son documentar la incidencia de lesiones de los nervios craneales en lesiones en la cabeza, que se correlaciona con la incidencia de los hallazgos radiológicos, para evaluar el tiempo de recuperación con respecto a los signos y síntomas en la presentación inicial. Se presenta un caso de un varón de 51 años de edad, con lesiones nerviosas del segundo, sexto, séptimo, octavo, noveno y décimo después de una lesión grave en la cabeza. Lo admitieron a la víctima con un historial de conducir una motocicleta utilizando un casco y con una caída a alta velocidad. Su Resonancia Magnética (RM) presenta contusión en el tronco cerebral y su tomografía computarizada (TC) simple mostró pequeña hemorragia a la derecha del tronco cerebral y el paciente fue tratado de forma conservadora. Por otra parte, si se detectan múltiples lesiones de los nervios craneales hay una necesidad de evaluar más a fondo la lesión del tronco cerebral por RM con el fin de evaluar mejor el tronco cerebral. La mayoría de las lesiones de los nervios craneales pueden recibir tratamento conservador, aunque algunos autores indican intervención quirúrgica temprana para el tratamiento de la parálisis facial con fractura a través del canal facial.

Injury to the cranial nerves is a common accompaniment of head trauma. Cranial nerve injuries associated with closed head trauma has been found to be associated with injuries of a higher severity. The incidence of cranial nerve injury in head trauma varies in the literature, ranging from 5 to 23 percent. The objectives of this study are: to document the incidence of cranial nerve injuries in head trauma; to correlate the incidence with radiological findings and to assess recovery time according with signs and symptoms at initial presentation. We report a case of a 51-year-old male having second, sixth, seventh, eighth, ninth and tenth nerve injuries after severe head trauma. He was admitted after an accident with a history of riding a motorcycle wearing a helmet and falling at high speed. Study by Magnetic Resonance Imaging (MRI) of this case presented stem contusion and a plain Computerized Tomography (CT) showed small hemorrhage on the right of the brain stem. The patient was managed conservatively. Multiple cranial nerve palsies after head injury may not carry a bad prognosis as previously thought, and may be reversible. Moreover, if multiple cranial nerve injuries are detected, a better evaluation of the stem brain is needed by MRI in order to evaluate possible lesions in this site. The majority of the cranial nerve injuries are treated conservatively, although some authors indicate early surgical intervention to treat facial palsy with fracture through the facial canal.

Visualization of a Traumatic Pseudoaneurysm at Internal Carotid Artery Bifurcation due to Blunt Head Injury: A Case Report / 대한신경손상학회지

Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.

Trombosis de seno venoso secundaria a traumatismo encéfalo craneano: caso clínico / Cerebral vein thrombosis secondary to closed head injury: Report of one case

Intracranial sinus thrombosis (1ST) after closed head injury is an uncommon but potentially serious complication. It has no correlation with the severity of the injury. The symptoms and clinical course are highly variable. The most frequent but least specific symptom is severe headache. Cerebral lesions and neurologic signs develop in half of patients with IST. We report a 29 year-old male who had an IST after a severe closed head injury. The patient initially developed headache and had later 2 secondarily generalized seizures. The magnetic resonance imaging showed a superior sagittal sinus thrombosis. Anticoagulation with unfractionated heparin and intravenous phenytoin was started. At the moment of this report he is asymptomatic and continues with oral anticoagulants and phenytoin.

Dementia Pugilistica with Clinical Features of Frontotemporal Dementia and Parkinsonism: Case Report

Dementia pugilistica (DP) or chronic traumatic encephalopathy (CTE) is a neurodegenerative disease or dementia that may affect amateur or professional boxers as well as athletes in other sports who suffer concussions. The condition is thought to affect around 15% to 20% of professional boxers and caused by repeated concussive or subconcussive blows. CTE was in the past referred to as dementia pugilistica, which reflected the prevailing notion that this condition was restricted to boxers. Recent research, however, has demonstrated neuropathological evidence of CTE in retired American football players, a professional wrestler, a professional hockey player and a soccer player, as well as in nonathletes. It is probable that many individuals are susceptible to CTE, including those who experience falls, motor vehicle accidents, assaults, epileptic seizures, or military combat, and that repeated mild closed head trauma of diverse origin is capable of instigating the neurodegenerative cascade leading to CTE. We report a 62-year old man suspicious of dementia pugilistica with clinical features of frontotemporal dementia and parkinsonism.

Isolated Oculomotor Nerve Palsy Following Minor Head Trauma : Case Illustration and Literature Review

Isolated oculomotor nerve palsy (ONP) attributable to mild closed head trauma is a distinct rarity. Its diagnosis places high demands on the radiologist and the clinician. The authors describe this condition in a 36-year-old woman who slipped while walking and struck her face. Initial computed tomography did not reveal any causative cerebral and vascular lesions or orbital and cranial fractures. Enhancement and swelling of the cisternal segment of the oculomotor nerve was seen during the subacute phase on thin-sectioned contrast-enhanced magnetic resonance images. The current case received corticosteroid therapy, and then recovered fully in 13 months after injury. Possible mechanism of ONP from minor head injury is proposed and previous reports in the literature are reviewed.

Protective effects of carnosine against closed head injury in mice / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the protective effects of carnosine against experimental closed head injury (CHI) in mice.</p><p><b>METHODS</b>The CHI model was established by free-falling weight-drop. Carnosine (250 mg/kg or 500 mg/kg) was administered intraperitoneally 30 min before brain trauma, then q.d for 7 d; while normal saline was administrated for control group. The neurological defect was evaluated by neurological severity score (NSS) within 7 d; the survival rate and the histological alternations were observed.</p><p><b>RESULTS</b>Carnosine prevented the body weight loss of mice at dose of 500 mg/kg; significantly increased the survival rate, and reduced the neurological defect and histological damage at dose of 250 and 500 mg/kg.</p><p><b>CONCLUSION</b>Carnosine can attenuate closed head injury in mice.</p>

Analysis of cranio-cerebral injuries by blunt force.

Despite current advances in public education and in automobile safety requirements, cranio-cerebral injuries continues to be a major cause of morbidity and mortality and accounts for significant portion of health care costs today. Trauma respects neither geography nor body systems. Consequently head injury occurs every 15 seconds and a patient dies from a head injury every 12 minutes, a day doesn’t pass that an emergency department physician is not confronted with a head injured patient. The present work is based on the observation and study made on 117 cases collected. These cases include 39 cases who died before being admitted to any hospital and were sent directly by the police to postmortem, Mysore Medical College, Mysore, and 78 cases that died in the hospital under medical care. Clinical data are available for 78 cases that died in the hospital after undergoing some treatment. An attempt is made in these cases to correlate clinical findings with the autopsy findings.

Closed head injury in rats: histopathological aspects in an experimental weight drop model / Trauma craniano fechado em ratos: aspectos histopatológicos em um modelo experimental de queda de peso

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.

OBJETIVO: Investigar as alterações histopatológicas produzidas por um modelo de trauma craniano fechado por queda de peso em ratos. MÉTODOS: Utilizando uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida, 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0,762J e 1J respectivamente e G5 (Sham). Sob analgesia, cada grupo teve seus encéfalos coletados e processados para análise histopatológica por microscopia óptica convencional. RESULTADOS: Houve maior número de neurônios lesados em animais do grupo 4, mas morte neuronal também pôde ser constatada nos animais do grupo 5. Hemorragias parenquimatosas foram mais frequentes nos animais do grupo 4 e o inchaço cerebral citotóxico e congestão vascular foram mais intensos neste grupo. CONCLUSÃO: Os achados à análise histopatológica permitem observar alterações típicas do trauma craniano e estas guardaram proporção direta com a energia do impacto.

Delayed-onset bilateral abducens paresis after head trauma.

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

Establishment of a blunt impact-induced brain injury model in rabbits / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish an animal model to replicate the blunt impact brain injury in forensic medicine.</p><p><b>METHODS</b>Twenty-four New Zealand white rabbits were randomly divided into control group (n equal to 4), minor injury group (n equal to 10) and severe injury group (n equal to 10). Based on the BIM-II Horizontal Bio-impact Machine, self-designed iron bar was used to produce blunt brain injury. Two rabbits from each injury group were randomly selected to monitor the change of intracranial pressure (ICP) during the impacting process by pressure microsensors. Six hours after injury, all the rabbits were dissected to observe the injury morphology and underwent routine pathological examination.</p><p><b>RESULTS</b>Varying degrees of nervous system positive signs were observed in all the injured rabbits. Within 6 hours, the mortality rate was 1/10 in the minor injury group and 6/10 in the severe injury group. Morphological changes consisted of different levels of scalp hematoma, skull fracture, epidural hematoma, subdural hematoma, subarachnoid hemo- rrhage and brain injury. At the moment of hitting, the ICP was greater in severe injury group than in mild injury group; and within the same group, the impact side showed positive pressure while the opposite side showed negative pressure.</p><p><b>CONCLUSIONS</b>Under the rigidly-controlled experimental condition, this animal model has a good reproducibility and stable results. Meanwhile, it is able to simulate the morphology of iron strike-induced injury, thus can be used to study the mechanism of blunt head injury in forensic medicine.</p>

Forensic medical study on morphology and formative mechanism of blunt head injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise.</p><p><b>METHODS</b>The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries.</p><p><b>RESULTS</b>Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%), followed by suicide (49, 24.3%) and accident (44, 21.8%). The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants.</p><p><b>CONCLUSION</b>Studies on the morphology and its formative rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury.</p>

Apport de l'imagerie médicale dans le bilan des traumatismes crâniens au Niger : à propos de 311 cas à l'Hopital National de Niamey (Niger)

But : Décrire les aspects épidémiologiques et cliniques et évaluer l'apport de l'imagerie médicale en particulier le scanner dans la prise en charge des traumatismes crâniens.Patients et méthodes : Il s'agissait d'une étude prospective de 24 mois (Décembre 2005-Décembre 2007) portantsur 311 patients (270 hommes et 41 femmes, sexe ratio=6,5) âgés de 4 mois à 79 ans, admis à l'hôpital nationalde Niamey pour traumatisme crânien avec notion de perte de connaissance initiale et amnésie post traumatiqueou coma. L'âge moyen était de 27 ans. Les étiologies étaient dominées par les accidents de la voie publique(A.V.P.) (75,24 %). Ces patients ont bénéficié d'un examen tomodensitométrique (T.D.M. ou scanner) et/oud'examens radiographiques complémentaires. Résultats : Lebilan radiologique mettait en évidence une prédominance des lésions parenchymateuses avec 38,28 %. Leslésions osseuses isolées représentaient 14,85 % des cas. Conclusion : lestraumatismes crâniens sont fréquents et particulièrement graves au Niger.L'imagerie médicale et la T.D.M. enparticulier, trouvent une place de choix dans la prise en charge adéquate de ces patients