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.

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.

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.

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.

Traumas cerebrales en niños secundarios a cabeceo de balones en fútbol: Modelo de simulación matemática / Mathematical simulation of mild brain injury in children heading soccer balls

Background: Heading professional soccer balls can generate mild traumatic brain injury in children. The long-term consequences could include difficulty in solving problems and deficits in memory and language. Aim: To assess the impact of a professional adult soccer ball on a child´s head, using the finite element method and dynamic effects to predict brain damage. Material and Methods: The minimum conditions of an adult game were considered: the ball speed was 6 m/s and the diffuse blow was 345 and 369 Newtons (N), on the forehead and top of the head, respectively. A head was modeled in order to know the stresses, strains and displacements generated by the impacts. The extent of the alteration was determined by comparing the strength of brain tissue, with predictions of computed stresses. The geometric characteristics of the head were transferred from medical images. The input data of the materials of a child´s head was obtained from the literature. Results: In the case of heading with the forehead, mathematical simulation showed frontal lobe alterations, with brain stresses between 0.064 and 0.059 N/mm2. When the heading was with the upper head zone, the brain alterations were in the parietal lobe, with stresses between 0.089 and 0.067 N/mm². In the cerebral spinal fluid the pressure was 3.61 to 3.24 N/mm2. Conclusions: The mathematical simulations reveal evidence of brain alterations caused by a child heading adult soccer balls. The model presented is an economical and quick tool that can help predict brain damage. It demonstrates the ability of the cerebral spinal fluid (CSF) to absorb shock loads.

Blow-in fracture of the orbital roof presenting as a case of non-resolving choroidal effusion.

A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.

Pattern of fatal blunt head injury: A two year retrospective / prospective medico legal autopsy study.

The current study was conducted from 1 November 2002 to 31 October 2004 at Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai. A total of 189 victims of fatal blunt head injury were recorded and a complete medicolegal autopsy was conducted on each of these victims during this period. The postmortem study revealed that males were the most common victims with the highest number being in the age group of the third and fourth decades. Accidents were responsible for most of them, followed by homicidal deaths, with suicides recorded as the least. Of the accidents, railway accidents were responsible for the maximum number. The study revealed that the highest number of fatalities occurred during the peak hours of the day. The fissured fracture was the most common type of fracture observed. Among the specialized fractures of the base of the skull, type-1 hinge fracture was the most common. A combination of subdural and subarachnoid haemorrhages was the most common observation. Blunt cranio-cerebral injury was the primary cause of death in more than half of the victims

Central retinal artery occlusion associated with traumatic carotid cavernous fistula: case report

Carotid cavernous fistulas are a rare entity occurring as result of head trauma and also spontaneously. The authors report a rare case of central retinal artery occlusion complicating traumatic carotid-cavernous fistula, resulting in severe visual acuity loss. Spontaneous closure of the fistula was observed. The possible mechanisms responsible for this complication are discussed.

Fístulas carótido-cavernosas são raras e ocorrem como resultado de trauma cefálico e também espontaneamente. Os autores relatam um caso raro de oclusão de artéria central da retina complicando fístula carótido-cavernosa traumática, resultando em perda grave da acuidade visual. Fechamento espontâneo da fístula foi observado. Os possíveis mecanismos responsáveis por esta complicação são discutidos.

Traumatic pseudoaneurysm of the superficial temporal artery: case report

A 26 year-old woman suffered a blunt head injury on the left temporal area and developed an arteriovenous fistula with a pseudoaneurysm on the superficial temporal artery. These fistulas are rare and usually associated with pseudoaneurysms, most commonly in the frontal arterial branch. The aneurysms generally appear late after trauma and present as a pulsatile painfully growing mass in the temporal region, associated with fremitus and bruit. The diagnosis is made by angiography and surgery is a very effective treatment.

Uma mulher de 26 anos desenvolveu uma fístula arteriovenosa associada a pseudoaneurisma da artéria temporal superficial após traumatismo craniano fechado. Tais fístulas são raras e geralmente associadas a pseudoaneurismas da artéria temporal superficial, mais comumente do ramo frontal. As lesões habitualmente surgem tardiamente em relação ao traumatismo causador e se manifestam como uma massa dolorosa pulsátil na região temporal, crescente, associada à frêmito e sopro. O diagnóstico é confirmado através de arteriografia e o tratamento cirúrgico proporciona ótimos resultados.

Bilateral internuclear ophthalmoplegia following head injury.

A 40-year-old female after a closed head injury presented with bilateral internuclear ophthalmoplegia. Attempted convergence was abnormal and MRI revealed the focal hemorrhage in the medial longitudinal fasciculus region by showing bright signal in the a pontomesencephalic region in the midline on both T1 and T2 weighted images. The patient regained normal ocular mobility after six months of the injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, is an unusual and rare finding, particularly in patients victims of head injury without further neurological signs. Isolated internuclear ophthalmoplegia should be considered in the differential diagnosis when one encounters an adduction deficit in a patient suffering head injury.

Traumatic superficial temporal artery aneurysm.

Traumatic aneurysm of the superficial temporal artery is an uncommon lesion. Two cases of post-traumatic superficial temporal artery aneurysm are presented.

Acinetobacter meningitis following head trauma.

A case of acinetobacter meningitis following head injury in a patient who developed cerebrospinal fluid otorrhea, and did not have any neurosurgical procedure, is presented. Previously reported cases are cited, with a review of the literature. Pefloxacin monotherapy is associated with a poor clinical response.

Estudo de caso de um paciente com dislexia periférica e as implicaçöes dessa condiçäo nos processamentos centrais / Study of case of a patient with peripherical dyslexia

O presente estudo descreve o procedimento de avaliaçäo das capacidades de leitura de um paciente com dislexia adquirida, decorrente de traumatismo cranioencefálico. A avaliaçäo de sua leitura através do método psicolinguístico (leitura de palavras e de näo-palavras isoladas) mostrou efeitos exagerados de extensäo, de frequência e lexical, assim como maior tempo de processamento de palavras que possuem grafemas que necessitam de contexto para sua correta conversäo em fonemas. Provas específicas apontaram integridade das memórias envolvidas nas vias lexical e perilexical. A hipótese de falhas visuais foi confirmada pela maior dificuldade em identificar igualdade e diferença de estímulos gráficos visualmente semelhantes. Tal estudo sugere que o efeito de extensäo e de interferência das regras contextuais säo cinsequência de uma leitura letra-por-letra, enquanto os efeitos de frequência e o lexical-näo esperados neste quadro-demonstram a utilizaçäo de estratégias top-down no processamento literal