Shaken baby syndrome in neonate: a clinical masquerade

Abusive head trauma, which is a subset of Shaken baby syndrome, refers to a type of brain injury that occurs when the baby's head is subjected to undesirable forces. The characteristic lack of contributory history often leads to misdiagnosis, delayed treatment and suboptimal clinical outcome. We reported a neonatal presentation of abusive head trauma which posed significant diagnostic challenges. This manuscript depicts our journey to the correct diagnosis and also a review of current literature on abusive head trauma.

Successful management of a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy

Large population-based studies on stroke report that intracerebral haemorrhage is rare in young women however it is a grave and disturbing complication of pregnancy. Preeclampsia is usually clinically silent, but may cause symptoms of neurological dysfunction such as headache, visual disturbances and impairment of consciousness. Eclampsia is in the occurrence of seizures in the context of preeclampsia and is often, but not always, preceded by the above neurological symptoms. Most published data support the view that preeclampsia and eclampsia are important causative factors for pregnancy related ICH. Sparse data is available with respect to the management of such cases. Identification of near miss cases is an important step in reducing mortality. Herein we report a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy.

Effect of Climatological Variables for all Seasons on the Frequency of Incident Stroke Hospitalizations in Scotland.

Background: Stroke is a disease, which has a complex multi-factorial etiology. Non-modifiable risk factors are genetics, familial history, age, sex, ethnicity and race, whereas smoking, drinking, physical activity and diet can be modified to reduce the risk of stroke significantly. Aims: The aim of the present study was to see the association between climate variations and incidence of stroke in Scotland. Methods: We have obtained the stroke data as SMR01 (Scottish Morbidity Record 01) as 1,57,639 incident stroke hospitalization in Scotland between 1986 and 2005. To observe for variation in weather parameter, with first stroke incidences per day, daily mean temperature, total rainfall and average daily atmospheric pressure were compared with the frequency of incident strokes per day using ANOVA (Analysis of Variance). Result: An overall meteorological analysis of incident strokes per day reveals an inverse statistically significant relationship for average daily temperature (P<0.001) whereas total daily rainfall (P=0.03) and average daily atmospheric pressure (P=0.05) exhibit borderline significance. Correlation of low temperature with stroke might be due to the concurrent occurrence of respiratory infections. We suggest some precautionary measures to minimize the chance of stroke i.e. protection from cold weather, decrease alcohol consumption and maintaining blood pressure within a safe range during winter season. Conclusion: Overall, high stroke incidence during winter season is a combined effect of temperature, rainfall, atmospheric pressure.

Clinical and etiological profile of neonatal seizures: a tertiary care hospital based study.

Background: The most vulnerable period of life to develop seizures is the neonatal period. These events very often signify serious damage or malfunction of the immature developing central nervous system. Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Objective: Our study was aimed at finding the incidence, etiological factors, and time of onset, clinical types and various biochemical abnormalities in neonatal seizures. Methods: A hospital based prospective observational study was undertaken in a tertiary care paediatric hospital of Government Medical College Srinagar. A total of 100 consecutive neonates presenting with seizures from September 2013 to August 2014 were enrolled in the study. Detailed antenatal history and baseline characteristics of convulsing neonate were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded. Venous blood was collected as soon as possible and blood glucose, total serum calcium levels, Na+, K+, Mg and P-levels were done immediately after baby had seizures and before instituting any treatment. Data was described as mean ± SE and %age. SPSS 16.0 and MS Excel software were used for data analysis. Results: Cumulative frequency of 3.9% was recorded in neonatal seizures in our setup. Hypoxic ischemic encephalopathy was the commonest etiology of neonatal seizures. Intracranial haemorrhage followed by Hypoxic ischemic encephalopathy was the commonest seizure etiology in preterm neonates. Majority of Hypoxic ischemic encephalopathy patients presented with seizures in the first 72 hrs. of life. Focal clonic and subtle seizures were the commonest seizure types encountered. 17 neonates (31%) had primary metabolic seizures. Hypocalcaemia was the commonest biochemical abnormality in primary metabolic seizures and was present in 70% neonates in this group. Hypoglycaemia was the next commonest abnormality and was present in 41% neonates within this group. Conclusions: Hypoxic ischemic encephalopathy was the commonest etiology with focal clonic and subtle seizures being the commonest clinical types encountered. Hypocalcaemia was the most frequent biochemical abnormality found.

Spontaneous Intracranial Haemorrhage in Children with Chronic Immune Thrombocytopenic Purpura

Spontaneous intracranial haemorrhage (ICH) is a rare complication of chronic immune thrombocytopenic purpura (ITP) in children. We report four patients with cITP who developed ICH. The latency between onset of ITP and ICH varied from 1-8 years. All our patients were profoundly thrombocytopenic (platelet count of <10 x 109/l) at the time of their intracranial bleed. The presenting features and management are discussed. All patients survived, three had complete neurological recovery while one had a minimal residual neurological deficit. KEY WORDS: Chronic immune thrombocytopenic purpura; intracranial haemorrhage; children

Demographic profile of head injury cases in Agra region.

Head injury is a serious health problem throughout the world. Increasing vehicles on roads work as catalyst for high incidence of casualties especially of Cranio-cerebral injuries. This is an autopsy based study of head injury cases, conducted in the Department of Forensic Medicine, S.N. Medical College Agra in year 2009-2010 for their demographic and etiological profile. Majority of the victims of head injury are male (76%) and of 3rd – 4th decade of life (54.4%). 66.4% head injury cases due to accident, Road traffic accident is the single largest cause i.e. 59.2%; out of which two wheelers are responsible for one-third (33%) of the casualties. Most common external injury is laceration of the scalp with or without contusion. Fracture of skull bones (97.2% cases; mostly fissured and comminuted fracture of parietal & temporal) and intracranial hemorrhages (96.4%) are seen in almost all the cases. Contre-coup injuries seen in about 2.8% cases, contre-coup haemorrhage observe mostly fronto-temporal area. Majority of the victim died on the spot or in the way to hospital without any medical assistance where the Cause of death mostly haemorrhage and shock.

Therapeutic effect of Xingnaojing in treatment of 40 patients with intracerebral haematomas / 中国基层医药

Objective To investigate the therapeutic effect of Xingnaojing in treatment of hypertensive cerebral hemorrhage.Methods 90 patients diagnosed as cerebral hemorrhage patient hospitalized were randomly divided into treatment group and control group,treatment group 45 cases,control group 45 cases,including 23 males and 22 females aged 52～75 years(71 ±4).Results Treatment group:After 14 days treatment,neurological deficits had been greatly improved,the total effective was 97.3％ ;Control group:Aftenr treatment,the improvement of neurological deficit was worse,the total effective was 77.3％.Hematoma volume in the two groups did not change significantly after one week treatment,but significant changed after two weeks treatment.There was significant difference between the two groups.Conclusion Xingnaojing had significant effect in treatment of hypertensive cerebral hemorrhage.

The some influential factors and causes of the intracranial haemorrhage among infants / Монголын Анагаах Ухаан

Background: The Incidence of Intracranial haemorrhage (ICH) in childhood compare to adulthood not very common. The multifactorial etiology ICH may involve coagulation disturbance, venousinfarction, infection, heart congenital abnormalities, birth asphyxia and trauma. ICH is a major cause of morbidity and mortality in neonates and it’s related to vitamin K deficiency. The previous studies have shown, that 37.8% of children with Cerebral Palsy and 31.2% of infants with hypoxic-ischemic encephalopathy had ICH and 48.2% of dead premature infants due to ICH. The number of infants with ICH are increasing year by year. Therefore, the aim of this study was to identify and explore influential factors and causes of ICH among infants in own country.Materials and Methods: The present study was conducted atseveral departments such as PICU, neurology, and cardiology of the State Maternal and Child Health Research of Mongolia. Sixty one patient with ICH involved in the case group and one hundred twenty two infants were involved in control group.Statistical methods. The Mann Whitney U and Fisher’sexact tests were used to compare clinical characteristics of thecontrol infants and infants with ICH. Ethics. The present study was approved by the ethics committee of the MoH and MCHRC. Informedparental consent was obtained for each patient before entry into the study.Results: Among children with ICH 95.1% were under one year and just 4.9% were aged 1-5 years. The following causes of ICH in infants aged under one year were identified: hemorrhagic disorder-39.7%; HIE-13.3%, trauma- 10.4%, unknown reason-12.1% and congenital heart abnormality- 3.4% and Intrauterine infection – 3.4%. However, most common cause of ICH among children aged 1-5 years was trauma – 66.7%, and 33.3% were related to infection.Conclusion:1. The incidence of ICH is high among infants.2. The most common cause of ICH among children were hemorrhagic disorder-37.7%; HIE-13.1%; trauma-13.1%; infection-sepsis -14.8%; intrauterine infection- 9.9%; congenital abnormality of the brain- 3.3% and congenital heart defect-3.3%.3. Influential factors of ICH are preeclampsia (OR=8.6), CS (OR=3.4), newborn asphyxia (OR=3.3) and pathological jaundice (OR=6.8).

Angioarchitecture of Brain Arteriovenous Malformations and the Risk of Bleeding: An Analysis of Patients in Northeastern Malaysia

Background: Central nervous system arteriovenous malformation (AVM) is a vascular malformation of the brain and involves entanglement of veins and arteries without an intervening capillary bed. Affecting predominantly young male patients, AVM presents with different clinical manifestations namely headache, seizures, neurological deficit and intracranial haemorrhage. The patients who present acutely with intracranial bleeding have a significant morbidity and mortality. The aim is to study the angioarchitecture of brain AVM (BAVM) and determine the risk factors for intracranial bleeding. Ultimately, the goal of the study is to look for the association between volume of haematoma and architecture of BAVM. Methods: A cross-sectional study of 58 patients was conducted at the Hospital Universiti Sains Malaysia. Data were collected over a period of seven years (2000 to 2007) to look for the association between the angioarchitecture of brain arteriovenous malformations (BAVM), haemodynamics and the natural history and risk of intracranial haemorrhage. Results: BAVM was predominantly found in young male patients in 65.5%. Small nidal size (P-value=0.004), deep location (P-value=0.003) and deep venous drainage (P-value=0.006) were found to be significant factors contributing to intracranial haemorrhage. All patients with coexisting intranidal or prenidal aneurysms presented with intracranial haematoma. Conclusion: The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay. Small sized and deep seated lesions have a diffuse type of intracranial bleed which eventually need more attention to the managing team as diffuse haematoma indicates more insult to brain.

Delayed traumatic intracranial haemorrhage and progressive traumatic brain injury in a major referral centre based in a developing country

A repeat Computer Tomographic (CT) brain after 24 -48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of admission (p=0.024), GCS status (p=0.02), pupillary changes (p=0.014), number of intracranial lesion (p=0.004), haemoglobin level (p=0.038), prothrombin time (p=0.016) as the best predictors of early detection of changes. Multiple logistics regression analysis indicated that age, severity, GCS status (motor component) and GCS during admission were significantly associated with second CT scan with changes. This study showed that 9.9% of the total patients seen in the period of study had DTICH and 42% had PTBI. In the early period after traumatic head injury, the initial CT brain did not reveal the full extent of haemorrhagic injury and associated cerebral oedema. Different referral hospitals of different trauma level, GCS status, motor component of the GCS, haemoglobin level, platelet count and time interval between trauma and the first CT brain were the significant predictors for DTICH. Whereas the key determinants of PTBI were age, race, types of admission, GCS status, pupillary changes, number of intracranial bleed, haemoglobin level, prothrombin time and of course time interval between trauma and first CT brain. Any patients who had traumatic head injury in hospitals with no protocol of repeat CT scan or intracranial pressure monitoring especially in developing countries are advised to have to repeat CT brain at the appropriate quickest time .

Some of epidemiologic characteristics of intracranial haemorrhage in children from newborn to 15 old of age on National Hospital Pediatrics

Background: Intracranial haemorrhage is a common emergency with high mortality and neurological sequelae Objectives: The aim of study were to estimate the distribution of intracranial haemorrhage between the groups of age in children and the relationship of epidemiologic characteristics to the etiology.Subjects and method: We gathered prospectively data on 621 children (0-15 ans of age) with intracranial haemorrhage in 3 years (2000, 2001, 2002) hospital records in the National Hospital Pediatrics. Results: There are annual 200 patients (0-15 ans of age) of administration. 1) Neonatal infants consisted of 97 (15,6%) patients and 35 (36,1%) of death. Some of epidemiologic characteristics associated with the etiology were premature, asphyxial over 3500 gram birth weight, interventional birth infants and infants with congenital and acquis coagulation disorders. 2) Breastfed infants consisted of 469 (75,5%) patients of administration and 52 (11,1%) of death. Infants at 29 days to 3 months of age were the most frequence (92,3%). The etiology was associated with coagulation disorders (82,9%), cholestasis (6,2%). 3)Children (1-15ans) consisted of 55 (8,9%) and 7,3% of death, specially adolescent children (7-15ans) occupied 86,3% patients in this group. The etiology could be cerebral vasculare malfmation. Conclusion: There are different distribution of administration, mortality, etiology between neonate, breastfed infants, children (1-15 ans of age)

Características de las hemorragias intracraneanas espontaneas en TC y RM / Characteristics of spontaneous intracranial hemorrhages on CT and MRI

The certain diagnosis of spontaneous intracranial hemorrhage represents a frequent challenge in radiologist practice, creating the need of being familiarized with this pathology . This article describes the neurobiological basis of the usual evolution of intracranial hematomas. It revises the imaging characteristics of its images, considering the variability of its appearance in computed tomography and magnetic resonance. Radiological signs are described and signs that help us in the distinction from benign to malign origin of hematomas. Finally, the frequent causes of spontaneous haemorrhage are described.

El diagnóstico certero de la hemorragia intracraneana espontánea representa un desafío frecuente en la práctica del radiólogo, por lo que debemos estar familiarizados con esta patología. Este artículo describe las bases neurobiológicas de la evolución natural de los hematomas intracraneanos. Revisa también las características de sus imágenes, considerando la variabilidad de su apariencia en tomografía computada (TC) y resonancia magnética (RM). Además, se describen los signos radiológicos que ayudan en la distinción de hematomas de origen benigno y maligno. Por último, se consideran las causas frecuentes de hemorragia intracraneana espontánea.

Hemorragia intracraneal en el recién nacido a término / Intracranial hemorrhage in a term infant

Los accidentes vasculares hemorrágicos cerebrales en el recién nacido a término constituyen un aspecto importante de la morbimortalidad en la etapa neonatal. Se presenta el caso de un recién nacido a término, normopeso, varón, nacido de parto distócico en presentación pelviana (distocia de cabeza última), con una asfixia severa al nacer, que requirió de medidas de reanimación y de asistencia ventilatoria mecánica, constatando las manifestaciones clínicas de un accidente vascular hemorrágico, que se corroboró con los estudios imagenológicos realizados. Es egresado al mes de edad, sin compromiso de sus funciones vitales, y seguido por una consulta multidisciplinaria. A los tres meses de edad muestra evidencias de secuelas determinadas por retraso en su desarrollo psico-motor y trastornos neurosensoriales. La rehabilitación se está realizando con el objetivo de mejorar su actividad motora y su proyección psicosocial.

Cerebrovascular haemorrhagic accidents in term infant constitute an important feature of mortality in neonatal stage. A case of a male normoweight term infant who was born from a dystocic delivery in pelvis presentation (late-head dystocia) with a severe asphyxia at birth was analyzed. The infant required resuscitation techniques and mechanical ventilation, noting the clinical manifestations of haemorrhagic vascular accident, which could be proved through imaging studies carried out. At the age of one month the patient was discharged from the hospital with no compromise of vital functions and multidisciplinary follow-up. At the age of 3 months he showed specific sequels of retardation in psychomotor development and neurosensory disorders. Rehabilitation is been carried out with the objective of improving motor activity and psychosocial projection.

Dynamical Changes of Plasma Motilin and Serum Gastrin Levels in Neonates with Intracranial Haemorrhage / 实用儿科临床杂志

Objective To explore the changes of the plasma motilin(MTL)and serum gastrin(GAS)levels and their relationship with course of disease,the severity,the complication of digestive system in neonates with intracranial haemorrhage(ICH).Methods The objects were 26 cases of term newborns with ICH,the healthy control group contained 30 cases of healthy term newborns.Plasma motilin and serum gastrin concentration were measured by radioimmmunoassay in 26 cases of newborns with ICH in the 2 d,3-5 d,7-10 d,and 12-15 d after birth,and compared with the healthy control group.Results Compared with healthy control group,the blood GAS and MTL levels of neonatal ICH group increased dramatically(Pa