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.

Development of the Korean Academy of Medical Sciences Guideline for Rating the Impairment in the Brain Injured and Brain Diseased Persons with Motor Dysfunction

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score.

Clinical application of magnetic resonance in acute traumatic brain injury

PURPOSE: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. METHOD: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8 percent) males and 21 (38.2 percent) females, with acute (0 to 5 days) and closed TBI. RESULTS: Statistical significant differences (McNemar test): ocurred fractures were detected by CT in 29.1 percent and by MRI in 3.6 percent of the patients; subdural hematoma by CT in 10.9 percent and MRI in 36.4 percent; diffuse axonal injury (DAI) by CT in 1.8 percent and MRI in 50.9 percent; cortical contusions by CT in 9.1 percent and MRI in 41.8 percent; subarachnoid hemorrhage by CT in 18.2 percent and MRI in 41.8 percent. CONCLUSION: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI.

PROPÓSITO: Avaliar a aplicação clínica da ressonância magnética (RM) em pacientes vítimas de traumatismo craniencefálico (TCE) agudo, na identificação do tipo, número, gravidade e correlação clínica-radiológica. MÉTODO: Foram estudados prospectivamente 55 pacientes vítimas de TCE agudo fechado (0-5 dias), por TC e RM, sendo 34 do sexo masculino e 21 do feminino. RESULTADOS: Houve diferença estatisticamente significante (teste McNemar): fraturas de crânio foram detectadas em 29,1 por cento pacientes na TC e 3,6 por cento pela RM; hematoma subdural 10,9 por cento na TC e 36,4 por cento pela RM; lesão axonal difusa (LAD) 1,8 por cento pela TC e 50,9 por cento na RM; contusões corticais 9,1 por cento na TC e 41,8 por cento pela RM, hemorragia subaracnóidea 18,2 por cento na TC e 41,8 por cento pela RM. CONCLUSÃO: A RM foi superior à TC na identificação da LAD, hemorragia subaracnóidea, contusões corticais e hematoma subdural agudo, porém inferior no diagnóstico de fraturas. A detecção de LAD pela RM foi associada com maior gravidade do TCE agudo.

The effect of alcohol on incidence, pattern, severity and outcome from traumatic brain injury.

Alcohol consumption is known to be a major contributing factor for the occurrence of traumatic brain injuries (TBIs) in both developed and developing countries. It also influences diagnosis, management and recovery from TBIs, subsequent to injury occurrence. The present report examines the association of alcohol in injury occurrence, and its impact on severity and outcome from TBIs. Subjects were identified from 7 major hospitals in the city of Bangalore, India with data collection undertaken by standardised methods. Alcohol users (n = 243) and non-users (n = 1310) were compared on various characteristics and injury details. Sixteen per cent of the injured patients were intoxicated at the time of hospital registration. While the incidence of road traffic injuries was similar in both the groups, falls were higher in the alcohol user group. Evening-and night-time consumption of alcohol was a major risk factor for injuries. Drivers and occupants of motorised two wheeler vehicles, and pedestrians were involved in crashes to a greater extent among alcohol users. Severity of brain injuries (based on Glasgow coma scale), duration of hospital stay, death and post-traumatic disabilities among alcohol users were significantly higher compared with non-users. With the emergence of injuries and alcohol as twin major public health problems, immediate efforts are required to reduce the burden in developing societies. Legislative and enforcement strategies along with education developed on epidemiological, clinical and public health research need to be co-ordinated, target oriented, visible and with stiffer penalties for achieving desired results.

An Apgar score of three or less at one minute is not diagnostic of birth asphyxia but is a useful screening test for neonatal encephalopathy.

OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.

Traumatismos cráneoencefálicos en pacientes del Hospital tipo II El Vigía, Mérida, Venezuela / Cranium encephalic injuries in patients of the Hospital type II El Vigía, Merida, Venezuela

Este trabajo revisa en forma retrospectiva la frecuencia, causas y distribución de los traumatismos cráneo encefálicos (TEC) durante el período de 1990 a 1994 en el área del Hospital II de la ciudad de El Vigía, Mérida, Venezuela. En la costa oriental del Lago de Maracaibo, área de comercio con una población flotante importante, durante el quinquenio encontramos 1,577 pacientes con TEC, 6 por ciento de la mortalidad total registrada durante el período estudiado, 56 por ciento de las lesiones fueron catalogadas como TEC simples (sin lesión del Sistema Nervioso o sus envolturas): 78 por ciento de los pacientes eran masculinos, 38 por ciento la población afectada estaba en edad entre 14 y 24 años. Los accidentes de tránsito 62 por ciento de los casos se originaron por accidentes de tránsito. Los TEC, se distribuyen en forma similar a lo reportado por otros autores y es una patología del grupo productivo de la población. Los TEC, bajo control y vigilancia médica capacidad disminuyen el número de complicaciones de los TEC, y es posible disminuir el número de secuelas incapacitantes

Fisiopatogenia das lesöes traumáticas crânio-encefálicas / Phatophysiology of traumatic cranio-cerebral lesions

A compreensäo da fisiopatogenia das lesöes traumáticas crânio-encefálicas representa importante etapa para ajudar no manuseio dos múltiplos eventos patológicos envolvidos quando de um trauma craniano. No presente trabalho os autores discutem os mecanismos e tipos de lesöes crânio-encefálicas, bem como seus efeitos, apresentando ainda uma proposta de sistematizaçäo da classificaçäo dos traumatismos crânio-encefálicos, baseada principalmente no estudo da fisiopatogenia destas lesöes

Factores de riesgo y tipo de ACV / Risk factors and VCA

En la literatura revisada hay diversos elementos implicados como factores de riesgo para ACV, en este trabajo se cuestiona si alguno de estos factores actúa como Predictor del tipo de ACV, como gráficamente hablamos (isquémico o hemorrágico). El objetivo de este estudio fue investigar si existía alguna relación entre el tipo de ACV y los siguientes parámetros: Concentración de Fibrinógeno Plasmático, Hematocrito, Hábito tabáquico, sexo, raza y enfermedad asociada