RESUMO
Seventeen patients with posterior fossa extradural haematoma are presented. While 7 patients had acute course, 6 had subacute and 4 had chronic course. All patients had evidence of occipital injury. Two patients did not have any fracture in the occipital bone. Concomitant lesions included cerebellar contusion in 3 cases, cerebral contusion in 4 patients, supratentorial extradural haematoma in 2 and hydrocephalus in 2 patients. All but one patient were treated surgically. None of the supratentorial lesions were operated upon. All patients with subacute and chronic course had good outcome while 43% with acute course succumbed to death. Besides the initial clinical status the co-existing lesions signifying the increased severity of injury have influenced the mortality and quality of outcome. In presence of occipital fracture a careful observation and timely intervention are warranted.
Assuntos
Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Lesões Encefálicas/complicações , Hemorragia Cerebral/diagnóstico , Criança , Pré-Escolar , Fossa Craniana Posterior , Feminino , Hematoma/diagnóstico , Humanos , Masculino , Osso Occipital/lesões , Lobo Occipital/lesões , Fraturas Cranianas/complicaçõesRESUMO
Sixty cases of brain abscesses in patients with cyanotic heart disease is reported. Forty four (73.3%) belonged to pediatric age group. There was only single case of infratentorial abscess located in the cerebellar paravermian region. The abscesses were multiloculated in 42%, multiple in 10% and solitary in 48% cases. Streptococci was the commonest (77%) micro-organism isolated from pus culture. Forty eight patients were treated by aspiration through twist drill, 7 patients conservatively and 5 had primary excision of abscesses. Forty four patients improved in their neurological status, three had fixed neurological deficits and 5 patients deteriorated further. There were 8 deaths. Complication like cyanotic spells was recorded in 17% cases treated by aspiration. None of the patients treated by twist drill aspiration had seizure. It is suggested that aspiration of abscesses through twist drill hole and antibiotic therapy could be the treatment of choice. Vascular slowing in a localised area resulting in infraction and thus preparing the focus for abscess formation is the possible mechanism in the evolution of these abscesses.