Tree Stand-Related Injuries in Nonadmitted and Admitted Patients at a Level 2 Trauma Center in Michigan: 2015-2019.

INTRODUCTION: Tree stand-related injuries (TSRI) are more common than firearm-related injuries in hunters. Most previous studies on the topic used trauma databases that only include admitted patients. This study characterizes injury patterns found in nonadmitted and admitted TSRI patients presenting to a level 2 Michigan trauma center. TSRI prevention interventions are also discussed. METHODS: Cases were obtained through a retrospective chart review of the Henry Ford Allegiance Health trauma registry and EPSi cost-accounting database from 2015 to 2019. Keywords searched included fall, hunter, tree, tree stand, treestand, ICD 9 diagnosis (E884.9_Other accidental fall from one level to another), and ICD 10 diagnosis (W14.XXXA_Fall from tree, initial encounter). We analyzed age, sex, body mass index, injury severity score, disposition, alcohol use, injuries sustained, reported height of fall, and narrative of fall. RESULTS: Thirty-three patients were identified. Patient age was 45±13 y (mean±SD). All patients were male. Injury severity score for nonadmitted patients was 2±1 vs 13±11 in admitted patients. Thirty-three percent of cases were nonadmitted; 67% were admitted. The most common injuries sustained were spinal (33%) and lower extremity fractures (15%). The average yearly TSRI case rate was 5.73 per 10,000 hunters in the study area. CONCLUSIONS: Our study found that spinal and lower extremity fractures were the most common injuries sustained. One-third of our patients were nonadmitted and therefore not included in the Henry Ford Allegiance Health trauma registry. Some nonadmitted patients had significant injuries requiring specialist consultation, orthopedic braces, or outpatient surgery.

Acute Oculomotor Nerve Palsy Caused by Compression from an Aberrant Posterior Communicating Artery.

Oculomotor nerve palsy (ONP) is a rare neurological deficit associated with numerous underlying pathologies. Of these, aneurysm of the posterior communicating artery (PCOM) has been described due to the intimate association with the third cranial nerve in the basal cistern. Less described are other vascular abnormalities and their contribution to ONP. We describe a case of ONP thought to result from a PCOM aneurysm, per the associated magnetic resonance imaging (MRI) scan, yet found intraoperatively to be caused by a congenital vascular aberrancy. This is the first case, to our knowledge, of this presentation.

Preoperative Embolization in Tandem with Surgical Resection for Cerebral Arteriovenous Malformations.

A number of treatment options are available for cerebral arteriovenous malformations (AVMs) including surgical resection, stereotactic radiosurgery, and endovascular embolization. Endovascular embolization may be used pre-operatively to reduce the size of large AVMs and thus reduce surgical complications. Here we present two patients who successfully underwent preoperative embolization of their AVMs and subsequent surgery. Preoperative embolization is a viable option for AVMs to reduce complications and improve patient outcomes.

Intracranial germinoma.

Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland.

A pictorial review of complications of acute coalescent mastoiditis.

This case study highlights the extracranial and intracranial manifestations of severe otomastoiditis. A 35-year-old man presented with numerous symptoms, including ear and neck pain, headache, temporary vision loss, fever, malaise, and nausea and vomiting. Imaging studies led to the diagnosis of coalescent mastoiditis with septic dural sinus thrombosis, venous hemorrhagic infarctions, brain abscesses, and subdural empyema.

In utero spontaneous cervical thoracic epidural hematoma imitating spinal cord birth injury.

A neonate male born cesarian due to a breech presentation was noted to have no spontaneous movements of the limbs after delivery. Radiographs were not demonstrative of pathology. However, MRI revealed a large intraspinal mass with significant distortion of the cervicothoracic spinal cord. At operation, a brown, fibro-gelatinous, moderately adherent mass was evident extradurally dorsal to the spinal cord. It was noted to extend anterolaterally to the left such that the cord was deviated anteriorly and to the right. There was no indication of the mass being under pressure but the cord was not pulsatile. There was sufficient mass to the anterolateral component of the cord that it appeared rotated to the right within the canal. The right cervical roots exited dorsally, with a markedly lengthened course through the spinal canal before exiting above their respective pedicles. Histology was that of blood clot. The patient clinically demonstrated no neurologic improvement post-operatively. Now, six months after surgery, the patient has still had no significant change in clinical function. To our review, this is the first reported case of a spontaneous spinal epidural hematoma mimicking a birth-related spinal injury.

Duane's syndrome and giant parietal foramina.

We report a 14-month-old male with Duane's syndrome and bilateral parietal calvarial defects. This child had no other known medical conditions. The Duane's syndrome involved the left eye. Imaging was demonstrative of bilateral enlarged parietal foramina. We believe this to be the first reported case of simultaneous Duane's syndrome and bilateral giant parietal foramina. Further case reports of our current association are required to determine if these simultaneous findings are spurious or a low-frequency association.

Eyebrow incision with supraorbital trephination for endoscopic corpus callosotomy: a feasibility study.

OBJECTIVE: We describe a novel technique for the partial bisection of the corpus callosum in order to increase the minimally invasiveness of this procedure. METHODS: Brow incisions with midline trephinations were performed in six adult cadavers. An endoscope was next introduced and used to transect approximately the anterior two-thirds of the corpus callosum. RESULTS: No complications such as injury to the superior sagittal sinus or anterior cerebral artery were encountered in any of our cadaveric specimens. The corpus callosum was easily transected in each specimen. CONCLUSION: As a feasibility study, we believe this technique could provide a less invasive mechanism for patients who require corpus callosotomy and will minimize much of the morbidity associated with the traditional methods of sectioning the corpus callosum.

Delayed resolution of Chiari I-associated hydromyelia after posterior fossa decompression: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: The expected time interval for resolution of hydromyelia after Chiari I decompression is lacking in the literature. This case report highlights one instance of delayed resolution of Chiari-induced hydromyelia. CLINICAL PRESENTATION: We report an adolescent girl with a Chiari I malformation and hydromyelia. INTERVENTION: A suboccipital craniectomy and C1 laminectomy with intradural exploration and duraplasty were performed. Serial imaging at 1 and 2 years after posterior cranial fossa decompression with duraplasty demonstrated no change in the size of the hydromyelia. At 3 years after surgery and before reoperation for continued hydromyelia, repeat magnetic resonance imaging demonstrated significant diminution of the fluid cavity. If this hydromyelia did resolve as a result of surgery, the interval for radiological observation clearly needs to be reconsidered. CONCLUSION: Unfortunately, this is an area in which the literature is lacking. With this case as a nidus, studies are now necessary to determine the range of time necessary for Chiari I malformation-related hydromyelia to resolve.