ABSTRACT
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Subject(s)
Humans , Hematoma, Subdural, Intracranial/diagnosis , Cerebral Hemorrhage, Traumatic/diagnosis , Diagnosis, DifferentialABSTRACT
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Subject(s)
Humans , Facial Paralysis/etiology , Facial Injuries/complications , Facial Nerve Injuries/complications , Skull Fracture, Basilar/complicationsABSTRACT
BACKGROUND: Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. PATIENTS AND METHODS: We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. RESULTS: Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. DISCUSSION AND CONCLUSIONS: The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.
Subject(s)
Craniocerebral Trauma/pathology , Craniocerebral Trauma/therapy , Accidents, Home , Accidents, Traffic , Automobiles , Biomechanical Phenomena , Brain/pathology , Cerebrospinal Fluid Otorrhea/etiology , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , Child , Child, Preschool , Craniocerebral Trauma/epidemiology , Critical Care , Diffuse Axonal Injury/etiology , Diffuse Axonal Injury/pathology , Female , Glasgow Coma Scale , Humans , Infant , Intracranial Pressure/physiology , Length of Stay , Male , Skull Base/pathology , Skull Fractures/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The authors report the case of a 23-year-old woman with café-au-lait spots and axillary and inguinal freckling who presented with a diploic chronic spontaneous hematoma of the left parietal bone. To the authors' knowledge, this case represents the first description of a diploic hematoma in a patient with stigmata of neurofibromatosis Type 1 unrelated to head trauma. Plain skull radiography showed an osteolytic lesion with well-circumscribed margins, corresponding to the hematoma, together with exuberant perilesional vascular markings. Angiography demonstrated an incidental aneurysm of the left supraclinoidal internal carotid artery and an unusual cortical venous drainage toward the diploic vessels. The blood flow of these vessels on the right hemicranium was sluggish and exhibited enlarged diploic venous lacunas. The authors hypothesize that the hematoma was formed by both an abnormal venous drainage toward the diploic vascular net, together with a vasculopathy that caused stenosis and obstruction of the normal drainage pathways from these vessels.
Subject(s)
Brain/pathology , Brain/diagnostic imaging , Cerebral Angiography , Female , Hematoma/diagnostic imaging , Hematoma/pathology , Humans , Young AdultABSTRACT
BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate epidemiological and clinical aspects of brain abscess (BA) and changes in clinical patterns during the last 30 years. PATIENTS AND METHOD: Observational study of a cohort of non-pediatric patients with BA admitted at a 944-bed hospital. Data collection from clinical records was done according to a standard protocol. We analysed epidemiological, clinical and microbiological data and localization as well as changes during a 30 year period divided in 2 equal length phases: 1976-1989 (P1), and 1990-2005 (P2). RESULTS: 108 patients with BA were included (mean age: 45 years; range: 12-86; > 40 years in 42.4% P1, and 71.4% in P2, p < 0.05); 66 patients were treated in P1 and 42 in P2 (annual incidence: 4-5 cases and 2-3 cases per 10(6) population in P1 and P2, respectively). A predisposing condition was identified in 86% cases with statistically significant differences (p < 0.05) in: otitis media (18.2% vs 2.4%); dental infection (3% vs 16.7%); penetrating cranial trauma (16.7% vs 0%); post-neurosurgery (15.1% vs 21.4%), in P1 and P2, respectively; microbiologic diagnosis was made in 76% (no statistical differences P1/P2). Clinical aspects statistically different in P1/P2: severely altered mental status (10.6% vs 0%); vomiting (37.9% vs 21.4%); focal neurological deficits (37.9% vs 71.4%). No statistically significant differences were found in other epidemiological, clinical, radiological, microbiological or outcome characteristics in P1/P2. CONCLUSIONS: In spite of a lower incidence in P2 and certain epidemiological and clinical differences in P1/P2, mortality and relapses rates have not significantly changed in a 30 year period.
Subject(s)
Brain Abscess , Adolescent , Adult , Aged , Aged, 80 and over , Brain Abscess/diagnosis , Brain Abscess/epidemiology , Brain Abscess/microbiology , Child , Female , Humans , Male , Middle AgedABSTRACT
Fundamento y objetivo: Se ha realizado un estudio de las características epidemiológicas y clínicas de los pacientes con absceso cerebral (AC), y de los cambios que han tenido en los últimos 30 años. Pacientes y método: Estudio observacional de una cohorte de pacientes adultos con AC ingresados en un hospital de 944 camas. Los pacientes se evaluaron según protocolo de estudio. Analizamos las características epidemiológicas, clínicas y microbiológicas de los pacientes con AC, la localización y evolución de los AC, en un período de 30 años dividido en 2 mitades: 1976-1989 (P1) y 1990-2005 (P2). Resultados: Se valoró a 108 pacientes con AC (66 en P1 y 42 en P2), con una edad media de 45 años (extremos: 12-86). Tenían más de 40 años de edad el 42,4% de los pacientes en P1 y el 71,4% en P2 (p < 0,05). La incidencia anual fue de 4-5 y 2-3 casos por 106 habitantes/año en P1 y P2, respectivamente. El origen primario del AC se identificó en un 86% de los casos, con diferencias estadísticamente significativas entre ambos períodos en el foco (otitis media: el 18,2 frente al 2,4%; infección dental: el 3 frente al 16,7%; traumatismo craneoencefálico: el 16,7 frente al 0%; tras neurocirugía: el 15,1 frente al 21,4%, en P1 y P2, respectivamente). Hubo confirmación microbiológica en un 76% (sin diferencias significativas entre P1 y P2). En cuanto a las características clínicas, hubo diferencias significativas entre P1 y P2 en la alteración del nivel de conciencia (el 10,6 frente al 0%), vómitos (el 37,9 frente al 21,4%) y déficits neurológicos focales (el 37,9 frente al 71,4%). No hubo diferencias en otras variables epidemiológicas, clínicas, radiológicas, microbiológicas o en el pronóstico (mortalidad) de los pacientes entre P1 y P2. Conclusiones: A pesar de la menor incidencia de AC en P2 y de ciertas diferencias epidemiológicas y clínicas entre ambos períodos, la mortalidad y el porcentaje de recidivas en pacientes con AC no ha cambiado significativamente en los últimos 30 años
Background and objective: The aim of this study was to evaluate epidemiological and clinical aspects of brain abscess (BA) and changes in clinical patterns during the last 30 years. Patients and method: Observational study of a cohort of non-pediatric patients with BA admitted at a 944-bed hospital. Data collection from clinical records was done according to a standard protocol. We analysed epidemiological, clinical and microbiological data and localization as well as changes during a 30 year period divided in 2 equal length phases: 1976-1989 (P1), and 1990-2005 (P2). Results: 108 patients with BA were included (mean age: 45 years; range: 12-86; > 40 years in 42.4% P1, and 71.4% in P2, p < 0.05); 66 patients were treated in P1 and 42 in P2 (annual incidence: 4-5 cases and 2-3 cases per 106 population in P1 and P2, respectively). A predisposing condition was identified in 86% cases with statistically significant differences (p < 0.05) in: otitis media (18.2% vs 2.4%); dental infection (3% vs 16.7%); penetrating cranial trauma (16.7% vs 0%); post-neurosurgery (15.1% vs 21.4%), in P1 and P2, respectively; microbiologic diagnosis was made in 76% (no statistical differences P1/P2). Clinical aspects statistically different in P1/P2: severely altered mental status (10.6% vs 0%); vomiting (37.9% vs 21.4%); focal neurological deficits (37.9% vs 71.4%). No statistically significant differences were found in other epidemiological, clinical, radiological, microbiological or outcome characteristics in P1/P2. Conclusions: In spite of a lower incidence in P2 and certain epidemiological and clinical differences in P1/P2, mortality and relapses rates have not significantly changed in a 30 year period
Subject(s)
Humans , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Brain Abscess/diagnosis , Brain Abscess/epidemiology , Brain Abscess/microbiology , Observational StudyABSTRACT
OBJECT: Most craniocerebral injuries are caused by mechanisms of acceleration and/or deceleration. Traumatic injuries following progressive compression to the head are certainly unusual. The authors reviewed clinical and radiological features in a series of patients who had sustained a special type of cranial crush injury produced by the bilateral application of rather static forces to the temporal region. Their aim was to define the characteristic clinical features in this group of patients and to assess the mechanisms involved in the production of the cranial injuries and those of the associated cerebral and endocrine lesions found in this peculiar type of head injury. METHODS: Clinical records of 11 patients were analyzed with regard to the state of consciousness, cranial nerve involvement, findings on neuroimaging studies, endocrine symptoms, and outcome. Furthermore, an experimental model of bitemporal crush injury was developed by compressing a dried skull with a carpenter's vice. Seven of the 11 patients were 16 years old or younger. All patients presented with a characteristic clinical picture consisting of no loss of consciousness (six patients), epistaxis (nine patients), otorrhagia (11 patients), peripheral paralysis of the sixth and/or seventh cranial nerves (10 patients), hearing loss (five patients), skull base fractures (11 patients), pneumocephalus (11 patients), and diabetes insipidus (seven patients). Ten patients survived the injury and most recovered neurological function. CONCLUSIONS: Static forces applied to the head in a transverse axis produce fractures in the skull base that cross the midline structures without producing significant cerebral damage. Stretching of cranial nerves at the skull base explains the nearly universal finding of paralysis of these structures, whereas an increase in the vertical diameter of the skull accounts for the occurrence of diabetes insipidus in the presence of an intact function of the anterior pituitary lobe. The association of clinical, endocrine, and neuroimaging findings encountered in this peculiar type of head injury supports the idea that this subset of injured patients has a distinctive clinical condition, namely the syndrome of bitemporal crush injury to the head.
