Review of the Management of Infected Subdural Hematoma.

OBJECTIVE: Infection of a subdural hematoma is an unusual cause of subdural empyema, with fewer than 50 cases reported in the literature. The appropriate surgical option for this entity has not been determined because of its rarity. We present a case report of a post-traumatic subdural hematoma infected with Escherichia coli that was successfully treated with craniotomy. In addition, we performed a PubMed search to comprehensively illustrate the causative organism, source of infection, clinical picture, surgical treatment, and outcome for this condition. This article presents an update on the condition. CASE DESCRIPTION: A 55-year-old man was admitted to our hospital complaining of headache, seizure, and urinary incontinence. He had a history of alcoholism and several hospitalizations for mild head trauma. Neuroimaging studies revealed a chronic hematic collection in the left frontal-parietal region. Laboratory tests showed increased C-reactive protein levels. In addition, surgical results revealed an infected subdural hematoma. A bacterial culture of the purulent specimen identified E. coli. In view of the urinary complaint and leukocyturia, the cause of the infected subdural hematoma was postulated as a urinary tract infection. CONCLUSIONS: Infected subdural hematoma is an unusual disorder. We must keep in mind the possibility of this complication when seeing a patient who presents with any of the 3 most common symptoms in this review. In these patients, craniotomy should be the method of surgical drainage, especially in adults. It ensures maximal drainage of the loculated pus and allows the total removal of the infected hematoma capsule.

Review of the management of pneumocephalus.

BACKGROUND: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the "Mount Fuji sign." In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition. CASE DESCRIPTION: A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma. CONCLUSION: The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

Fratura evolutiva de crânio na infância ? Relato de cinco casos e revisão de literatura / Growing skull fracture of childhood ? Report of five cases and literature review

A fratura evolutiva é uma rara complicação que se observa geralmente na infância. Caracteriza-se por afastamento progressivo das bordas das fraturas, às vezes associado à formação de um cisto leptomeníngeo, também conhecido como cisto leptomeníngeo pós-traumático. De acordo com a literatura internacional, sua prevalência varia entre 0,03% e 1,6%. Analisamos a casuística de pacientes internados com traumatismo cranioencefálico no Hospital da Restauração de Recife (Brasil), um centro de referência em neurocirurgia pediátrica, no período de 1° de dezembro de 2000 a 30 de abril de 2008. O grupo de estudo compreendeu crianças de 0 a 14 anos. Durante essa investigação foram realizadas 19.758 admissões na emergência pediátrica por traumatismo cranioencefálico, e 74% foram admitidos da área metropolitana e 26% do interior do estado de Pernambuco. Foi observada fratura craniana em 6,3% dos casos, dos quais cinco crianças (menores de 3 anos) desenvolveram fratura evolutiva, representando 0,4% das fraturas de crânio e 0,02% dos traumatismos cranioencefálicos admitidos. Foi achada em todos os casos uma massa pulsátil, que apareceu em média no quarto mês após o trauma. As cinco crianças foram submetidas a tratamento cirúrgico, que compreendeu a ressecção do cisto leptomeníngeo e do tecido cerebral herniado, reparo do defeito dural e cranioplastia. A nossa experiência e a revisão bibliográfica mostram que crianças menores de 3 anos com história de traumatismo cranioencefálico e fratura de crânio apresentam risco de desenvolver fratura evolutiva. No entanto, sendo uma condição rara crianças com fratura de crânio menores de 3 anos, é obrigatório o acompanhamento clínico. Quando diagnosticado, o tratamento cirúrgico imediato é indicado para prevenir déficit neurológico.

Growing fracture is a rare complication that usually is observed in childhood. It is characterized by a progressive opening from the edges of fractures, sometimes associated with the formation of leptomeningeal cyst, also known as post-traumatic leptomeningeal cyst. According to the literature, its prevalence ranges from 0.03% to 1.6%. We analyzed a casuistic of patients hospitalized with head trauma at the Hospital da Restauração of Recife (Brazil), a referral center for pediatric neurosurgery, in the period from December 1st 2000 to April 30th, 2008. The study group consisted of children aged 0 to 14 years. During this research, were analyzed 19,758 emergency admissions for pediatric traumatic brain injury, which 74% were admitted to the metropolitan area and 26% were from the countryside, in the state of Pernambuco. Skull fracture was observed in 6.3% of cases, including 5 children under 3 years old, who developed growing fracture, constituting 0.4% of skull fractures and 0.02% of traumatic brain injury admitted. In all cases, it was found a pulsating mass that appeared in an average time in the 4th month after the trauma. The five children were submitted to surgical resection of the leptomeningeal cyst and of the herniated brain tissue, repair of dural defect and cranioplasty. Our experience and review of the literature show that children under 3 years old, with a history of traumatic brain injury and skull fracture, present at risk of developing a growing fracture. Even though, it is a rare condition, a clinical follow-up is mandatory for these children. When the growing fracture is diagnosed, an immediate surgical treatment is indicated to prevent neurologic deficit.

Opinião de enfermeiros sobre instrumento de atendimento sistematizado a paciente em emergência / Nurses' opinion on an instrument of systematized medical care for the emergency patient / Opinión de enfermeiros acerca de instrumento de atención sistematizada al paciente en emergencia

Este estudo exploratório objetivou identificar a opinião de enfermeiros sobre um instrumento deatendimento, baseado na Sistematização da Assistência de Enfermagem, para uso no setor de emergência. Ele foi realizado em um hospital extra porte em Recife-PE, no período de junho a agosto de 2009, com uma amostra acidental de 30 enfermeiros da emergência. Os dados foram coletados por meio de questionário e analisados utilizando estatística descritiva. A maioria dos enfermeiros opinou favoravelmente à contribuição do instrumento para: o trabalho na emergência (96,6%); a qualidade da assistência de enfermagem (86,6%); o planejamento das ações (97.0%); a autonomia do enfermeiro (86,9%); e a comunicação e a integração da equipe multiprofissional (83,6%); Além disso os enfermeiros opinam que o uso da ficha é viável (80,0%). As sugestões para melhora do instrumento foram de natureza organizacional e de adição ao seu conteúdo.

This exploratory study aimed at identifying nurses´ opinions on an instrument of care, based on the Systematization of Nursing Assistance to be used in the emergency room. It was carried out in a large hospital in Recife, Pernambuco, Brazil, from June to August 2009, with an accidental sample of 30 emergency nurses. The data were collected by means of a questionnaire and analyzed using descriptive statistics. Most nurses had a favorable opinion of the instrument´s contribution to the: work in the emergency room (96,6%); quality of nursing care (86,6%); action planning (97,0%); nurse´s autonomy (86,9%); and the communication and integration of the multi-professional team (83,6%). Besides that the nurses say that to use the form is viable (80, 0%). Suggestions for improvement were organizational in nature and for the addition of content.

Estudio exploratorio cuyo objetivo fue identificar la opinión de enfermeros acerca de instrumento de atención basado en la Sistematización de la Atención de Enfermería, para uso en emergencia. El estudio se realizó en hospital de Recife, Pernambuco, Brasil, de junio a agosto de 2009, con muestra accidental de 30 enfermeros de la emergencia. Los datos fueron recogidos por medio de cuestionario y analizados bajo la estadística descriptiva. La mayoría de los enfermeros tiene opinión favorable acerca de la contribución del instrumento para: el trabajo en la emergencia (96,6%); la calidad de la atención de enfermería (86,6%); el planeamiento de las acciones (97,0%); la autonomía del enfermero (86,9%); y la comunicación e integración del equipo multiprofesional (83,6%). Además, los enfermeros opinaron que el uso de la ficha es viable (80,0%). Las sugerencias para mejorar el instrumento fueron de naturaleza organizacional y de adicción a su contenido.

Perfil clínico-epidemiológico de pacientes acometidos com lesão cerebral traumática atendidos em uma unidade de emergência / Clinical and epidemiological profile of patients with traumatic brain injury treated in an emergency department / Perfil clínico-epidemiológico de pacientes con lesión cerebral traumática atendidos en la emergencia de un hospital

Objetivo: descrever o perfil clínico-epidemiológico de pacientes vítimas de lesão cerebral traumática (LCT), bem como relatar as intervenções de enfermagem no cuidado a esses pacientes. Método: estudo descritivo retrospectivo com abordagem quantitativa, a população foi composta por todos os pacientes admitidos na emergência do hospital e a amostra foi de 676 pacientes com diagnóstico de traumatismo cranioencefálico. Após aprovação pelo Comitê de Ética e Pesquisa do Hospital da Restauração (Protocolo n. 0025.0.102.000-09), os dados foram coletados nos prontuários através de um questionário preenchido pelo pesquisador. Os dados foram analisados e tabulados através do programa Excel da Microsoft usando a estatística descritiva. Resultados: houve um predomínio de LCT no sexo masculino (68,9%). A faixa etária mais acometida foi os maiores de 35 anos (45,8%). Quanto ao mecanismo de trauma, a maioria dos casos ocorreu devido às quedas (42,3%). Houve uma maior incidência de LCT leve (81,6%). A maioria dos pacientes não apresentou lesões ou anormalidades (63,6%). Conclusões: as características clínico-epidemiológicas dos pacientes com LCT forneceram informações importantes sobre os grupos de risco para LCT, oferecendo subsídios para o desenvolvimento de intervenções preventivas e de controle.(AU)

Objective: to describe the clinical and epidemiological profile of patients with traumatic brain injury (TBI), as well as to report the nursing interventions in the care of these patients. Method: this is a retrospective descriptive study with a quantitative approach, the population was composed of all patients admitted to the hospital's emergency department, and the sample was 676 patients diagnosed with cranioencephalic trauma. After the approval by the Committee of Ethics and Research of Hospital da Restauração (Protocol 0025.0.102.000-09), the data were collected from medical records through a questionnaire filled in by the researcher. The data were analyzed and plotted through the software Microsoft Excel using descriptive statistics. Results: there was a predominance of TBI in males (68.9%). The most affected age group was the older than 35 years (45.8%). Regarding the mechanism of trauma, most cases were due to falls (42.3%). There was a higher incidence of mild TBI (81.6%). Most patients had no lesions or abnormalities (63.6%). Conclusions: the clinical and epidemiological characteristics of patients with TBI provided important information on the risk groups for TBI, offering data for the development of preventive and control interventions.(AU)

Objetivo: describir las características clínicas y epidemiológicas de los pacientes con lesión cerebral traumática (LCT), así como informar las intervenciones de enfermería en el cuidado de estos pacientes. Método: estudio descriptivo retrospectivo con abordaje cuantitativa, la población estuvo constituida por todos los pacientes ingresados en la emergencia del hospital y la muestra fue de 676 pacientes con diagnóstico de traumatismo craneoencefálico. Después de la aprobación por el Comité de Ética y de Investigación del Hospital da Restauração (Protocolo 0025.0.102.000-09), los datos fueron recolectados de las historias clínicas a través de un cuestionario cumplimentado por el investigador. Los datos fueron analizados y tabulados por medio del programa Microsoft Excel usando la estadística descriptiva. Resultados: se encontró un predominio de LCT en el sexo masculino (68,9%). El grupo de edad más afectado fue el de más de 35 años (45,8%). En cuanto al mecanismo de trauma, en la mayoría de los casos se debió a caídas (42,3%). Hubo una mayor incidencia de LCT leve (81,6%). La mayoría de los pacientes no presentaba lesiones o anomalías (63,6%). Conclusiones: las características clínicas y epidemiológicas de los pacientes con LCT proporcionan información importante sobre los grupos de riesgo para LCT, ofreciendo subsidios para el desarrollo de intervenciones de prevención y control.(AU)