Airbags and children: a spectrum of C-spine injuries.

Over 30 children who were improperly restrained or in rear facing safety seats have been reported killed in motor vehicle accidents (MVA) involving airbags. The authors report one minor and two major injuries in properly restrained children in the front passenger seat. In case 1, A 10-year-old seat-belted boy was involved in an MVA (40 km/h) with deployment of both airbags. Physical examination findings showed right hyphema with corneal abrasion, right cheek abrasion and minimal cervical tenderness. C-spine x-ray was normal. He was treated for whiplash and facial burns resulting from contact with hot gas released by the airbags and discharged. In case 2, a 4-year-old boy wearing a lapbelt was in a MVA (20 km/h) with airbag deployment. On arrival, his Glasgow coma score was 3 and he was hemodynamically unstable. Secondary survey after stabilization showed left neck abrasions and ecchymoses, quadraplegia, priapism, and absent rectal tone. C-spine x-ray showed atlanto-occipital dislocation with possible complete spinal cord transection at C1. Aggressive maneuvers were withheld, and the patient was pronounced dead. Autopsy findings confirmed the clinical diagnosis. In case 3, a 3-year-old boy in a forward-facing safety seat was in a MVA (60 km/h) with air bag deployment. The patient was fully awake. C-spine x-rays were normal. Because of fluctuating level of consciousness, he underwent head computed tomography (CT) scan, which demonstrated a posterior fossa subarachnoid hemorrhage and a hematoma posterior to the odontoid, suggesting a ligamentous tear. He remained asymptomatic and was discharged on day 6. A head CT scan at 1 month showed a periosteal reaction in the area of the alar ligament suggestive of partial ligamentous avulsion; this injury was the forerunner of atlanto-occipital dislocation. Airbags deploy by releasing a hot effluent at 300 km/h. Mechanisms of injury include direct contact of hot gas with facial skin and energy transmitted directly from the airbag system to the child's head and neck. These cases illustrate a spectrum of C-spine injuries caused by airbag deployment and support the recommendation that children under 12 years of age travelling in a car equipped with dual airbags be seated in the back.

Relative localizing value of common tests used in the preoperative investigation of epileptic patients.

We have compared the relative localizing value of common tests in the presurgical evaluation of epilepsy in 73 patients with depth electrode (SEEG) confirmed epileptogenic foci and excellent surgical outcome. We found the tests of abnormality (CT, amytal, neuropsychology) to be frequently non-informative and often discordant with SEEG. The EEG was concordant with the SEEG in 38% of cases and provided lateralization in 78%. EEG was less localizing than ictal behavior in frontals but not in temporals. The need for SEEG is rather evident in these results but could become attenuated by the development of the localizing power of scalp EEG.

Spinal man after declaration of brain death.

Complex spinal automatism in a patient who was declared brain dead is described. These movements tend to appear once cerebrospinal shock has abated. We postulate that these manifestations are a reflection of the physiological potential of the isolated spinal cord. These spinal movements should be included in the revised guidelines for the determination of cerebral death.

Electrical stimulation of the human brain in epilepsy.

The concordance between the epileptogenic area as determined by intracranially recorded spontaneous seizure onset and that determined by electrically induced auras or seizures in 126 patients with medically intractable epilepsy was studied. Four to 11 multicontact depth electrodes were chronically implanted in patients as part of a preoperative investigation procedure. Localization of the epileptic area was obtained from the recording of three spontaneous seizures and from stimulation data including self-reported auras, seizures, and intracranial EEG afterdischarges recorded during an incremental stimulation sequence at all cortical pairs of contacts. Positive responses to stimulation were obtained in 63% of patients. Concordance between spontaneous and induced auras or seizures was greater than 90% with single unilateral foci and less with multiple foci. Stimulation data reliably predicted the resection area in unilateral and bilateral temporal foci but not in other locations. Afterdischarge thresholds were not reliable predictors of the spontaneous seizure focus. The intracranial stimulation procedure used appears to provide useful confirmatory and complementary localizing information in relation to that obtained from spontaneous seizures.

Sensitization of rat forebrain neurons to serotonin by adinazolam, an antidepressant triazolobenzodiazepine.

Adinazolam , a triazolobenzodiazepine , has been reported to be an effective antidepressant treatment in major depression. In the present study, a 14-day (but not a five-day) treatment with adinazolam enhanced the responsiveness of rat hippocampal pyramidal neurons to microiontophoretically applied 5-HT but not to NE. A 14-day treatment with diazepam failed to induce sensitization to either 5-HT or NE. Acute intravenous administration of adinazolam did not modify dorsal raphe 5-HT neuron firing rate. It is proposed that the antidepressant activity of adinazolam might be mediated by a heightened 5-HT neurotransmission.