Hematological factors predicting mortality in patients with traumatic epidural or subdural hematoma undergoing emergency surgical evacuation: A retrospective cohort study.

Hematological abnormalities at admission are common after traumatic brain injuries and are associated with poor outcomes. The objective of this study was to identify the predictive factors of mortality among patients who underwent emergency surgery for the evacuation of epidural hematoma (EDH) or subdural hematoma (SDH).This was a single-center retrospective cohort study of 200 patients who underwent emergency surgical evacuation of EDH or SDH between September 2010 and December 2018. Data on hematological parameters and clinical and intraoperative features were collected. The primary end-point was 1-year mortality after surgery. Univariate and multivariate analysis were performed, and the receiver operating characteristic (ROC) curves were assessed.Of the 200 patients included in this study, 102 (51%) patients died within 1 year of emergency surgery. Lymphocyte count at admission, creatinine levels, activated partial thromboplastin time (aPTT), age, intraoperative epinephrine use, and Glasgow Coma Scale (GCS) score were significantly associated with mortality in the multivariate analysis. The areas under the ROC curve for the GCS score, aPTT, and lymphocyte counts were 0.677 (95% confidence interval [CI] 0.602-0.753), 0.644 (95% CI 0.567-0.721), and 0.576 (95% CI 0.496-0.656), respectively.Patients with elevated lymphocyte counts on admission showed a higher rate of 1-year mortality following emergency craniectomy for EDH or SDH. In addition, prolonged aPTT and a lower GCS score were also related to poor survival.

Serum low-density lipoprotein cholesterol level predicts hematoma growth and clinical outcome after acute intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Lower serum low-density lipoprotein cholesterol (LDL-C) levels have been associated with increased risk of death after intracerebral hemorrhage (ICH). Nevertheless, their link with hematoma growth (HG) is unknown. Therefore, we aimed to investigate the relationship between LDL-C levels, HG, and clinical outcome in patients with acute ICH. METHODS: We prospectively studied 108 consecutive patients with primary supratentorial ICH presenting within 6 hours from symptoms onset. National Institutes of Health Stroke Scale score and ICH volume on computed tomography scan were recorded at baseline and at 24 hours. Lipid profile was obtained during the first 24 hours. Significant HG was defined as hematoma enlargement >33% or >6 mL at 24 hours. Early neurological deterioration as well as mortality and poor long-term outcome (modified Rankin Scale score >2) at 3 months were recorded. RESULTS: Although LDL-C levels were not correlated with ICH volume (r=-0.18; P=0.078) or National Institutes of Health Stroke Scale score (r=-0.17; P=0.091) at baseline, lower LDL-C levels were associated with HG (98.1±33.7 mg/dL versus 117.3±25.8 mg/dL; P=0.003), early neurological deterioration (89.2±31.8 mg/dL versus 112.4±29.8 mg/dL; P=0.012), and 3-month mortality (94.9±37.4 mg/dL versus 112.5±28.5 mg/dL; P=0.029), but not with poor long-term outcome (109.5±31.3 mg/dL versus 108.3±30.5 mg/dL; P=0.875). Moreover, LDL-C levels were inversely related to the amount of hematoma enlargement at 24 hours (r=-0.31; P=0.004). In multivariate logistic regression analysis, LDL-C level <95 mg/dL emerged as an independent predictor of HG (OR, 4.24; 95% CI, 1.26-14.24; P=0.020), early neurological deterioration (OR, 8.27; 95% CI, 1.66-41.16; P=0.010), and 3-month mortality (OR, 6.34; 95% CI, 1.29-31.3; P=0.023). CONCLUSIONS: Lower serum LDL-C level independently predicts HG, early neurological deterioration, and 3-month mortality after acute ICH.

[The state of thyroid system in patients with non-traumatic supratentorial hematomas].

Concentrations of thyroid hormones (thyrotrophic - TTG, T3, T4) were measured with radioimmunological assay in the blood serum of 69 operated patients with supratentorial stroke interbrain hematomas. Hematomas were removed using a puncture/ aspiration method with local fibrinolysis. The lethality was 19%. It has been shown that medial hematomas lead to the decrease in TTG secretion while lateral and lobar ones inhibit T4 and T3 synthesis. Replacement therapy with thyroid hormones is needed to improve results of operative treatment of non-traumatic interbrain hematomas.

Lesión intracraneal transorbitaria por florete. Caso clínico / Cranial wounds of the skull by fencing - foil

Introducción. Las heridas penetrantes intracraneales por arma blanca son poco frecuentes en países occidentales y su diagnóstico y tratamiento pueden presentar dificultades que las hacen diferentes al resto de los traumatismos de cráneo. Caso clínico. Se presenta el caso de un profesor de esgrima que practicando sin la debida protección, recibió una lesión por florete, transorbitaria derecha con penetración intracraneana. La misma le produjo un hematoma intraparenquimatoso temporoparietal derecho, con efecto de masa. Dicha lesión se hizo evidente en la evolución, ya que de inicio, el paciente no presentó ningún síntoma oftalmológico o neurológico. El hematoma se evacuó sin incidentes con buena evolución clí- nica del paciente. No hubo lesiones en el globo ocular. Discusión y conclusiones. La lesión de estructuras intracraneales por objetos penetrantes transorbitarios es poco frecuente. Su diagnóstico exige un alto índice de sospecha, teniendo en cuenta el objeto agresor, mas allá del estado clínico inicial del paciente (AU)

Penetrating stab cranial wounds of the skull by fencing - foil are rare in western countries. Case report. This 46 year old man suffered a penetrating stab wound of the skull throughout the right orbital region. As a consecuence he developed on intracranial hematoma requiring surgical evacuation. Discussion and conclusions. Damage of intracranial cuntents due to transorbital penetrating objects other than missiles is a rare event (AU)

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