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Acute trauma,head injury,

Hansen Deng, John K Yue, Beata Durcanova, Javid Sadjadi
Alcohol intoxication is a common risk factor of traumatic brain injury (TBI) and carries a significant health-care burden on underserved patients. Patients with chronic alcohol use may suffer a spectrum of bleeding diatheses from hepatic dysfunction not well studied in the context of TBI. A feared sequela of TBI is the development of coagulopathy resulting in worsened intracranial bleeding. We report the clinical course of an intoxicated patient found down with blunt head trauma and concurrent alcoholic cirrhosis who was awake and responsive in the field...
October 2018: Journal of Neurosciences in Rural Practice
S Adam, D H Sama, T Mouzou, A Akakpovi, K Tomta, M Bellier
The management of patients in emergency departments is an important indicator of the quality of a healthcare system. In sub-Saharan Africa, emergency care is characterized by human and material difficulties. The purpose of this work was to assess the difficulties in managing emergencies at the surgical emergency admissions unit of Sylvanus Olympio teaching hospital of Lomé. This descriptive prospective study took place during the last 6 months of 2013. Epidemiological, clinical, and therapeutic data were collected...
August 1, 2018: Médecine et Santé Tropicales
Brain D Sindelar, Vimal Patel, Shakeel Chowdhry, Julian E Bailes
Intracerebral hemorrhage (ICH) with or without intraventricular hemorrhage (IVH) is a highly morbid disease process due to the mass effect and secondary injury that occurs upon the surrounding brain. Historically, surgical evacuation has failed to demonstrate improved outcomes in comparison to standard medical therapy likely due to the significant brain trauma when accessing the clot. Recent minimally invasive techniques have proposed a way to improve outcomes by reducing this injury. We report here a 62-year-old male with ICH and IVH with acute neurological deterioration due to hydrocephalus was found to have no improvement following external ventricular drainage...
July 13, 2018: Curēus
Scott J Farber, Rami S Kantar, Eduardo D Rodriguez
As the United States continues to increase its use of Special Operations Forces worldwide, treatment of craniomaxillofacial (CMF) trauma must be adapted to meet the needs of the warfighter. The remoteness of Special Operations can result in potentially longer times until definitive treatment may be reached. A significant portion of Servicemembers incur injury to the CMF region (42%). Severe CMF trauma can result in substantial hemorrhage and airway compromise. These can be immediately life threatening and must be addressed expeditiously...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Abigail Kleinschmidt
Child maltreatment is a serious public health concern in the United States. Young infants and children younger than 3 years are at the highest risk of being abused and can experience both acute injuries and long-term developmental, behavioral, and mental health problems. Health care providers are mandated reporters of suspected abuse but may misdiagnose potentially abusive injuries because of lack of knowledge in recognizing maltreatment. Premobile infants rarely have bruising or intraoral injuries without a reported accident or underlying systemic disease and should raise concern for abuse...
September 3, 2018: Journal of Pediatric Health Care
Catherine M Lunter, Ellen L Carroll, Charlotte Housden, Joanne Outtrim, Faye Forsyth, Annie Rivera, Chris Maimaris, Adrian Boyle, Barbara J Sahakian, David K Menon, Virginia Fj Newcombe
OBJECTIVE: Despite mild traumatic brain injury (mTBI) accounting for 80% of head injury diagnoses, recognition of individuals at risk of cognitive dysfunction remains a challenge in the acute setting. The objective of this study was to evaluate the feasibility and potential role for computerised cognitive testing as part of a complete ED head injury assessment. METHODS: mTBI patients (n = 36) who incurred a head injury within 24 h of presentation to the ED were compared to trauma controls (n = 20) and healthy controls (n = 20) on tests assessing reaction time, speed and attention, episodic memory, working memory and executive functioning...
September 3, 2018: Emergency Medicine Australasia: EMA
Ian Roberts, Antonio Belli, Amy Brenner, Rizwana Chaudhri, Bukola Fawole, Tim Harris, Rashid Jooma, Abda Mahmood, Temitayo Shokunbi, Haleema Shakur
Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide reliable evidence on the effect of tranexamic acid on death and disability in TBI patients...
2018: Wellcome Open Research
Fardad T Afshari, Kamal Makram Yakoub, Athanasios Zisakis, Allan Thomas, Ismail Ughratdar, Steven Sturman, Antonio Belli
Venous sinus thrombosis secondary to traumatic brain injury and head trauma is increasingly detected following contrast enhanced cranial imaging in acute trauma. The presence of sinus thrombosis poses further challenges in the management of traumatic brain injury patients with cerebral contusions, intraparenchymal haemorrhages or subdural/extradural haemorrhages. The decision to anti-coagulate such trauma induced venous sinus thrombosis is controversial and requires further attention and research to delineate risks versus benefits of treatment...
August 28, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Emanuele Orru', Thierry A G M Huisman, Izlem Izbudak
BACKGROUND AND PURPOSE: Hypoxic-ischemic injuries (HIIs) are a scarcely investigated but important cause of morbidity and mortality in children who suffered abusive head trauma (AHT). The purpose of this study is to determine: (a) prevalence, types, and clinical relevance of cytotoxic edema compatible with HII in nonpenetrating AHT, (b) their relationship to other classic neuroimaging findings of AHT, and (c) their correlation with clinical outcomes. METHODS: Diffusion-weighted imaging sequences of magnetic resonance imagings performed on children under 5 years diagnosed with AHT were reviewed to detect the most common patterns of acute parenchymal damage...
August 19, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Kathleen M O'Connell, D Alex Quistberg, Robert Tessler, Bryce R H Robinson, Joseph Cuschieri, Ronald V Maier, Frederick P Rivara, Monica S Vavilala, Paul I Bhalla, Saman Arbabi
OBJECTIVE: The aim of this study was to examine the risk of delirium in geriatric trauma patients with rib fractures treated with systemic opioids compared with those treated with regional analgesia (RA). SUMMARY OF BACKGROUND DATA: Delirium is a modifiable complication associated with increased morbidity and mortality. RA may reduce the need for opioid medications, which are associated with delirium in older adults. METHODS: Cohort study of patients ≥65 years admitted to a regional trauma center from 2011 to 2016...
September 2018: Annals of Surgery
Amory de Roulet, Rita V Burke, Joanna Lim, Stephanie Papillon, David W Bliss, Henri R Ford, Jeffrey S Upperman, Kenji Inaba, Aaron R Jensen
BACKGROUND/PURPOSE: Acute Respiratory Distress Syndrome (ARDS) results in significant morbidity and mortality in pediatric trauma victims. The objective of this study was to determine risk factors and outcomes specifically related to pediatric trauma-associated ARDS (PT-ARDS). METHODS: A retrospective cohort (2007-2014) of children ≤18 years old from the American College of Surgeons National Trauma Data Bank (NTDB) was used to analyze incidence, risk factors, and outcomes related to PT-ARDS...
July 11, 2018: Journal of Pediatric Surgery
Limin Wu, Joon Y Chung, Shivani Saith, Lorenzo Tozzi, Erin M Buckley, Bharat Sanders, Maria A Franceschini, Sevda Lule, Saef Izzy, Josephine Lok, William J Edmiston, Lauren M McAllister, Sloane Mebane, Gina Jin, Jiaxi Lu, John S Sherwood, Sarah Willwerth, Suzanne Hickman, Joseph El Khoury, Eng H Lo, David Kaplan, Michael J Whalen
Repetitive mild traumatic brain injury during adolescence can induce neurological dysfunction through undefined mechanisms. Interleukin-1 (IL-1) contributes to experimental adult diffuse and contusion TBI models, and IL-1 antagonists have entered clinical trials for severe TBI in adults; however, no such data exist for adolescent TBI. We developed an adolescent mouse repetitive closed head injury (rCHI) model to test the role of IL-1 family members in post-injury neurological outcome. Compared to one CHI, three daily injuries (3HD) produced acute and chronic learning deficits and emergence of hyperactivity, without detectable gliosis, neurodegeneration, brain atrophy, and white matter loss at one year...
July 13, 2018: Journal of Cerebral Blood Flow and Metabolism
Elora Hussain
Head trauma is a leading cause of brain injury in children, and it can have profound lifelong physical, cognitive, and behavioral consequences. Optimal acute care of children with traumatic brain injury (TBI) requires rapid stabilization and early neurosurgical evaluation by a multidisciplinary team. Meticulous attention is required to limit secondary brain injury after the initial trauma. This review discusses pathophysiology, acute stabilization, and monitoring, as well as supportive and therapeutic measures to help minimize ongoing brain injury and optimize recovery in children with TBI...
July 1, 2018: Pediatric Annals
Christian Oldenburg, Anders Lundin, Gunnar Edman, Catharina Nygren Deboussard, Aniko Bartfai
OBJECTIVE: Prolonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective. DESIGN: Prospective cohort study. SETTING: Patients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden...
July 6, 2018: BMJ Open
Pamela Daher, Pedro G Teixeira, Thomas B Coopwood, Lawrence H Brown, Sadia Ali, Jayson D Aydelotte, Brent J Ford, Adam S Hensely, Carlos V Brown
Acute respiratory distress syndrome (ARDS) is a complex inflammatory process with multifactorial etiologies. Risk factors for its development have been extensively studied, but factors associated with worsening severity of disease, as defined by the Berlin criteria, are poorly understood. A retrospective chart and trauma registry review identified trauma patients in our surgical intensive care unit who developed ARDS, defined according to the Berlin definition, between 2010 and 2015. The primary outcome was development of mild, moderate, or severe ARDS...
June 1, 2018: American Surgeon
Massimo Pieraccini, Susanna Guerrini, Edoardo Laiolo, Alessio Puliti, Giandomenico Roviello, Leonardo Misuraca, Genni Spargi, Ugo Limbruno, Mauro Breggia, Morando Grechi
PURPOSE: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. MATERIALS AND METHODS: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4)...
July 6, 2018: Cardiovascular and Interventional Radiology
Eva Montanari, Gabriele Polonara, Roberto Montalti, Marco Vivarelli, Riccardo Antonio Ricciuti, Raffaele Giorgetti, Adriano Tagliabracci
BACKGROUND: Traumatic pseudoaneurysm of the middle meningeal artery (PMMA) is rare. Its rupture is associated with high mortality, so an early diagnosis is recommended for this risky condition. In the absence of a specific guideline, computed tomography (CT), digital subtraction angiography, and CT angiography (CTA) are proposed for its diagnosis. CTA is the technique of choice even if it is almost never performed, especially in mild head injury. We report a rare case of a delayed rupture of PMMA, analyzed from a forensic point of view...
September 2018: World Neurosurgery
Anthony Ding, Robert V OʼToole, Renan Castillo, Brad Reahl, Ryan Montalvo, Jason W Nascone, Marcus F Sciadini, Anthony R Carlini, Theodore T Manson
OBJECTIVES: To identify the risk factors for early reoperation after operative fixation of acetabular fractures. DESIGN: Retrospective evaluation. SETTING: Level I Trauma Center. PATIENTS: Seven hundred ninety-one patients with displaced acetabular fractures treated with open reduction and internal fixation (ORIF) from 2006 to 2015. Average follow-up was 52 weeks. MAIN OUTCOME MEASURES: Early reoperation after acetabular ORIF, defined as secondary procedure for infection or revision within 3 years of initial operation...
July 2018: Journal of Orthopaedic Trauma
Helge Kasch, Troels S Jensen
Background/aims The presence and severity of concussion related symptoms after acute whiplash injury are debatable. In this study we examine the distribution and development of the burden of concussion related symptoms in whiplash patients. Methods Consecutively 141 acute whiplash patients and 40 ankle injured controls were recruited from emergency units and were examined after 1 week, 1, 3, 6, 12 months obtaining neck/head VAS score, number-of-non-painful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, strength and duration of neck muscles...
December 29, 2017: Scandinavian Journal of Pain
Alessandro Orlando, A Stewart Levy, Benjamin A Rubin, Allen Tanner, Matthew M Carrick, Mark Lieser, David Hamilton, Charles W Mains, David Bar-Or
OBJECTIVE Isolated subdural hematomas (iSDHs) are one of the most common intracranial hemorrhage (ICH) types in the population with mild traumatic brain injury (mTBI; Glasgow Coma Scale score 13-15), account for 66%-75% of all neurosurgical procedures, and have one of the highest neurosurgical intervention rates. The objective of this study was to examine how quantitative hemorrhage characteristics of iSDHs in patients with mTBI at admission are associated with subsequent neurosurgical intervention. METHODS This was a 3...
June 15, 2018: Journal of Neurosurgery
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