[Show abstract][Hide abstract] ABSTRACT: Background: Pneumocephalus (PNC) is defined as a pathological collection of gas within the cranial cavity. The authors studied the effects of hyperbaric oxygenation (HBO2) therapy on a group of patients with PNC, comparing them with a control group to determine the relative impact on pneumocephalus volume, clinical symptoms, and duration of hospitalization.
Methods: Twenty-four patients with PNC treated at our hospital were consecutively studied. These patients were divided into a treated group (n=13) and a control group (n=11). Thirteen patients (treated group) were treated with HBO2 therapy sessions in a monoplace hyperbaric chamber at 2.5 atmospheres with 100% oxygen concentration. The control group was treated with normobaric oxygenation.
Results: Clinical improvement was seen in all patients. In the treated group, a decrease of the gas bubble was observed on the computerized tomography scan after each session of HBO2. The treated group also experienced a lower rate of meningitis compared with the control group. The length of hospital stay was significantly higher in the control group compared with the treated group.
Conclusions: HBO2 therapy in selective cases may lead to clinical and radiological improvement in patients with PNC.
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: A 36-year-old immunocompetent woman with a posterior fossa arteriovenous malformation (PF-AVM) and hydrocephalus presented with low fever and mental confusion 4 days after ventriculoperitoneal shunting (VPS). Methods: Cerebrospinal fluid (CSF) and ventricular catheter tip cultures isolated Corynebacterium sp. Similar to previous cases in the literature, species determination was not possible. However, the antibiotic sensitivity profile of this isolate suggested Corynebacterium jeikeium. Conversion to external ventricular drainage (EVD) was done and intravenous vancomycin was administered for 21 days. Results and conclusions: The patient showed progressive improvement. Since the first CSF shunt infection caused by Corynebacterium sp., 16 other cases in the literatures have been reported. Additionally, this study reports the difficulties in recognizing CSF shunt infection caused by this agent and the possible clinical or laboratory patterns as observed in the literature.
[Show abstract][Hide abstract] ABSTRACT: Background. The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis. Methods. Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram. Results. The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods. Conclusions. We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.
[Show abstract][Hide abstract] ABSTRACT: The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.
[Show abstract][Hide abstract] ABSTRACT: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.
A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.
112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years). The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%), car crashes (27.7%), and falls (25%). Systemic lesions were present in 80 (44.4%) patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8%) suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine). In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS) < 9 were statistically significant as risk factors (P < 0.05) for spine injury.
Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.
International Journal of General Medicine 09/2011; 4:613-5. DOI:10.2147/IJGM.S15811
[Show abstract][Hide abstract] ABSTRACT: Shaken baby syndrome is a serious form of physical child abuse, which is frequently overlooked. It is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma. This syndrome is seen most commonly in children under 2 years, mainly in children under 6 months. This article summarizes issues related to clinical presentation, diagnosis, risk factors, and interventions for healthcare professionals.
[Show abstract][Hide abstract] ABSTRACT: Mild head trauma had been defined in patients with direct impact or deceleration effect admitted with a Glasgow Coma Scale score of 13-15. It is one of the most frequent causes of morbidity in emergency medicine. Although common, several controversies persist about its clinical management. In this paper, we describe the Brazilian guidelines for mild head trauma, based on a critical review of the relevant literature.
International Journal of General Medicine 02/2011; 4:175-9. DOI:10.2147/IJGM.S13464
[Show abstract][Hide abstract] ABSTRACT: Craniocerebral gunshot wounds are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is 52-95% depending on the proportion of suicide victims in the series. The devastating nature of this lesion is accentuated by the fact that predominantly affects young and healthy patients. The most important predictive factor is the post-resuscitation Glasgow Coma Score (GCS). Early aggressive resuscitation, surgery and vigorous control of intracranial pressure offers the best chance of achieving a satisfactory outcome. In this paper the authors performed a critical literature review about this issue and
discuss the clinical aspects and management in these patients.
[Show abstract][Hide abstract] ABSTRACT: We describe a series of 10 children with intracranial hypertension complicating fulminant hepatic failure submitted to intracranial pressure (ICP) monitoring for intensive care and transplantation management.
Information from pediatrics patients acute liver failure admitted to our hospital was collected in a standard protocol form. We analyzed data from 10 patients, medium age 5.2 years old. In this period we studied aspects as ICP transducer used, number of days with ICP monitoring and complications of ICP monitoring.
Hepatitis A was diagnosed in five patients and hepatitis B in two cases. The initial ICP were 2 to 24 mmHg in transducer. Seven patients died, four due to intracranial hypertension, included the patient operated for subdural hematoma, and three with transplantation failure. Only a case of hematoma was verified.
The application of ICP monitoring allows intensive care for aggressive ICP management. It can be used in children without adaptations.
Revista de neurologia 03/2009; 48(3):134-6. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the angiographic findings in patients with small epidural hematomas and cranial fractures crossing over the trajectory of the middle meningeal artery and its branches. Additionally, the occurrence of traumatic vascular lesions and their clinical relevance and treatment are discussed.
A consecutive analysis was performed for 24 patients who harbored small epidural hematomas in middle meningeal artery topography associated with cranial fractures. Computed tomographic scans and plain x-ray studies were used to diagnose linear cranial fractures. Patients with large epidural hematomas or associated traumatic lesions were excluded from the study. Selective ipsilateral external carotid angiograms were obtained, and an endovascular procedure was performed if any vascular injury was evidenced.
In all patients with cranial fractures crossing over the middle meningeal artery and its branches, some kind of vascular lesion was seen. Two types of findings were noted: active extravasation of the contrast medium (71%) and pseudoaneurysms (29%). Early filling of diploic vessels was found in 8.3% of fractures concomitantly with active extravasation. Embolization was performed in all patients. No additional enlargement of the epidural hematoma was observed, and the postoperative period was uneventful.
This study shows that pseudoaneurysms and active extravasation of contrast are common findings in this subset of patients. Although the natural history of these lesions is still poorly understood, additional investigation with ipsilateral external carotid angiography may be recommended, considering the potentially catastrophic consequences of late rupture.
[Show abstract][Hide abstract] ABSTRACT: Descrevemos os resultados laboratoriais de um sistema de transdução modificado que elimina a maioria das desvantagens de sistemas hidrostáticos convencionais mencionados na literatura. Foram calculados medidas de acurácia absoluta, desvio-24 horas e testes dinâmicos de pressão. O ajuste de regressão linear utilizando-se os valores médios das 10 medidas efetuadas para cada trnasdutor prpiciou coeficientes de correlação significativos. Os testes de desvio-24 horas foram muito semelhantes entre os transdutores comparados, não havendo diferença estatística. O teste dinâmico também foi extremamente siginificativo: coeficiente de correlação (r)=0,9999; (sd)=0,78; p<0,0001. Concluiu-se que a modificação do sistema reproduziu valores tão correlatos quanto o sistema tradicional; o sistema hidrostático modificado pode se construir em uma boa alternativa técnica neurocirúrgica se a sua funcionalidade for comprovada na prática.
[Show abstract][Hide abstract] ABSTRACT: Extradural hematoma (EDH) is considered to be a rare complication of head trauma in children, and represents a serious and urgent pathology from which complete recovery can be expected if specialized treatment is instituted in time. In this article, the authors report the potential danger to a hydrocephalic shunted child who was apparently asymptomatic at the time of hospital admission with a mild head injury and developed an EDH of venous origin. This child had a rapid (time interval from injury to decerebrate posture of about 2 h), atypical (remained asymptomatic most of the time until abruptly deterioration) and fatal course, stressing the importance of early diagnosis and rapid therapy in order to avoid the death of the patient. The authors discuss the role of the ventriculoperitoneal shunting system in the lack of clinical symptoms associated with the presence of a giant EDH and a rapid and fatal course, and stress the importance of computed tomographic (CT) scanning in these patients, even if they are asymptomatic. If a skull fracture is suspected, a CT scan must be performed without delay.