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Guru Dutta Satyarthee, Luis Rafael Moscote-Salazar and Amit Agrawal

Abstract

Rigid collars are routinely used to immobilise the cervical spine during early phase of management of trauma cases until cervical clearance is obtained or else diagnosed as case of cervical spine injury following detailed clinical as well as neurological evaluation. Spinal injuries commonly coexist in patients sustaining severe head injury. Till date, there is no clear cut consensus about effect of application of a rigid collar in cases suffering with traumatic brain injury. However, concern are regularly raised over collar application, such practice may have adverse effect on cerebrovascular regulation and ultimately affecting intracranial pressure and outcome. Authors made detailed Pubmed, EMBASE, AMED, and Thomson Reuters, Medline line search and could find out six articles. According to existing literature, the cervical collar has the potential to influence intracranial pressure in patients suffering with head injury. There are several reports in the literature showing that cervical immobilization may alter intracranial pressure and the changes in ICP closely depend on the types of cervical collars used. Authors discuss the current status based on review of updated literature on possible effect on the intracranial pressure produced by application of rigid cervical collar and briefly literature is reviewed.

Open access

K. Aswani Kumar, B.V. Subrahmanyam, S.V. Phanidra, S. Satish Kumar, P.N. Harish, P. Ramamohan and Amit Agrawal

Abstract

Background: Traumatic spinal cord injury (SCI) is recognized as a serious public health problem resulting in significant morbidity, mortality and permanent disability. The present study is aimed to describe the epidemiological characteristics and outcome of patients with traumatic spinal cord injury in rural tertiary referral care center form South India.

Material and methods: The present study was conducted at Narayana Medical College and Hospital, Nellore. All patients admitted and managed for traumatic spinal cord injury were retrieved and data collected in a pre-designed proforma. Patient characteristics, details of etiology, mechanism of injury, level of injury, extent of neurological deficits, details of investigations, details of management and immediate outcome were recorded.

Results: A total 152 patients were included in the present study. The mean age was 38.45 years and majority the patients were young adult males. The mean hospital stay was 19.12 days. 71.7% percent patients were non-agriculture workers (mainly involved in construction work) and 28.3% patients were farmers. 61.2% of the patients sustained injuries due to fall from height and 34.2% patients sustained injuries due road traffic accidents. Cervical spine injuries were most common (44.1%), followed by thoraco-lumbar region (36.8%) and dorsal spinal region (19.1%). 9 patients expired in post-injury during hospital stay and all of them had complete cervical spinal cord injury. All patients received aggressive rehabilitation care.

Conclusion: In accordance with the literature our results reflect that traumatic spinal cord injuries affect young population and can leave these persons with significant functional and physical morbidity. The major limitation of the study is that it is a single institution based and may not reflect the true spectrum of traumatic spinal cord injuries in the population.

Open access

Guru Dutta Satyarthee, Rajpur Yada, Luis Rafael Moscote-Salazar and Amit Agrawal

Abstract

Extradural hematomas (EDH) represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH) constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

Open access

Vardan Kulshreshtha, Praveen Tripathi, Gaurav Jaiswal and Tarun Kumar Gupta

Abstract

Paediatric trauma is common emergency in emergency departments of hospitals worldwide. One of the uniqueness is the trauma sustained mostly in household areas and even the mode of injury is often subtle. Paediatric head injury is the one of the common reasons for children visiting the emergency department. Expert management and gentle care is an essential requirement in paediatric head injury cases. The management of the paediatric traumatic brain injury certainly depends upon the clinical conditions of patient and computed tomography {CT} findings. Most of the traumatic brain injuries can be managed conservatively but at times the surgical management has to be undertaken. A 6 month old child admitted with the history head injury. NCCT head revealed cerebellar hematoma with overlying subdural haemorrhage. Initially the child was managed conservatively but as the sensorium deteriorated the surgical evacuation was performed. The paediatric post fossa traumatic haemorrhage is a relatively uncommon and the management also needs to be individualized as per the patient’s condition.

Open access

Neha Gupta, Vivek Kumar Kankane and Tarun Kumar Gupta

Abstract

Traumatic Basal ganglia hemorrhage is rare entity but bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We describe five cases of traumatic bilateral basal ganglia hemorrhage, and its outcome and management. All Cases were managed conservatively. The general incidence of TBGH is reported between 2.4-3% of closed head injury. However, the incidence is higher in post mortem studies (9.8%). Five consecutive patients of TBGH, shown in initial Noncontrast CT (NCCT) head, admitted in our institute from August 2013 to August 2016, during this period total patient admitted of head injury is 1061 so incidence of Traumatic bilateral basal ganglia Hemorrhage in our series is 0.47% which is very less compare to previous literature formed the prospective study group. There were 3 males and 2 females; age ranging from 20 to 45 years (average 30 years).Hypertensive patients, drugs abuse history, history of coagulopathy with doubtful history of trauma or unknown mode of injury was excluded from the study. All patients had sustained road traffic accidents. NCCT head done of all patients after initial resuscitation. GCS at admission were 9 to 12 (mean 10.4), Outcome assessed by Glasgow outcome Score. All patients outcome was good. Average follow up 8.54 months.

Open access

C.A. Apetrei, C. Gheorghita, A. Tascu, A.St. Iencean, Tsz-Yan Milly Lo, Ian Piper and St.M. Iencean

Abstract

The complete name of this ERA-NET NEURON Grant is “Paediatric Brain Monitoring with Information Technology (KidsBrainIT). Using IT Innovations to Improve Childhood Traumatic Brain Injury Intensive Care Management, Outcome, and Patient Safety”. The Project Coordinators are Ms. Dr. Tsz-Yan Milly Lo (Consultant Paediatric Intensivist and Research Lead in Paediatric Critical Care Medicine ) and Ian Piper from University of Edinburgh, UK and the partners are: Prof. Bart Depreitere and his team from Neurosurgery & Intensive Care Research Group, University Hospitals Leuven, Belgium; Prof. Juan Sahuquillo and his team from Department of Neurosurgery, Vall d’Hebron University Hospital, Barcelona, Spain and the Romanian team with doctors CA Apetrei, C Gheorghita and A Tascu as principal investigators in three different hospitals. This material is based on the scientific project proposal with the basic project data. The aim of this grant is to test two clinically relevant hypotheses: after sustaining traumatic brain injury (TBI), paediatric patients with a longer period of measured cerebral perfusion pressure (CPP) maintained within the calculated optimal CPP (CPPopt) have an improved global clinical outcome and better tolerance against raised intracranial pressure (ICP). Paediatric TBI patients requiring intensive care are recruited from more contributing centres in 4 different countries. Their anonymised routinely collected bedside physiological monitoring data in minute-resolutions linking with anonmyised clinical and outcome data are exported and archived in the central KidsBrainIT data-bank. CPPopt is calculated and ICP dose-response analyses are performed on the KidsBrainIT dataset and their correlations with global outcome at 6 months are determined. The final aim of this study is to improve the treatments of the abnormal physiology insults: increase pressure from brain swelling (raised ICP) and brain perfusion pressure (CPP).

Open access

M. Gorgan, Angela Neacsu, Narcisa Bucur, V. Pruna, Catalina Lipan, Aurelia Mihaela Sandu and Catioara Fanica Cristescu

Abstract

Authors analyze 84 cases of brain abscesses operated between January 2000 and December 2011, in the Fourth Neurosurgical Department by the same surgical team. We underline the general series profile: the mean age was 42.96 years (range: 11-75 years old), 72.62% were males, association with heart defects in seven cases (8.33%), positive bacteriological examination for germs in only 37 cases (44.04%), all negative for HIV infection. The median number of days to diagnosis was 9. Most frequent clinical presentations included headache (40.47%), fever (35.71%), focal neurologic deficits (29.76%), increased intracranial pressure (28.57%) and seizures (11.90%).

The majority of cases (76.19%, n=64) presented a supposed medical condition favoring dissemination of a previous infection: malnutrition, tuberculosis, chronic alcoholism, chronic liver malady, neglected dental or ear infections, and only 5 cases (5.95%) had been diagnosed with secondary immunodeficiency syndromes following autoimmune systemic diseases.

According to our treatment policy all cases except for two (treated by puncture and aspiration) benefited of open surgery and total removal of the lesions, without local recurrence. Outcome was favorable in 82.14% (n=69) of subjects. General morbidity was 26.19%, and mortality stood at 7.14%. Six cases remained with permanent motor deficit (7.14%) and four (4.76%) with controllable seizures. Out of a total of 33.33% (n=28) of complications, 64.28% were due to medical causes.

Follow-up had been extended up to three years for at least 2/3 of patients, who resolved in time medical or surgical conditions which determined cerebral dissemination of the infection. Despite of a poor medical and biological condition, the patients with brain abscess outside of HIV infections benefit from neurosurgical adequate treatment, and if supportive medical and general therapy is continued and sustained, the healing and survival in good neurological status is the rule. Hematogenous spread and advance age were predictors of poor prognosis. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of aerobe germs

Open access

Guru Dutta Satyarthee, Luis Rafael Moscote-Salazar and Amit Agrawal

;16(2):191-4. 16. Hiromasa K, Shin K, Seiji A, Akihiko K, Ryotaro I, Morio M, Kota W, Yorihisa I, Kaoru O, Taneaki N. Transoral anterior approach using median mandibular splitting in upper spinal tumor extirpation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Nov;114(5):e12-6. 17. Mattei TA, Ramos E, Rehman AA, Shaw A, Patel SR, Mendel E. Sustained long-term complete regression of a giant cell tumor of the spine after treatment with denosumab. Spine J. 2014 Jul 1; 14(7):e15-21. 18. Chen G, Li J, Li X, Fan H, Guo Z, Wang Z. Giant cell tumor of axial vertebra

Open access

Gobran Taha Ahmed Alfotih, Fang-Cheng Li, Xin-Ke Xu and Shang-Yi Zhang

indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir (Wien) 1978;41:49-60. 24. Macdonald RL, Wallace MC, Coyne TJ. The effect of surgery on the severity of vasospasm. J Neurosurg 1994;80:433-9. 25. De Gans K, Nieuwkamp DJ, Rinkel GJ, Algra A.Timing of aneurysm surgery in subarachnoid hemorrhage:a systematic review of the literature. Neurosurgery 2002;5 :336-340. 26. Origitano TC, Wascher TM, Reichman OH, Anderson DE.Sustained increased cerebral blood flow with

Open access

R. Sivakumar, B.V. Subrahmanyam, S.V. Phanindra, Ashok Munivenkatappa, S. Satish Kumar and Amit Agrawal

SR, Bagali MA, Goudar ES, Qadri SY. Pattern of injuries and death sustained by the occupants of the two-wheeler during road traffic accidents. 2014. 16. Swarnkar M, Singh PK, Dwivedi S. Pattern of trauma in central India: an epidemiological study with special reference to mode of injury. The Internet Journal of Epidemiology 2010;9. 17. Plunkett J. Fatal pediatric head injuries caused by short-distance falls. The American journal of forensic medicine and pathology 2001;22:1-12. 18. Ahmed A, Mustahsan SM, Tariq F, Abidi