Unusual Head Trauma: About Three Observations at the Chu Pr Bocar Sidy Sall (BSS) of Kati

Introduction: Penetrating head injuries are often due to human-to-human violence, mainly by firearms, those by stab are rare. CT is the exam of choice in the assessment of emergency lesions. We report three observations, all victims of knife assault during the brawl in order to clarify the contribution of DTM in the care. Observations: 1) Mr. I S, 21-year-old, student, was admitted with the hillside implanted in the skull. There were traces of blood on his face and clothes. There was no neurological deficit on examination. The CT scan performed showed the knife penetrating the vault of the skull at the left parietal level, up to 5 cm in the cerebral parenchyma with a minimal subdural and intracerebral hematoma;2) Mr. S C, 43-year-old, farmer, admitted with a large left fronto-temporo-parietal wound, bleeding and right hemiplegia. The CT scan performed showed a frontal linear fracture (with fronto-ethmoid hemosinus) and left temporoparietal with a parietal intraparenchymal hematoma and homolateral frontoparietal subdural hematoma;3) Mr. S B: 40 years old, driver, admitted with a parietal wound. The CT scan performed objectified a left parietal cortical hematoma in relation to a metallic foreign body (3000 HU) corresponding to the distal end of the knife penetrating the vault of the skull. They all underwent emergency surgery and received antibiotics and preventive serotherapy. The postoperative follow-up was simple, the follow-ups are without neurological sequelae. Conclusion: Head trauma by knife is rare, it results from inter-human violence. The lesion diagnosis is computed tomography. The prognosis depends on the severity.

OBSERVATION ON THERAPEUTIC EFFECT OF ELECTROACUPUNCTURE HEAD PONINT-THROUGH-POINT BY PENETRATING TWO POINT ON ISCHEIC STROKE

Objective To probe methods and therapeutic effects of Head Acupuncture on ischemic stroke. Methods One hundred and twelve cases were randomly divided into observation group (head acupuncture group) and control group (body acupuncture group). After treatment of 28 days, changes of linguistic function and paralysis level of limbs before and after treatment were investigated. Results The total effective rate was 96.6% in the observation group and 90.7%, in the control group, with a significant difference between the two groups (P<0.05). Conclusion The electroacupuncture head point-through-point by penetrating two point therapy is one of effective methods for ischemic stroke.

THERAPEUTIC EFFECTS OF HEAD ACUPUNCTURE ON STROKE

According to the "International Standard of Chinese Head Acupoints" 207 patientssuffering from stroke were treated by needling along the anterior and posterior obligue lines of vertex-temporal, and the line 1 and line 2 lateral to vertex. The markedly effective rate accounted for73. 43% of the total, and the overall effective rate represented 89. 86%. After the treatment somesymptoms as hemiplegia, lingual dysfunction, facial and tongue paralysis were obviously improved (P【 0. 01 ). The therapeutic effect of head acupuncture was obviously better than that of Westernmedicine(P【0.01). Comparison of therapeutic effects made among needling along different lines andbetween those applied on the intact and affected sides of the body showed that they were all effectivein improving the symptoms, but there was no significant difference(P【0. 05)

Mathematical Model for Stroke and White Matter Hyperintensities

A mathematical model was developed to predict the risk of having a stroke as a person ages. The age component was derived from the concept that the change in risk of stroke with age is a function of the current risk of developing a stroke. This equation modeled the trend with age reported in the literature for two different data sets with R2 values of 0.97 or better for both men and women. A second equation of a similar nature was developed to predict the accumulation of white matter hyperintensities, WMH, as a person ages. It appears that each equation includes a set of common risk factors. This set of common risk factors allows an individual’s risk for stroke to be based on measured WMH. A third equation links WMH with the risk of developing a stroke. This equation allows an individual to use measured WMH from brain scans to predict the future risk of developing a stroke. In theory, a person with a relatively high measurement of WMH can project future risk for stroke with age and use counter measures such as exercise and medications to keep other risk factors low as a person continues to age.

The clinical characteristics and treatment of head trauma patients with skull defect

Objective To investigate the clinical characteristics and therapeutic of head trauma patients with skull defect. Methods A retrospective study of clinical data of 47 brain injury patients with skull defect in our hospital from Janary 1993 to Janary 2009 was performed. Results Compared with

Delayed neurological deterioration following head trauma

We report a patient who presented with neurological deterioration 26 days after a motor vehicle accident. A 25-year-old man crashed a car onto farmland from a height of approximately 3 meters. Neurological deterioration including ataxia and visual disturbance became apparent 26 days after the accident. Brain magnetic resonance imaging did not reveal any abnormality, but brain single photon emission computed tomography showed mild hypoperfusion in the left frontotemporal lobe. An ophthalmic examination revealed no specific abnormality, but visual-evoked potentials revealed prolonged latencies in both eyes. We propose that this neurological deterioration might have resulted from traumatic axonal injury. As such, future studies should examine preventive strategies against delayed deterioration in patients with head trauma.

The usefulness of diffusion tensor imaging in detection of diffuse axonal injury in a patient with head trauma

Diffuse axonal injury is the predominant mechanism of injuries in patients with traumatic brain injury. Neither conventional brain computed tomography nor magnetic resonance imaging has shown sufficient sensitivity in the diagnosis of diffuse axonal injury. In the current study, we attempted to demonstrate the usefulness of diffusion tensor imaging in the detection of lesion sites of diffuse axonal injury in a patient with head trauma who had been misdiagnosed as having a stroke. A 44-year-old man fell from a height of about 2 m. Brain magnetic resonance imaging （32 months after onset） showed leukomalactic lesions in the isthmus of the corpus callosum and the left temporal lobe. He presented with mild quadriparesis, intentional tremor of both hands, and trunkal ataxia. From diffusion tensor imaging results of 33 months after traumatic brain injury onset, we found diffuse axonal injury in the right corticospinal tract （centrum semiovale, pons）, both fomices （columns and crus）, and both inferior cerebellar peduncles （cerebellar portions）. We think that diffusion tensor imaging could be a useful tool in the detection of lesion sites of diffuse axonal injury in patients with head trauma.

Detection of the Severity of Brain Injury in Head Trauma Patients Using Biochemical Blood Markers and Its Correlation with Glasgow Coma Scale

Head trauma is one of common injury related mortality and morbidity. Blood biomarkers are valuable tools for the identification and characterization of initial injury and secondary pathological processes for traumatic brain injury (TBI). This study evaluated the performance of a recently developed visfatin and its correlation with other blood circulating biomarkers that reflect specific pathological mechanisms including neuro inflammatory, neuron injury and oxidative damage in moderate to severe TBI patients. Peripheral blood was taken from TBI patients (n = 78) at hospital admission, maximum 6 hours post-injury. Severity and neurological outcome were assessed using the Glasgow Coma Scale (GCS) and blood level of: visfatin, neuron specific enolase (NSE), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH). Concentrations of visfatin (28 ± 1.68 μg/L, 25 ± 2.09 μg/L) was significantly higher (p < 0.0001) in sever and moderate groups of TBI patients respectively compared to control group (7.62 ± 0.87 μg/L), NSE concentrations also were significantly higher (p < 0.0001) in both groups of TBI patients (20.47 ± 3 ng/ml, 13.49 ± 2.66 ng/ml) compared to control group (4.3 ± 0.52 ng/ml), MDA was significantly elevated (p < 0.001) in sever TBI patients group (6.88 ± 0.58 μmol/L) compared to control group (5.12 ± 0.76 μmol/L), while SOD (245.12 ± 24.2 U/L, 276.097 ± 30.8 U/L) and GSH (112.07 ± 2.09 μmol/L, 119.26 ± 2.7 μmol/L) were highly significantly decreased (p < 0.0001) in TBI patients compared to control group (304.17 ± 27.17 U/L and 151.64 ± 9.9 μmol/L) respectively. Visfatin was positively correlated with NSE and MDA, while there was negative correlation with SOD and GSH. In conclusion blood level of visfatin in correlation with other blood biomarkers can be used for prediction of severity of TBI cases.

Anticipation of Dural Tear in Patients with Blunt Head Trauma

Background: Dural tears are considered among the neurosurgical challenges to be dealt with during management of head trauma patients;it’s important to anticipate such pathology pre-operatively;the purpose of this study is to discuss and analyze various predictors of dural tear as a sequala of blunt head trauma. Methods: Patients with blunt head trauma who underwent surgery during the year 2020 were analyzed;operative data were reviewed;only patients with reported dural repair as a step during surgery were included. Patients with penetrating head injury were excluded. Preoperative radiology, epidemiological and clinical details were analyzed to conclude specific criteria for dural tear. Results: Twenty-three patients were involved in the study;male predominance was evident. The most common primary injury was depressed fracture (73.9%), while the most common mode of trauma was domestic injury (43.5%), especially in pediatric group (76.9%). Two cases of growing skull fracture were involved, and both were in pediatric group. CT findings were conclusive for immediate dural tear findings, however, suggestive for patients with growing skull fractures. Mean depth of depression for depressed fracture group was 15.07 mm. Conclusion: Dural tears are not a serious complication of head trauma, however, their sequalae are life-threatening. Anticipation of dural tear is feasible radiologically pre-operatively for immediate dural repair and craniotomy fashioning;for cases of growing skull fractures, it’s difficult to anticipate the course from time of impact till time of presentation.

Shock index and its variants as predictors of mortality in severe traumatic brain injury

BACKGROUND The increase in severe traumatic brain injury(sTBI)incidence is a worldwide phenomenon,resulting in a heavy disease burden in the public health systems,specifically in emerging countries.The shock index(SI)is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock,which is increased in sTBI.Considering the high mortality of sTBI,scrutinizing the predictive potential of SI and its variants is vital.AIM To describe the predictive potential of SI and its variants in sTBI.METHODS This study included 71 patients(61 men and 10 women)divided into two groups:Survival(S;n=49)and Non-survival(NS;n=22).The responses of blood pressure and heart rate(HR)were collected at admission and 48 h after admission.The SI,reverse SI(rSI),rSI multiplied by the Glasgow Coma Score(rSIG),and Age multiplied SI(AgeSI)were calculated.Group comparisons included Shapiro-Wilk tests,and independent samples t-tests.For predictive analysis,logistic regression,receiver operator curves(ROC)curves,and area under the curve(AUC)measurements were performed.RESULTS No significant differences between groups were identified for SI,rSI,or rSIG.The AgeSI was significantly higher in NS patients at 48 h following admission(S:26.32±14.2,and NS:37.27±17.8;P=0.016).Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function,only the AgeSI was a viable outcome-predictive tool in sTBI,warranting future research in different cohorts.

Knowledge, Attitude, and Practice of Using Helmets in Children amongst Parents to Prevent Head Injuries: A Cross-Sectional Study in Riyadh, Saudi Arabia

Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-sectional study, done by online survey using a snowball sampling technique, the number of included responses were 386 parents (Male and female) living in Riyadh Aged 21 - 60 years old or above. Results: The study showed that there is a difference in Parents’ belief in the importance of helmet use while riding a Bicycle vs Motorcycle/Quad bike and that was affected by parents’ education level, almost all the people who answered the survey (76.7%) agree that it is important for their children to wear a helmet when riding both a Bicycle and a Motorcycle or Quadbike with a cumulative percentage of (93.8%). And almost all agreed on multiple approaches to help increase helmet use be it by forcing rental shops to give out helmets, forcing sellers to recommend the use of helmets, increasing awareness campaigns, and imposing fines for not wearing helmets. Conclusions: This study is the first to explore Family helmet use while riding Bicycles and Motorcycles/Quad bikes. Although Parent’s belief in the importance of helmet use for their children was high, it is clear that the level of practice is low. With that the risk of head injuries might be high, our findings suggest that safety interventions for increasing pediatric helmet use are needed to increase helmet use and reduce the risk of head injury and hospitalization.

Massive Epistaxis Revealing a Post-Traumatic Aneurysm of the Internal Carotid Artery: A Clinical Case and Review of the Literature

Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.

Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia:A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials

Objective:To evaluate the existing randomized controlled trials(RCTs)for evidence of the efficacy and safety of head acupuncture(HA)plus Schuell’s language rehabilitation(SLR)in post-stroke aphasia.Methods:Seven databases including Embase,PubMed,Cochrane Library,Technology Periodical Database,the China National Knowledge Infrastructure,SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14,2021.RCTs that compared HA plus SLR with sham(or blank)control,acupuncture therapy alone,certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included.Data were extracted and assessed,and the quality of RCTs was evaluated.Fixed-effects model was used,with meta-influence analysis,meta-regression,and regression-based sub-group analyses applied for exploration of heterogeneity.Publication bias was estimated by funnel plots and Egger’s tests.Results:A total of 32 RCTs with1,968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia.(1)For patients with aphasia after ischemic stroke,HA plus PSA showed significantly higher accumulative markedly effective rate[relative risk(RR)=1.55,95% confidence interval(CI):1.19-2.02,I^(2)=0%]and accumulative effective rate(RR=1.22,95%CI:1.09-1.36,I^(2)=0%).(2)For patients with comprehensive types of stroke,HA plus PSA was more effective in increasing recovery rate(RR=1.89,95%CI:1.39-2.56,I^(2)=0%),accumulative markedly effective rate(RR=1.53,95%CI:1.36-1.72,I^(2)=9%)and accumulative effective rate(RR=1.14,95%CI:1.09-1.19,I^(2)=34%).(3)For patients with aphasia after stroke,HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate(RR=2.08,95%CI:1.24-3.46,I^(2)=0%),accumulative markedly effective rate(RR=1049,95%CI:1.24-1.78,I^(2)=0%)and accumulative effective rate(RR=1.15,95%CI:1.06-1.24,12=39%).(4)For patients with multiple types of aphasia,HA plus PSA also demonstrated significantly higher recovery rate(RR=1.86,95%CI:1.28-2.72,I^(2)=0%),accumulative markedly effective rate(RR=1.55,95%CI:1.35-1.78,I2=22%),and accumulative effective rate(RR=1.17,95%CI:1.11-1.23,I^(2)=41%).(5)For patients with motor aphasia after ischemic stroke,compared with PSA alone,HA plus PSA showed significantly higher accumulative markedly effective rate(RR=1.38,95%CI:1.06-1079,I^(2)=0%)and accumulative effective rate(RR=1.20,95%CI:1.05-1.37,I^(2)=0%).Meta-regression analyses were performed without significant difference,and publication bias was found in some comparisons.Conclusion:HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia,and HA should be operated cautiously especially during acupuncture at eye and neck.(Registration No.CRD42020154475).

Evidence for Cerebral Microvascular Injury in Head Trauma Involving Infants and Young Children

Background:The pathophysiology of lethal head trauma in infants and young children involves repetitive rotational forces of sufficient magnitude to produce subdural hemorrhage and brain swelling,which leads to considerable morbidity and mortality.The precise mechanism for brain swelling is unclear.Materials and Methods:We examined cerebral tissue from ten pediatric deaths due to blunt force trauma,along with seven control infants who asphyxiated in unsafe sleep environments.To assess the competence of the blood-brain barrier,we performed immunohistochemical stains for albumin and immunoglobulin G(IgG).Results:IgG and albumin were increased in subpial and superficial perivascular tissue in those cases due to blunt force trauma,and in particular,the blunt force trauma associated with subdural hematoma.This included two deaths at the scene without hospital survival time.Conclusions:Our findings suggest disruption of the blood-brain barrier with vasogenic edema as an early event in head trauma involving young children upstream of global ischemic brain injury.We hypothesize that mechanical injury to the cortical vasculature results in vasogenic edema by oncotic(increased plasma proteins in the cortical interstitium)and hydrostatic(increased capillary pressure)mechanisms,with subsequent cortical ischemia.This may explain why ischemic sequelae appear to occur in head trauma involving young children,regardless of whether anoxia,hypotension,or cardiac arrest complicate the disease course and may in part underlie the high morbidity and mortality of head trauma in early childhood.

Brain Injury Biomechanics and Abusive Head Trauma

Contemporary biomechanical theory of traumatic brain injury has its foundation in Holbourn’s thesis on shear strain and Ommaya’s primate experimentation demonstrating the role of rotation in a variety of lesions including subdural hematoma(SDH)and diffuse axonal injury.Empirical human observations have since confirmed,for the most part,the early concepts.Ethical concerns regarding primate research,however,have prompted in vitro models,which in turn has led to challenges with respect to the correlation between in vitro observations and the clinical data.Despite these challenges,medicolegal proceedings may call upon biomechanical engineers to reconstruct complex injury scenarios and offer opinions on the scientific plausibility of clinical disease states,such as SDH,hemorrhagic retinopathy,and cerebral edema,associated with hypothetical or proffered action sequences during the course of an unwitnessed homicide.It is important to note,however,that in vitro models by their nature are low‑evidence quality studies that attempt to advance hypotheses but do not address cause and effect.As a whole,biomechanical models,as they pertain specifically to the brain and spine,are mathematically imprecise.Often,endpoints of limited relevance are relied upon(e.g.,skull fracture thresholds),which predictably overestimate the in vivo risk of significant injury.Given the increasing role of biomechanical engineering in the interpretation of fatal pediatric head trauma,a heightened awareness of the limitations warranted.

Forensic Examination of Abusive Head Trauma in Child Abuse Cases

Abusive head trauma(AHT)in child abuse cases is rarely encountered in the practice of forensic examination in China,and such cases are rarely reported.The authors reviewed a large number of relevant domestic and foreign studies to differentiate between the definitions of AHT and shaken baby syndrome;determine the relationship between the two;and discuss their epidemiology,mechanism,and symptoms.In addition,the main points in forensic examination and strategies for preventing AHT are also summarized to help forensic workers and clinicians identify and prevent such injuries.

A case of malignant fibrous histiocytoma of the head after trauma and radiation therapy

Malignant fibrous histiocytoma(MFH) firstly described as"malignant fibrous xanthoma"by O' Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life.Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity.MFH only rare arises from structures of the head and neck.When it does, it most often originates in facial structures, particularly the maxilla.This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes.Radical excision was a surgical challenge because of the extensiveness of the lesion.

Head trauma can cause transient elevation of intraocular pressure in patients with open angle glaucoma

AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.

The Department of Otolaryngology Head and Neck Surgery,PLA General Hospital (national key academic unit) The PLA Institute of Otolaryngology (PLA key laboratory for acoustic trauma) The PLA Medical College Department of Deafness Education Key Laboratory

Led by four generations of leadership from late Prof.JIANG Sichang(academician,Chinese Academy of Engineering),Prof.YANG Weiyan(Honorary President,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association),Prof.HAN Dongyi(President Elected,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association)to now Prof.YANG Shiming(President,Division of Otolaryngologists,

Head Trauma in Infants: Experience of a High Flow Tertiary Hospital in a Developing Country

Background and Objective: Head trauma in infants is a common health problem that has not been the focus of many research articles. The aim of study was to describe the epidemiology, etiology, management and clinical outcome of head trauma in infants (<2 years) in a high flow tertiary hospital. Patients and Methods: This study was conducted on 95 consecutive infants with head trauma admitted to the neurotrauma unit in Cairo University hospitals during the period between September 2013 and December 2014. The data of these patients including age, sex, mode of trauma, neurological status on admission, CT findings, operative details in surgical cases, clinical outcome, and length of hospital stay were analyzed. Results: The study included 57 boys and 38 girls, with mean age of 13.2 months (range: 3 days - 23 months). The most common mode of trauma was falls (82.1%). Most of the patients had mild head injury (84.2%). Twenty two patients were operated upon, including 9 patients for evacuation of hematomas, 11 patients for elevation of depressed fractures, 1 patient for decompressive craniotomy and 1 patient for growing skull fracture. Good recovery followed in 83 patients. There were 4 deaths. Mean length of stay was 4 days (range: 1 - 31 days). Conclusion: Most of head injuries in infants are mild. The commonest etiology is falls, which is a preventable cause in many circumstances. The majority of these patients do not require surgical intervention. Good recovery is the rule in most of these infants with low mortality rates.