Introduction: Cranioencephalic trauma caused by bladed weapons is rare, and that caused by sharp objects is exceptional. The aim of our study was to describe the clinical, therapeutic and evolutionary aspects. Materia...Introduction: Cranioencephalic trauma caused by bladed weapons is rare, and that caused by sharp objects is exceptional. The aim of our study was to describe the clinical, therapeutic and evolutionary aspects. Materials and method: This was a descriptive and analytical study over a 48-month period at CHU la Renaissance from January 1, 2018 to December 31, 2021, concerning patients admitted for penetrating cranioencephalic trauma by pointed object. Results: Twelve cases, all male, of penetrating cranioencephalic sharp-force trauma were identified. The mean age was 34 ± 7 years, with extremes of 11 and 60 years. Farmers and herders accounted for 31% and 25% of cases respectively. The average admission time was 47 hours. Brawls were the circumstances of occurrence in 81.2% of cases. Knives (33%), arrows (25%) and iron bars (16.6%) were the objects used. Altered consciousness was present in 43.8% of cases, and focal deficit in 50%. Scannographic lesions were fracture and/or embarrhment (12 cases), intra-parenchymal haematomas (6 cases) and presence of object in place (4 cases). Surgery was performed in 11 patients. Postoperative outcome was favorable in 9 patients. After 12 months, 2 patients were declared unfit. Conclusion: Penetrating head injuries caused by sharp objects are common in Chad. Urgent surgery can prevent disabling after-effects.展开更多
Unusual head trauma is rare with various mechanisms of occurrence. The injuries can be similar to those of road accidents but sometimes with significant complexities. The objective was to determine the frequency of th...Unusual head trauma is rare with various mechanisms of occurrence. The injuries can be similar to those of road accidents but sometimes with significant complexities. The objective was to determine the frequency of this pathology in our practice, describe the different mechanisms and report the craniocerebral lesions caused by this type of trauma. Materials and Method: This was a descriptive study with retrospective collection spread over a period of 3 years. After selecting the files, the patients and/or their companions were contacted by telephone to inquire about them and then returned to the consultation for reassessment. Disease history and information were obtained from patients’ medical records. Result: The frequency of this pathology was 1.78% and his incidence was 0.4 cases per month. The average age of the patients was 13.47 years. All the victims were male. 41.17% of patients were in school. The mechanisms of trauma were the hoof blow 47.1%, the horn blow 29.4% and the stone blow 11.7% respectively. 23.5% of patients were confused and 11.7% children were in coma. One patient presented an anisocoria. The motor deficit was present in 5 cases. CT-scan made it possible to highlight a skull depressing fracture 58.8% and confirm a craniocerebral wound in 35.3%. The average time between patient admission to hospital and completion of surgery was 24.5 hours. The surgery had consisted of the trimming of cranio-cerebral wounds, exploration, duroplasty and lifting of skull depressing fracture. After 15 months of follow-up, the evolution was favorable in 53.3%, the morbidity was 33.4% and the mortality 17.6%. Conclusion: These are rare but serious conditions because they are fatal and disabling. An early and multidisciplinary management can hope to have a good favorable.展开更多
The fetal head trauma is rare and seen in pregnant road accidents and during extractive maneuvers during childbirth. We have reported a case of congenital depressed skull fracture due to an innocuous fall from her own...The fetal head trauma is rare and seen in pregnant road accidents and during extractive maneuvers during childbirth. We have reported a case of congenital depressed skull fracture due to an innocuous fall from her own height of a pregnant of 35 weeks of amenorrhea. The diagnosis was made at birth, by vaginal delivery, by the discovery of a left frontal depressed skull fracture without neurological disorder. A surgical lifting of the drepressed skull fracture was made at the 2nd day of life. Outcome was good marked by a normal psychomotor development.展开更多
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 hosp...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展开更多
Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavern...Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.展开更多
Background: Growing skull fractures (GSF) are a rare complication of pediatric head trauma that comprises post-traumatic skull defect associated with an underlying dural tear and an intact arachnoid membrane. They are...Background: Growing skull fractures (GSF) are a rare complication of pediatric head trauma that comprises post-traumatic skull defect associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease with neurological sequelae. GSF are rare and their incidence has been estimated as 0.05% - 1% of all pediatric skull fractures. This low incidence and the subtlety of its presentation often make diagnosis challenging with consequent delay in management. Surgery is recommended to treat GSF and involved dural repair with or without cranioplasty. In this paper, we report a case of a patient with GSF in whom the surgical repair was successful with good cosmetic and functional outcome. Case Report: A 12 months old girl was admitted to our neurosurgical department with right parietal swelling that had been gradually enlarging over 3 months. The history of the disease began when the girl was 1 month old with a fall with cranial impact resulting in head trauma with initial loss of consciousness. At presentation the girl was alert with normal consciousness. Clinical examination revealed the deformed skull with large pulsatile and painless swelling lesion in the right parietal region and hemiparesis on the left side. The CT scan revealed type 3 GSF including parietal bone diastasis with hypodense fluid collection that mimicked the leptomeningeal and porencephalic cyst. Surgical repair was performed. The post-operative course was uneventful and the child was discharged home five days after surgical intervention. Conclusion: GSF can lead to serious neurologic complications. Therefore educating parents on this potential outcome and close follow-up with clinical and imaging screening is recommended to screen children at risk for the development of the disease.展开更多
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 stu...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.展开更多
目的:探讨早期颅骨修补术在颅脑外伤术后颅骨缺损患者中的应用。方法:选取2019年1月—2023年1月常熟市中医院神经外科收治的80例颅脑外伤术后颅骨缺损患者作为研究对象。根据随机数表法将其分为对照组和观察组,各40例。两组均给予颅骨...目的:探讨早期颅骨修补术在颅脑外伤术后颅骨缺损患者中的应用。方法:选取2019年1月—2023年1月常熟市中医院神经外科收治的80例颅脑外伤术后颅骨缺损患者作为研究对象。根据随机数表法将其分为对照组和观察组,各40例。两组均给予颅骨修补术。对照组在颅脑外伤术后4~6个月实施颅骨修补术,观察组在颅脑外伤术后1~3个月实施颅骨修补术。比较两组术前、术后1个月认知功能、神经功能、日常生活能力、颅脑外伤严重程度、生活质量及并发症。结果:术后1个月,两组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分低于术前,简易智力状态检查量表(mini-mental state examination,MMSE)评分、Barthel指数(BI)评分均高于术前,观察组NIHSS评分低于对照组,MMSE评分、BI评分均高于对照组,差异有统计学意义(P<0.05)。术后1个月,两组认知功能、运动功能、睁眼反应、进食、如厕、语言表达能力、整体功能、受雇能力评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组术后1个月的社会功能、躯体功能、物质生活、心理功能评分均高于对照组,差异有统计学意义(P<0.05)。结论:早期颅骨修补术能够有效改善颅脑外伤术后颅骨缺损患者的认知功能和神经功能,降低患者并发症发生率,提高患者的日常生活能力和生活质量。展开更多
文摘Introduction: Cranioencephalic trauma caused by bladed weapons is rare, and that caused by sharp objects is exceptional. The aim of our study was to describe the clinical, therapeutic and evolutionary aspects. Materials and method: This was a descriptive and analytical study over a 48-month period at CHU la Renaissance from January 1, 2018 to December 31, 2021, concerning patients admitted for penetrating cranioencephalic trauma by pointed object. Results: Twelve cases, all male, of penetrating cranioencephalic sharp-force trauma were identified. The mean age was 34 ± 7 years, with extremes of 11 and 60 years. Farmers and herders accounted for 31% and 25% of cases respectively. The average admission time was 47 hours. Brawls were the circumstances of occurrence in 81.2% of cases. Knives (33%), arrows (25%) and iron bars (16.6%) were the objects used. Altered consciousness was present in 43.8% of cases, and focal deficit in 50%. Scannographic lesions were fracture and/or embarrhment (12 cases), intra-parenchymal haematomas (6 cases) and presence of object in place (4 cases). Surgery was performed in 11 patients. Postoperative outcome was favorable in 9 patients. After 12 months, 2 patients were declared unfit. Conclusion: Penetrating head injuries caused by sharp objects are common in Chad. Urgent surgery can prevent disabling after-effects.
文摘Unusual head trauma is rare with various mechanisms of occurrence. The injuries can be similar to those of road accidents but sometimes with significant complexities. The objective was to determine the frequency of this pathology in our practice, describe the different mechanisms and report the craniocerebral lesions caused by this type of trauma. Materials and Method: This was a descriptive study with retrospective collection spread over a period of 3 years. After selecting the files, the patients and/or their companions were contacted by telephone to inquire about them and then returned to the consultation for reassessment. Disease history and information were obtained from patients’ medical records. Result: The frequency of this pathology was 1.78% and his incidence was 0.4 cases per month. The average age of the patients was 13.47 years. All the victims were male. 41.17% of patients were in school. The mechanisms of trauma were the hoof blow 47.1%, the horn blow 29.4% and the stone blow 11.7% respectively. 23.5% of patients were confused and 11.7% children were in coma. One patient presented an anisocoria. The motor deficit was present in 5 cases. CT-scan made it possible to highlight a skull depressing fracture 58.8% and confirm a craniocerebral wound in 35.3%. The average time between patient admission to hospital and completion of surgery was 24.5 hours. The surgery had consisted of the trimming of cranio-cerebral wounds, exploration, duroplasty and lifting of skull depressing fracture. After 15 months of follow-up, the evolution was favorable in 53.3%, the morbidity was 33.4% and the mortality 17.6%. Conclusion: These are rare but serious conditions because they are fatal and disabling. An early and multidisciplinary management can hope to have a good favorable.
文摘The fetal head trauma is rare and seen in pregnant road accidents and during extractive maneuvers during childbirth. We have reported a case of congenital depressed skull fracture due to an innocuous fall from her own height of a pregnant of 35 weeks of amenorrhea. The diagnosis was made at birth, by vaginal delivery, by the discovery of a left frontal depressed skull fracture without neurological disorder. A surgical lifting of the drepressed skull fracture was made at the 2nd day of life. Outcome was good marked by a normal psychomotor development.
文摘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
文摘Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.
文摘Background: Growing skull fractures (GSF) are a rare complication of pediatric head trauma that comprises post-traumatic skull defect associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease with neurological sequelae. GSF are rare and their incidence has been estimated as 0.05% - 1% of all pediatric skull fractures. This low incidence and the subtlety of its presentation often make diagnosis challenging with consequent delay in management. Surgery is recommended to treat GSF and involved dural repair with or without cranioplasty. In this paper, we report a case of a patient with GSF in whom the surgical repair was successful with good cosmetic and functional outcome. Case Report: A 12 months old girl was admitted to our neurosurgical department with right parietal swelling that had been gradually enlarging over 3 months. The history of the disease began when the girl was 1 month old with a fall with cranial impact resulting in head trauma with initial loss of consciousness. At presentation the girl was alert with normal consciousness. Clinical examination revealed the deformed skull with large pulsatile and painless swelling lesion in the right parietal region and hemiparesis on the left side. The CT scan revealed type 3 GSF including parietal bone diastasis with hypodense fluid collection that mimicked the leptomeningeal and porencephalic cyst. Surgical repair was performed. The post-operative course was uneventful and the child was discharged home five days after surgical intervention. Conclusion: GSF can lead to serious neurologic complications. Therefore educating parents on this potential outcome and close follow-up with clinical and imaging screening is recommended to screen children at risk for the development of the disease.
文摘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.
文摘目的:探讨早期颅骨修补术在颅脑外伤术后颅骨缺损患者中的应用。方法:选取2019年1月—2023年1月常熟市中医院神经外科收治的80例颅脑外伤术后颅骨缺损患者作为研究对象。根据随机数表法将其分为对照组和观察组,各40例。两组均给予颅骨修补术。对照组在颅脑外伤术后4~6个月实施颅骨修补术,观察组在颅脑外伤术后1~3个月实施颅骨修补术。比较两组术前、术后1个月认知功能、神经功能、日常生活能力、颅脑外伤严重程度、生活质量及并发症。结果:术后1个月,两组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分低于术前,简易智力状态检查量表(mini-mental state examination,MMSE)评分、Barthel指数(BI)评分均高于术前,观察组NIHSS评分低于对照组,MMSE评分、BI评分均高于对照组,差异有统计学意义(P<0.05)。术后1个月,两组认知功能、运动功能、睁眼反应、进食、如厕、语言表达能力、整体功能、受雇能力评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组术后1个月的社会功能、躯体功能、物质生活、心理功能评分均高于对照组,差异有统计学意义(P<0.05)。结论:早期颅骨修补术能够有效改善颅脑外伤术后颅骨缺损患者的认知功能和神经功能,降低患者并发症发生率,提高患者的日常生活能力和生活质量。
