British journal of neurosurgery
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We performed a retrospective study of 2484 consecutive patients with mild head injury (Glasgow Coma Scale score 13-15) who were seen during a period of 18 months. Of these, 2351 (94.6%) patients scored 15 points, 88 (3.5%) scored 14 points and 45 (1.3%) 13 points. A multivariate analysis showed that advanced age, a lower GCS (13-14) and the presence of skull fracture, and focal signs, significantly increased the incidence of abnormal computed tomography (CT) findings. ⋯ Such a policy makes skull radiography unnecessary in this subgroup. By contrast, skull radiographs may be useful for the triage of patients with a GCS of 15 that represent most of the mild head injury cases; radiographs should be obtained in patients presenting with initial loss of consciousness or posttraumatic amnesia (27.9% of the total cases) as these two findings were associated with a significantly higher incidence of fracture. Patients without these two findings (72.1% of the cases) showed a very low incidence of skull fracture (0.9% in this study) and may be discharged home with a warning sheet.
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Case Reports
Postoperative subdural empyema caused by Propionibacterium acnes--a report of two cases.
Two patients with postoperative subdural empyema following burr hole evacuation of chronic subdural haematoma are reported, both caused by Propionibacterium acnes. The need to consider this diagnosis in patients developing recurrent symptoms after surgical drainage of chronic subdural haematoma is emphasized.
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A pineal region meningioma without dural attachment is rare. We present a case and review 12 cases reported in the literature. The preoperative diagnosis is difficult, but a vertebral angiogram if correlated to the MRI and clinical picture may give a clue. The infratentorial supracerebellar approach is suitable for this type of tumour.
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Pain and nausea were prospectively assessed in 52 patients following elective craniotomy. When assessed at 6-hourly intervals the mean pain scores in patients during the first 24 h for all types of craniotomy were relatively low. However, for a period of at least 2 h 18% of patients complained of excruciating pain, 37% of patients complained of severe pain, 29% of patients complained of moderate pain, 4% of patients complained of mild pain and only 12% of patients complained of no pain in the 24 h following craniotomy. ⋯ For at least 2 h 37% of patients complained of severe nausea or vomiting, 35% of patients complained of moderate nausea and only 29% of patients reported no symptoms of nausea during the 24-h study period. Again, no statistically significant differences were found in the severity of emetic symptoms when comparing patients undergoing craniotomy at different sites. Contrary to standard assumptions, severe or moderate pain in the first 24 h after craniotomy is common and is poorly treated with codeine phosphate alone.
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We report a case of traumatic embolization of a shotgun pellet in the middle cerebral artery. The patient was successfully treated by emergency embolectomy performed 12 h after the accident. The literature seems to support the protective role of surgical treatment against cerebral ischaemia and subsequent infarction in such cases.