British journal of neurosurgery
-
The effects of high velocity missiles are described. A series of cases of craniocerebral tangential gunshot wounds over a 6 year period is presented with unsuspected cerebral contusion shown by CT. ⋯ The short- and long-term sequelae and the extent of cerebral damage belie the innocent appearance of the scalp wound. This influences the management of this unusual type of head injury.
-
The association between skull fracture, intracranial pathology and outcome in pediatric head injury.
We prospectively studied 653 consecutive head-injured children (less than or equal to 14 years old) treated over a 54-month period (1984-88) at the Department of Neurosurgery of the Rambam Medical Center (Haifa, Israel). Demographic and clinical data were collected, the patients were divided into five age groups (birth to 2 years, 169; 3-5 years, 194; 6-9 years, 164; 10-12 years, 77; and 13-14 years, 49), and the information relative to each was then compared. All patients (except three who died on the operating table) underwent computed tomography (CT) scans; 225 (34.6%) had intracranial pathology, e.g. focal mass lesions, diffuse axonal injury, and subarachnoid haemorrhage. ⋯ The mortality was 6.6% (43 patients); of these, 39 (90.7%) had admission Glasgow Coma Scale scores below 8. In our area the annual incidence of neurosurgical hospitalization due to head injury in the pediatric group was 37.6 per 100,000 inhabitants per year. This study substantiates the findings of other series on the effects of prognosis of factors such as associated trauma, admission Glasgow Coma Score, mass lesions with persistent intracranial pressure elevation, or diffuse axonal injury.(ABSTRACT TRUNCATED AT 250 WORDS)
-
A bipolar electrode has been designed to assess the possibility of locating accurately the electrode tip position within a nerve pathway prior to its thermal coagulation without having recourse to a wake-up procedure. By electrically stimulating each of the peripheral divisions of the trigeminal nerve and recording the evoked activity pre-ganglionically from the electrode, using an averaging computer, a clear triphasic response is recorded. ⋯ A preliminary series of 12 patients with trigeminal neuralgia requiring operative treatment were assessed in this study. In eight cases a clear response was obtained, in two the signal-to-noise ratio was too small, in one stimulus artefact obscured the response and in one a blood vessel was hit.
-
On 8 January 1989 at 20:25 h, a British Midland Boeing 737/400 on approach to East Midlands Airport crashed across the M1 motorway with the immediate loss of 39 lives from the 126 people on board. In the aftermath of the accident a clinical review was commenced to determine the mechanisms of injury in the 87 initial survivors and hopefully provide data to improve commercial aircraft safety in the future. Seventy-seven survivors sustained head and facial trauma in the crash, 45 of whom had periods of amnesia surrounding the event. ⋯ Loss of consciousness and duration of amnesia were directly related to the degree of superficial head trauma. Adoption of the fully flexed brace position for crash-landing offered significant protection from head injury and concussion, and possibly reduced injuries from behind. Suggestions are made for potentially improving the survivability of aircraft accidents.
-
A facio-cranio-cerebral injury due to a large piece of shrapnel causing direct and heat damage to the temporal lobe is described. It was managed by initial dural repair which was followed by sloughing and repeated wound débridement, leaving an open cerebral wound communicating with a facial wound. Auto-rotation of the temporal lobe occurred, allowing split-skin grafting onto arachnoid mater to obtain dural closure. Further treatment of the facial wound by skin-grafting the cavity and prosthetic reconstruction allowed early return to society and a full rehabilitation programme.