Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
The evidence for post-traumatic migraine as the cause of the postconcussion syndrome in a proportion of patients is reviewed. ⋯ patients suffering recurrent post-traumatic headaches or other elements of the postconcussion syndrome should be treated for migraine.
-
The aim of this study was to analyse the results of the use of preoperative embolisation in the management of arteriovenous malformations of the brain at one institution between 1989 and 1999. ⋯ These results reflect that cases selected for embolisation were those at most risk from intraoperative haemorrhage. Arteriovenous malformations that are less than 3 cm in maximal diameter should only rarely be considered for preoperative embolisation because of their low surgical morbidity. In the presence of a significant deep perforating artery contribution that cannot be effectively embolised the risks of operative haemorrhage is high irrespective of the effectiveness of embolising ancillary non-perforating arteries.
-
Since 1992 the Consultative Committee on Road Traffic Fatalities in Victoria (CCRTF) has examined the medical management of patients who died following motor vehicle accidents. Three hundred and fifty-five fatalities with head injury occurring between 1 July, 1992 and 31 December 1997 were assessed by the CCRTF. They represented 79% of the total 449 fatalities examined by the Committee. ⋯ Improved delivery and quality of trauma care could reduce the identified problems in emergency services and clinical management. Basic principles of trauma management remain the most important means of reducing morbidity and death following road trauma. The leadership role of the neurosurgeon in neurotrauma care is emphasised.
-
A 13 year old Fijian boy sustained a stab wound to the left orbit 3 years ago. It was not appreciated by the treating physicians in Fiji that the plastic pen had crossed from the left orbit, through the nose, right orbit and right optic nerve, into the right middle cranial fossa and lodged in the right temporal lobe and that the pen remained in situ for the past 3 years. ⋯ The retained foreign body was not detected on computed tomography imaging, but was detected on subsequent magnetic resonance image. A combined neurosurgery/plastic surgery craniofacial approach was undertaken with successful complete removal of the retained pen, and preservation of vision in his only seeing eye.
-
Many investigators attribute the postconcussion syndrome following mild closed head injury to permanent brain damage. The evidence supporting this conclusion is reviewed, including the force necessary to cause permanent brain damage; the basis for determining whether the patient was exposed to sufficient force in the accident to permanently damage the brain; the basis for determining whether the patient actually has permanent brain damage (not just brain dysfunction) traceable to the accident; and whether the location and severity of brain damage is sufficient to account for the postconcussion syndrome. ⋯ the evidence for permanent traumatic brain damage as the cause of the postconcussion syndrome following mild closed head injury is weak.