65042-Brain Trauma
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Management of the Head Injury Patient
Management of the Head Injury Patient William Schecter, MD Epidemilogy • 1.6 million head injury patients in the U.S. annually • 250,000 head injury hospital admissions annually • 60,000 deaths • 70-90,000 permanent disability • Estimated cost: $100 billion per year Causes of Brain Injury • Motor Vehicle Accidents • Falls • Anoxic Encephalopathy • Penetrating Trauma • Air Embolus after blast injury • Ischemia • Intracerebral hemorrhage from Htn/aneurysm • Infection • tumor Brain Injury • Primary Brain Injury • Secondary Brain Injury Primary Brain Injury • Focal Brain Injury – Skull Fracture – Epidural Hematoma – Subdural Hematoma – Subarachnoid Hemorrhage – Intracerebral Hematorma – Cerebral Contusion • Diffuse Axonal Injury Fracture at the Base of the Skull Battle’s Sign • Periorbital Hematoma • Battle’s Sign • CSF Rhinorhea • CSF Otorrhea • Hemotympanum • Possible cranial nerve palsy http://health.allrefer.com/pictures-images/ Fracture of maxillary sinus causing CSF Rhinorrhea battles-sign-behind-the-ear.html Skull Fractures Non-depressed vs Depressed Open vs Closed Linear vs Egg Shell Linear and Depressed Normal Depressed http://www.emedicine.com/med/topic2894.htm Temporal Bone Fracture http://www.vh.org/adult/provider/anatomy/ http://www.bartleby.com/107/illus510.html AnatomicVariants/Cardiovascular/Images0300/0386.html Epidural Hematoma http://www.chestjournal.org/cgi/content/full/122/2/699 http://www.bartleby.com/107/illus769.html Epidural Hematoma • Uncommon (<1% of all head injuries, 10% of post traumatic coma patients) • Located -
A Review of Traumatic Axonal Injury
Acta Medica 2021; 52(2): 102-108 acta medica REVIEW A Review of Traumatic Axonal Injury Dicle Karakaya1, [MD] ABSTRACT ORCID: 0000-0003-1939-6802 Traumatic brain injury is a major cause of mortality and neurological Ahmet İlkay Işıkay2, [MD] disability worldwide and varies according to its cause, pathogenesis, ORCID: 0000-0001-7790-4735 severity and clinical outcome. This review summarizes a significant aspect of diffuse brain injuries – traumatic axonal injury – important cause of severe disability and vegetative state. Traumatic axonal injury is a type of traumatic brain injury caused by blunt head trauma. It is defined both clinically (immediate and prolonged unconsciousness, characteristically in the absence of space-occupying lesions) and pathologically (widespread and diffuse damage of axons). Following traumatic brain injury, progressive axonal degeneration starts with 1Hacettepe University, Faculty of Medicine, Department disruption of axonal transport, axonal swelling, secondary axonal of Neurosurgery, Ankara, Turkey disconnection and Wallerian degeneration, respectively. However, traumatic axonal injury is difficult to define clinically, it should be Corresponding Author: Ahmet İlkay Işıkay considered in patients with Glasgow coma score < 8 for more than six Hacettepe University, Faculty of Medicine, Department hours after trauma and diffuse tensor imaging and sensitivity-weighted of Neurosurgery, Sıhhiye/Ankara, Turkey imaging MRI sequences are highly sensitive in its diagnosis. Glasgow Phone: +90 312 305 17 15 coma score at the time of presentation, location and severity of axonal E-mail: [email protected] damage are prognostic factors for clinical outcome. https://doi.org/10.32552/2021.ActaMedica.467 Keywords: Diffuse, traumatic, axonal, injury. Received: 29 May 2020, Accepted: 9 March 2021, Published online: 8 June 2021 INTRODUCTION Traumatic axonal injury (TAI) is a distinct it is not diffuse but actually widespread and/or clinicopathological topic that can cause severe multifocal [3]. -
Feigned Consensus: Usurping the Law in Shaken Baby Syndrome/ Abusive Head Trauma Prosecutions
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Michigan School of Law University of Michigan Law School University of Michigan Law School Scholarship Repository Articles Faculty Scholarship 2020 Feigned Consensus: Usurping the Law in Shaken Baby Syndrome/ Abusive Head Trauma Prosecutions Keith A. Findley University of Wisconsin Law School D. Michael Risinger Seton Hall University School of Law Patrick D. Barnes Stanford University Medical Center Julie A. Mack Pennsylvania State University Medical Center David A. Moran University of Michigan Law School, [email protected] See next page for additional authors Available at: https://repository.law.umich.edu/articles/2102 Follow this and additional works at: https://repository.law.umich.edu/articles Part of the Criminal Procedure Commons, Evidence Commons, Juvenile Law Commons, and the Medical Jurisprudence Commons Recommended Citation Findley, Keith A. "Feigned Consensus: Usurping the Law in Shaken Baby Syndrome/Abusive Head Trauma Prosecutions." Michael Risinger, Patrick Barnes, Julie Mack, David A. Moran, Barry Scheck, and Thomas Bohan, co-authors. Wis. L. Rev. 2019, no. 4 (2019): 1211-268. This Article is brought to you for free and open access by the Faculty Scholarship at University of Michigan Law School Scholarship Repository. It has been accepted for inclusion in Articles by an authorized administrator of University of Michigan Law School Scholarship Repository. For more information, please contact [email protected]. Authors Keith A. Findley, D. Michael Risinger, Patrick D. Barnes, Julie A. Mack, David A. Moran, Barry C. Scheck, and Thomas L. Bohan This article is available at University of Michigan Law School Scholarship Repository: https://repository.law.umich.edu/articles/2102 FEIGNED CONSENSUS: USURPING THE LAW IN SHAKEN BABY SYNDROME/ ABUSIVE HEAD TRAUMA PROSECUTIONS KEITH A. -
Overcoming Defense Expert Testimony in Abusive Head Trauma Cases
NATIONAL CENTER FOR PROSECUTION OF CHILD ABUSE Special Topics in Child Abuse Overcoming Defense Expert Testimony in Abusive Head Trauma Cases By Dermot Garrett Edited by Eleanor Odom, Amanda Appelbaum and David Pendle NATIONAL CENTER FOR PROSECUTION OF CHILD ABUSE Scott Burns Director , National District Attorneys Association The National District Attorneys Association is the oldest and largest professional organization representing criminal prosecutors in the world. Its members come from the offices of district attorneys, state’s attorneys, attorneys general, and county and city prosecutors with responsibility for prosecuting criminal violations in every state and territory of the United States. To accomplish this mission, NDAA serves as a nationwide, interdisciplinary resource center for training, research, technical assistance, and publications reflecting the highest standards and cutting-edge practices of the prosecutorial profession. In 1985, the National District Attorneys Association recognized the unique challenges of crimes involving child victims and established the National Center for Prosecution of Child Abuse (NCPCA). NCPCA’s mission is to reduce the number of children victimized and exploited by assisting prosecutors and allied professionals laboring on behalf of victims too small, scared or weak to protect themselves. Suzanna Tiapula Director, National Center for Prosecution of Child Abuse A program of the National District Attorneys Association www.ndaa.org 703.549.9222 This project was supported by Grants #2010-CI-FX-K008 and [new VOCA grant #] awarded by the Office of Juvenile Justice and Delinquency Prevention. The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the U.S. -
NIH Public Access Author Manuscript J Neuropathol Exp Neurol
NIH Public Access Author Manuscript J Neuropathol Exp Neurol. Author manuscript; available in PMC 2010 September 24. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: J Neuropathol Exp Neurol. 2009 July ; 68(7): 709±735. doi:10.1097/NEN.0b013e3181a9d503. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury Ann C. McKee, MD1,2,3,4, Robert C. Cantu, MD3,5,6,7, Christopher J. Nowinski, AB3,5, E. Tessa Hedley-Whyte, MD8, Brandon E. Gavett, PhD1, Andrew E. Budson, MD1,4, Veronica E. Santini, MD1, Hyo-Soon Lee, MD1, Caroline A. Kubilus1,3, and Robert A. Stern, PhD1,3 1 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 2 Department of Pathology, Boston University School of Medicine, Boston, Massachusetts 3 Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts 4 Geriatric Research Education Clinical Center, Bedford Veterans Administration Medical Center, Bedford, Massachusetts 5 Sports Legacy Institute, Waltham, MA 6 Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts 7 Department of Neurosurgery, Emerson Hospital, Concord, MA 8 CS Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Abstract Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed “dementia pugilistica” and more recently, chronic traumatic encephalopathy (CTE). We review the 47 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 professional athletes: one football player and 2 boxers. -
Diffuse Axonal Injury in Head Trauma
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.7.838 on 1 July 1989. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1989;52:838-841 Diffuse axonal injury in head trauma PETER C BLUMBERGS, NIGEL R JONES, JOHN B NORTH From the Neuropathology Laboratory, Institute ofMedical and Veterinary Science and Neurosurgery Department, Royal Adelaide Hospital, Adelaide, South Australia SUMMARY Diffuse axonal injury (DAI) as defined by detailed microscopic examination was found in 34 of 80 consecutive cases of head trauma surviving for a sufficient length of time to be clinically assessed by the Royal Adelaide Hospital Neurosurgery Unit. The findings indicate that there is a spectrum ofaxonal injury and that one third ofcases ofDAI recovered sufficiently to talk between the initial head injury producing coma and subsequent death. The macroscopic "marker" lesions in the corpus callosum and dorsolateral quadrants of the brainstem were present in only 15/34 of the cases and represented the most severe end of the spectrum of DAI. Diffuse axonal injury (DAI) that is, widespread superior cerebellar peduncles, (2) evidence of diffuse damage to axons in the white matter of the brain, was damage to axons. originally defined by Strich' and the concept was Patients who sustain severe DAI are unconscious expanded by Adams et al.2 Strich described diffuse from the moment ofimpact, do not experience a lucid Protected by copyright. degeneration ofthe cerebral white matter in a series of interval, and remain unconscious, vegetative -
Oligodendrocyte Pathology Following Traumatic Brain Injury
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1311 Oligodendrocyte pathology following Traumatic Brain Injury Experimental and clinical studies JOHANNA FLYGT ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-554-9846-7 UPPSALA urn:nbn:se:uu:diva-316401 2017 Dissertation presented at Uppsala University to be publicly examined in Hedstrandsalen, Akademiska Sjukhuset, Uppsala, Friday, 5 May 2017 at 09:00 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in English. Faculty examiner: Professor Fredrik Piehl (Karolinska Institutet). Abstract Flygt, J. 2017. Oligodendrocyte pathology following Traumatic Brain Injury. Experimental and clinical studies. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1311. 76 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-9846-7. Traumatic brain injury (TBI) caused by traffic and fall accidents, sports-related injuries and violence commonly results in life-changing disabilities. Cognitive impairments following TBI may be due to disruption of axons, stretched by the acceleration/deceleration forces of the initial impact, and their surrounding myelin in neuronal networks. The primary injury, which also results in death to neuronal and glial cells, is followed by a cascade of secondary injury mechanisms including a complex inflammatory response that will exacerbate the white matter injury. Axons are supported and protected by the ensheathing myelin, ensuring fast conduction velocity. Myelin is produced by oligodendrocytes (OLs), a cell type vulnerable to many of the molecular processes, including several inflammatory mediators, elicited by TBI. Since one OL extends processes to several axons, the protection of OLs is an important therapeutic target post- TBI. -
Intracranial Hemorrhage
Intracranial Hemorrhage MARK MOSS, M.D. INTERVENTIONAL NEURORADIOLOGY WASHINGTON REGIONAL MEDICAL CENTER Definitions Stroke Clinical syndrome of rapid onset deficits of brain function lasting more than 24 hours or leading to death Transient Ischemic attack (TIA) Clinical syndrome of rapid onset deficits of brain function which resolves within 24 hours Epidemiology Stroke is the leading cause of adult disabilities 2nd leading cause of death worldwide 3rd leading cause of death in the U.S. 800,000 strokes per year resulting in 150,000 deaths Deaths are projected to increase exponentially in the next 30 years owing to the aging population The annual cost of stroke in the U.S. is estimated at $69 billion Stroke can be divided into hemorrhagic and ischemic origins 13% hemorrhagic 87% ischemic Intracranial Hemorrhage Collective term encompassing many different conditions characterized by the extravascular accumulation of blood within different intracranial spaces. OBJECTIVES: Define types of ICH Discuss best imaging modalities Subarachnoid hemorrhage / Aneurysms Roles of endovascular surgery Intracranial hemorrhage Outside the brain (Extra-axial) hemorrhage Subdural hematoma (SDH) Epidural hematoma (EDH) Subarachnoid hematoma (SAH) Intraventricular (IVH) Inside the brain (Intra-axial) hemorrhage Intraparenchymal hematoma (basal ganglia, lobar, pontine etc.) Your heads compartments Scalp Subgaleal Space Bone (calvarium) Dura Mater thick tough membrane Arachnoid flimsy transparent membrane Pia Mater tightly hugs the -
Extradural Hematoma – Is Surgery Always Mandatory?
Rom J Leg Med [22] 45-50 [2014] DOI: 10.4323/rjlm.2014.45 © 2014 Romanian Society of Legal Medicine Extradural hematoma – is surgery always mandatory? Ligia Tataranu1,2,*, Vasile Ciubotaru2, Dan Paunescu2, Andrei Spatariu2, Mugurel Radoi1 _________________________________________________________________________________________ Abstract: Although surgery remains the treatment of choice for extradural hematomas (EDH), there were many cases reported in the literature with good outcome, even if they were not treated surgically. The aim of this study was to discover the most important factors influencing the management strategy and outcome of EDH and to outline a set of guidelines for the treatment. Fifty-six consecutive adult patients treated for EDH between 2008 and 2012 formed the base of this retrospective study. The patients were treated as follows: 28 cases (50.0%) underwent urgent surgery, 13 cases (23.2%) were managed nonoperatively and 15 cases (26.8%) required delayed surgery. The conservative management was directly related to the volume of the EDH, and the EDH volume over 30 cm3 was a significant prognostic factor for conversion to surgery (95 % CI, p < 0.001). Patients in coma (Glasgow Coma Score < 8) have a poorer outcome than patients in good neurological status, regardless of to the therapy followed (95% CI, p = 0.0034). The volume of the EDH was not demonstrated to be a prognostic factor related to outcome (95 % CI, p = 0.2031). In conclusion, the diagnosis of the EDH must be promptly made by CT scan and the patient should be handled as an emergency and admitted into a neurosurgical center. Surgical indications mainly rely on the patient’s neurological status and CT findings. -
Epilepsy and Psychosis
Central Journal of Neurological Disorders & Stroke Review Article Special Issue on Epilepsy and Psychosis Epilepsy and Seizures *Corresponding author Daniel S Weisholtz* and Barbara A Dworetzky Destînâ Yalcin A, Department of Neurology, Ümraniye Department of Neurology, Brigham and Women’s Hospital, Harvard University, Boston Research and Training Hospital, Istanbul, Turkey, Massachusetts, USA Email: Submitted: 11 March 2014 Abstract Accepted: 08 April 2014 Psychosis is a significant comorbidity for a subset of patients with epilepsy, and Published: 14 April 2014 may appear in various contexts. Psychosis may be chronic or episodic. Chronic Interictal Copyright Psychosis (CIP) occurs in 2-10% of patients with epilepsy. CIP has been associated © 2014 Yalcin et al. most strongly with temporal lobe epilepsy. Episodic psychoses in epilepsy may be classified by their temporal relationship to seizures. Ictal psychosis refers to psychosis OPEN ACCESS that occurs as a symptom of seizure activity, and can be seen in some cases of non- convulsive status epilepticus. The nature of the psychotic symptoms generally depends Keywords on the localization of the seizure activity. Postictal Psychosis (PIP) may occur after • Epilepsy a cluster of complex partial or generalized seizures, and typically appears after • Psychosis a lucid interval of up to 72 hours following the immediate postictal state. Interictal • Hallucinations psychotic episodes (in which there is no definite temporal relationship with seizures) • Non-convulsive status epilepticus may be precipitated by the use of certain anticonvulsant drugs, particularly vigabatrin, • Forced normalization zonisamide, topiramate, and levetiracetam, and is linked in some cases to “forced normalization” of the EEG or cessation of seizures, a phenomenon known as alternate psychosis. -
Diffuse Axonal Injury and Oxidative Stress: a Comprehensive Review
International Journal of Molecular Sciences Review Diffuse Axonal Injury and Oxidative Stress: A Comprehensive Review Alessandro Frati 1,2, Daniela Cerretani 3, Anna Ida Fiaschi 3, Paola Frati 1,4, Vittorio Gatto 4, Raffaele La Russa 1,4 ID , Alessandro Pesce 2, Enrica Pinchi 4, Alessandro Santurro 4 ID , Flavia Fraschetti 2 and Vittorio Fineschi 1,4,* 1 Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; [email protected] (A.F.); [email protected] (P.F.); [email protected] (R.L.R.) 2 Department of Neurosciences, Mental Health, and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; [email protected] (A.P.); fl[email protected] (F.F.) 3 Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy; [email protected] (D.C.); annaida.fi[email protected] (A.I.F.) 4 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy; [email protected] (V.G.); [email protected] (E.P.); [email protected] (A.S.) * Correspondence: vfi[email protected]; Tel.: +39-06-49912-722; Fax: +39-06-4455-335 Received: 16 September 2017; Accepted: 28 November 2017; Published: 2 December 2017 Abstract: Traumatic brain injury (TBI) is one of the world’s leading causes of morbidity and mortality among young individuals. TBI applies powerful rotational and translational forces to the brain parenchyma, which results in a traumatic diffuse axonal injury (DAI) responsible for brain swelling and neuronal death. -
Part Ii – Neurological Disorders
Part ii – Neurological Disorders CHAPTER 19 HEAD AND SPINAL INJURY Dr William P. Howlett 2012 Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania BRIC 2012 University of Bergen PO Box 7800 NO-5020 Bergen Norway NEUROLOGY IN AFRICA William Howlett Illustrations: Ellinor Moldeklev Hoff, Department of Photos and Drawings, UiB Cover: Tor Vegard Tobiassen Layout: Christian Bakke, Division of Communication, University of Bergen E JØM RKE IL T M 2 Printed by Bodoni, Bergen, Norway 4 9 1 9 6 Trykksak Copyright © 2012 William Howlett NEUROLOGY IN AFRICA is freely available to download at Bergen Open Research Archive (https://bora.uib.no) www.uib.no/cih/en/resources/neurology-in-africa ISBN 978-82-7453-085-0 Notice/Disclaimer This publication is intended to give accurate information with regard to the subject matter covered. However medical knowledge is constantly changing and information may alter. It is the responsibility of the practitioner to determine the best treatment for the patient and readers are therefore obliged to check and verify information contained within the book. This recommendation is most important with regard to drugs used, their dose, route and duration of administration, indications and contraindications and side effects. The author and the publisher waive any and all liability for damages, injury or death to persons or property incurred, directly or indirectly by this publication. CONTENTS HEAD AND SPINAL INJURY 413 EPIDEMIOLOGY � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �