DOCSLIB.ORG

Complete Issue (PDF)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complete Issue (PDF) APRIL 2014 THE JOURNAL OF DIAGNOSTIC AND VOLUME 35 INTERVENTIONAL NEURORADIOLOGY NUMBER 4 WWW.AJNR.ORG Ethical use of neuroimaging in medical testimony Stent retrievers in stroke Stent-assisted coiling vs. coiling alone for aneurysms Official Journal ASNR • ASFNR • ASHNR • ASPNR • ASSR Dedicated to the development The MicroVention family of neuroendovascular products: DELIVERY & DETACHMENT SYSTEMS ACCESS PRODUCTS microvention.com MICROVENTION, Headway, Chaperon, Traxcess, HydroFrame, HydroFill, HydroSoft, VFC, MicroPlex, Cosmos, HyperSoft, Scepter C, Scepter XC, V-Trak and V-Grip are registered trademarks of MicroVention, Inc. Scientific and clinical data related to this document are on file at MicroVention, Inc. Refer to Instructions for Use for additional information. Federal (USA) law restricts this device for sale by or on the order of a physician. © 2014 MicroVention, Inc. 2/14 of innovative endovascular technologies HYDROGEL COIL PRODUCTS PLATINUM COIL PRODUCTS Introducing… The softness of the HyperSoft ® Coil available in Complex Form! Now you can Frame, Fill and Finish with the softness you need to match almost any aneurysm morphology. MicroVention, Inc. Worldwide Headquarters PH +1.714.247.8000 1311 Valencia Avenue Tustin, CA 92780 USA MicroVention UK Limited PH +44 (0) 191 258 6777 MicroVention Europe, S.A.R.L. PH +33 (1) 39 21 77 46 MicroVention Deutschland GmbH PH +49 211 210 798-0 Smooth and Stable Whether you are framing, filling or finishing, Target Detachable Coils deliver consistently smooth deployment and exceptional microcatheter stability. Focused on design, Target Coils feature a host of advantages to ensure the high-powered performance you demand. For more information, please visit www.strykerneurovascular.com/Target or contact your local Stryker Neurovascular sales representative. Copyright © 2014 Stryker Stroke: Our Only Focus. Our Ongoing Promise. NV00006677.AA AMERICAN JOURNAL OF NEURORADIOLOGY APRIL 2014 Publication Preview at www.ajnr.org features articles released in advance of print. AJNRVOLUME 35 Visit www.ajnrblog.org to comment on AJNR content and chat with colleagues NUMBER 4 and AJNR’s News Digest at http://ajnrdigest.org to read the stories behind the WWW.AJNR.ORG latest research in neuroimaging. EDITORIALS PERSPECTIVES 615 Thinking in Different Directions M. Castillo EDITORIAL 616 Acute Stroke Intervention Results: The “Denominator” Fallacy M. Goyal REVIEW ARTICLES 619 Raise the Bar and Lower the Dose: Current and Future Strategies for Radiation Dose Reduction in Head and Neck Imaging M. Ibrahim, H. Parmar, E. Christodoulou, and S. Mukherji 625 The Role of MR Imaging in Assessment of Brain Damage from Carbon Monoxide Poisoning: A Review of the Literature T. Beppu METHODOLOGIC PERSPECTIVES 632 Guidelines for the Ethical Use of Neuroimages in Medical Testimony: Report of a Multidisciplinary Consensus Conference C.C. Meltzer, G. Sze, K.S. Rommelfanger, K. Kinlaw, J.D. Banja, and P.R. Wolpe Indicates Editor’s Choices selection PRACTICE PERSPECTIVES Indicates Fellows’ Journal Club selection 638 Attitudes about Medical Malpractice: An American Society of Neuroradiology Survey N.P. Pereira, J.S. Lewin, K.P. Yousem, and D.M. Yousem Indicates open access to non- subscribers at www.ajnr.org Indicates article with PATIENT SAFETY supplemental on-line table 644 Radiation Dose Reduction in Paranasal Sinus CT Using Model-Based Indicates article with supplemental on-line photo Iterative Reconstruction J.M. Hoxworth, D. Lal, G.P. Fletcher, A.C. Patel, M. He, Indicates article with R.G. Paden, and A.K. Hara supplemental on-line video 650 Neurointerventions in Children: Radiation Exposure and Its Import EBM Indicates Evidence-Based Medicine 1 Level 1 D.B. Orbach, C. Stamoulis, K.J. Strauss, J. Manchester, E.R. Smith, R.M. Scott, and N. Lin EBM Indicates Evidence-Based Medicine 2 Level 2 HEALTH CARE REFORM VIGNETTE 657 Budget Sequester: Potential Impact on Health Care Providers M.J. Ferrara BRAIN 660 DWI Reversal Is Associated with Small Infarct Volume in Patients with TIA and Minor Stroke N. Asdaghi, B.C.V. Campbell, K.S. Butcher, J.I. Coulter, J. Modi, A. Qazi, M. Goyal, A.M. Demchuk, and S.B. Coutts DKI tractography at 667 The Impact of Arterial Collateralization on Outcome after Intra-Arterial various stages of brain Therapy for Acute Ischemic Stroke S. Seeta Ramaiah, L. Churilov, P. Mitchell, development. R. Dowling, and B. Yan PERFORMANCE AND VALUE DELIVERED MADE IN AMERICA MKTG-020 REV. B 673 Pretreatment ADC Histogram Analysis Is a Predictive Imaging Biomarker for Bevacizumab Treatment but Not Chemotherapy in Recurrent Glioblastoma B.M. Ellingson, S. Sahebjam, H.J. Kim, W.B. Pope, R.J. Harris, D.C. Woodworth, A. Lai, P.L. Nghiemphu, W.P. Mason, and T.F. Cloughesy 680 White Matter Water Diffusion Changes in Primary Sjo¨gren Syndrome L.C. Tzarouchi, A.K. Zikou, N. Tsifetaki, L.G. Astrakas, S. Konitsiotis, P. Voulgari, A. Drosos, and M.I. Argyropoulou 686 Imaging Features of a Gelatin-Thrombin Matrix Hemostatic Agent in the Intracranial Surgical Bed: A Unique Space-Occupying Pseudomass K.O. Learned, S. Mohan, I.Z. Hyder, L.J. Bagley, S. Wang, and J.Y. Lee FUNCTIONAL 691 Shoulder Apprehension Impacts Large-Scale Functional Brain Networks S. Haller, G. Cunningham, A. Laedermann, J. Hofmeister, D. Van De Ville, K.-O. Lovblad, and P. Hoffmeyer INTERVENTIONAL Published in collaboration with Interventional Neuroradiology 698 Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes S.W. Hetts, A. Turk, J.D. English, C.F. Dowd, J. Mocco, C. Prestigiacomo, G. Nesbit, S.G. Ge, J.N. Jin, K. Carroll, Y. Murayama, A. Gholkar, S. Barnwell, D. Lopes, S.C. Johnston, and C. McDougall, on behalf of the Matrix and Plati- num Science Trial Investigators 706 Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes A.M. Mortimer, M.D. Bradley, P. Mews, A.J. Molyneux, and S.A. Renowden 715 Endovascular Treatment of Middle Cerebral Artery Aneurysms for 120 Nonselected Patients: A Prospective Cohort Study B. Gory, A. Rouchaud, S. Saleme, F. Dalmay, R. Riva, F. Caire, and C. Mounayer 721 Validation and Initial Application of a Semiautomatic Aneurysm Measurement Software: A Tool for Assessing Volumetric Packing Attenuation H. Takao, T. Ishibashi, T. Saguchi, H. Arakawa, M. Ebara, K. Irie, and Y. Murayama 727 Variable Porosity of the Pipeline Embolization Device in Straight and Curved Vessels: A Guide for Optimal Deployment Strategy M. Shapiro, E. Raz, T. Becske, and P.K. Nelson 734 Stent Retrievers in Acute Ischemic Stroke: Complications and Failures during the Perioperative Period G. Gascou, K. Lobotesis, P. Machi, I. Maldonado, J.F. Vendrell, C. Riquelme, O. Eker, G. Mercier, I. Mourand, C. Arquizan, A. Bonafe´, and V. Costalat 741 Emergency Cervical Internal Carotid Artery Stenting in Combination with Intracranial Thrombectomy in Acute Stroke S. Stampfl, P.A. Ringleb, M. Mo¨hlenbruch, C. Hametner, C. Herweh, M. Pham, J. Bo¨sel, S. Haehnel, M. Bendszus, and S. Rohde 747 The Outcome and Efficacy of Recanalization in Patients with Acute Internal Carotid Artery Occlusion J.H. Kwak, L. Zhao, J.K. Kim, S. Park, D.-g. Lee, J.H. Shim, D.H. Lee, J.S. Kim, and D.C. Suh EXTRACRANIAL VASCULAR 754 Correlation between Fissured Fibrous Cap and Contrast Enhancement: Preliminary Results with the Use of CTA and Histologic Validation L. Saba, E. Tamponi, E. Raz, L. Lai, R. Montisci, M. Piga, and G. Faa 20132013 LUCIENLUCIEN LEVYLEVY AJNR BEBESTST RESEARCHRESEARCH ARTICLE AMERICAN JOURNAL OF NEURORADIOLOGY AWARD WINNER AND NOMINEES Other nominated papers were: The Editors of AJNR are pleased to announce “ When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative the fi rst annual Lucien Levy Best Research Article for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health Award has been presented to System Perspective” by M.A. Almekhlafi , M.D. Hill, S. Wiebe, M. Goyal, D. Yavin, J.H. Wong, “ Potential Role of Preoperative and F.M. Clement Conventional MRI Including Diffusion “ Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Measurements in Assessing Epidermal Matched-Pair Analysis” by S.C. Cantrell, B.W. Peck, G. Li, Q. Wei, E.M. Sturgis, Growth Factor Receptor Gene and L.E. Ginsberg “ Higher Rates of Decline for Women Amplifi cation Status in Patients and Apolipoprotein E ε4 Carriers” by D. Holland, R.S. Desikan, A.M. Dale, with Glioblastoma” and L.K. McEvoy, for the Alzheimer’s by R.J. Young, A. Gupta, A.D. Shah, J.J. Graber, A.D. Schweitzer, Disease Neuroimaging Initiative A. Prager, W. Shi, Z. Zhang, J. Huse, and A.M.P. Omuro. “ Role of Diffusion Tensor Imaging as an Independent Predictor of Cognitive and Language Development in This award is named for the late AJNR Extremely Low-Birth-Weight Infants” by U. Pogribna, K. Burson, R.E. Lasky, Senior Editor who championed its estab- P.A. Narayana, P.W. Evans, and lishment and recognizes the best original N.A. Parikh research paper accepted in 2013. The “ Phlebographic Study Does Not Show winning paper, submitted by authors from Differences between Patients with MS and Control Subjects” by M. Stefanini, Memorial Sloan-Kettering Cancer Center S. Fabiano, F.G. Garaci, S. Marziali, and Weill Cornell Medical College/ A. Meschini, V. Cama, M. Fornari, New York Presbyterian Hospital in New S. Rossi, D. Centonze, R. Floris, R. Gandini, and G. Simonetti York City, was published electronically “ Mind the Gap: Impact of on June 27, 2013 and appeared in the Computational Fluid Dynamics December print issue. It was selected Solution Strategy on Prediction of by a vote of the Journal’s Editor-in-Chief Intracranial Aneurysm Hemodynamics and Rupture Status Indicators” by and Senior Editors. K. Valen-Sendstad and D.A. Steinman 760 Can Doppler Flow Parameters of Carotid Stenosis Predict the Occurrence of New Ischemic Brain Lesions Detected by Diffusion-Weighted MR Imaging after Filter-Protected Internal Carotid Artery Stenting? Y.
Load more

Recommended publications
  • 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
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • An Application of Social Frameworks Evidence to Shaken Baby Syndrome Lauren Quint
    Hastings Law Journal Volume 62 | Issue 6 Article 9 7-2011 Note – Bridging the Gap: An Application of Social Frameworks Evidence to Shaken Baby Syndrome Lauren Quint Follow this and additional works at: https://repository.uchastings.edu/hastings_law_journal Part of the Law Commons Recommended Citation Lauren Quint, Note – Bridging the Gap: An Application of Social Frameworks Evidence to Shaken Baby Syndrome, 62 Hastings L.J. 1839 (2011). Available at: https://repository.uchastings.edu/hastings_law_journal/vol62/iss6/9 This Note is brought to you for free and open access by the Law Journals at UC Hastings Scholarship Repository. It has been accepted for inclusion in Hastings Law Journal by an authorized editor of UC Hastings Scholarship Repository. Bridging the Gap: An Application of Social Frameworks Evidence to Shaken Baby Syndrome LAUREN QUINT* Ever since the syndrome was first recognized in the 1960s, a diagnosis of shaken baby syndrome ("SBS") was believed to be pathognomonic of abuse. New data calls into question the accuracy of the diagnosis and its association with nonaccidental death. This data points to alternative causes of brain injuries in infants and small children and casts doubt on the validity of evidence frequently used at trial. This Note explores problems associated with expert testimony in the context of SBS. It argues that despite the ability to accurately present general causation evidence at trial, introduction of specific causation testimony is often premature and unsupported by existing scientific proof A careful application of John Monahan and Laurens Walker's social frameworks theory provides the groundwork for new evidentiary techniques in the defense and prosecution of SBS.
    [Show full text]
  • Tra Umatic Acute Subdural Hematoma: Analysis of Factors Afecting Outcome
    Volwne12 Medical Journal of the Nwnber4 Islamic Republic oCIran Winter1377 FebJUary 1999 TRA UMATIC ACUTE SUBDURAL HE MAT OMA: ANALYSI S OF FACTORS AFFECTING OUTCOME IN COMATOSE PATIENTS SHIRZAD AZHARI, M.D., HOSEIN SAFDARI, M.D., MASSOUD SHABEHPOOR, M.D., HOSEIN NAYEBAGHAIE, M.D., AND ZOHREH AMIRI, B.S. From the Department of Neurosurgery, Imam Hosein Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, IslamicRepublic ofIran. ABSTRACT To determine the factors affectingthe outcome of patients with traumaticacute subdural hematoma, we reviewed the records of74 consecutive comatose patients with a Glascow coma scale Sl;:ore (OCS) of less than 8 who had been admitted to Imam Hosein Medical Center from 1990 to 1996 and had undergone a uniform treatmentprotocol. The overall mortality rate was 73% and 23% had functional recovery, but 4% were severely disabled or vegetative. Thefollowing variables had a statistically significant correlation with poor outcome: age over 65 years (p<0.05),preoperative GCS of 3 or 4 (p<0.05), bilateral absent pupillary light reflexes (p<0.05), and immediate and sustained coma from the moment of injury to operation without any lucid interval (p<0.00l). The time interval between injury and operation, sex, mechanism of injury, and associated craniocerebral injuries were not significantly correlated with outcome. In patients with immediate post-traumatic unconsciousness, the extent of primary brain injury is the crucial factor to predict the outcome. However, in patients with a lucid interval, the mass effect of hematoma seems to be more important, therefore prompt surgical decompression in addition to management of secondary brain insults improves the outcome Downloaded from mjiri.iums.ac.ir at 2:06 IRST on Wednesday October 6th 2021 remarkably.
    [Show full text]
  • Closed Head Injury
    Pittsburgh EMS Pre-Hospital Care Monograph Closed Head Injuries This monograph is dedicated to the professional men and women of Pittsburgh EMS. This monograph was prepared by Lawrence J. Kardasz Jr. EMT-P and Thomas Donaldson EMT-P with the assistance of the EMS Training Division and the Medical Directors of the City of Pittsburgh EMS. Paul Paris, MD Medical Director Ron Roth, MD Associate Medical Director Vince Mosesso, MD Assistant Medical Director Ted Delbridge, MD Assistant Medical Director John Cole, MD Assistant Medical Director Owen Traynor, MD Assistant Medical Director Guillermo Pierluisi, MD EMS Fellow Scott, Harrington, MD EMS Fellow August 1998 C:\My Documents\WordPerfect\Headinjuries21.wpd Closed Head Injuries 1 Introduction Head injuries are one of the most common causes of death in trauma related incidents. They are also the leading cause of death for those between the ages of 1 and 44. Severe head injuries are also a major cause of disability. Only half the patients that survive a severe head injury actually return to normal function. Head injuries may occur in one of two ways: 1. Closed head injury - occurs when the moving head is stopped rapidly, as when hitting a windshield, or when it is hit by a blunt object, causing the brain to smash into the hard bony surface inside the skull. A closed head injury may also occur without direct external trauma to the head if the brain undergoes a rapid forward or backward movement, such as when a person experiences whiplash, or when babies are shaken. 2. Penetrating head injury - occurs when a fast moving object such as a bullet pierces the skull.
    [Show full text]
  • 73 Risks Factors of Client Outcome with Head Injury
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Ners Unair Repository RISKS FACTORS OF CLIENT OUTCOME WITH HEAD INJURY Nurul Bariyyah, Rizky Meuthia Pratiwi, Hery Sasongko, Candra Adi Wirawan Faculty of Nursing Airlangga University Email: [email protected] ABSTRACT Introduction: head injury is one of the causes of mortality and morbidity. Several studies mention predictors over outcome. The objective of this systematic review is to explore and synthesis factors which contribute to client outcome with head injury. Method: source of articles used was obtained from the search through data base which includes Pro Quest, PubMed, and EbscoHost. This search is confined from 2006 to 2016. Subsequently, the journals were reviewed for systematic review. Result: there were 10 articles reviewed. Significant risk factors of head injury include socio demographic factors such as old age, male sex, low education level, clinical factor (GCS), injury due to road traffic accident, hypotension, hypoxia, increased intracranial pressure, absence of pupillary reaction, hypo and hyperglycemia, coagulopathy, hypo and hyperthermia, abnormal electrolyte level, episode of coma, result of intracranial lesion CT scan. Conclusion: outcome predictor in a patient with head injury will be useful in Triage criteria, prognosis of injury, care and discharge planning, the use resources and patient and family counseling Keyword: risk factor, outcome, head injury INTRODUCTION client outcome with head injury, it can be Head injury is the most cases in the used to develop management system and world. Data center for disease control and Triage for clients with head injury so that it prevention (CDC) based on the emergency can be reduce mortality and morbidity visit, hospitalization, and mortality resulting from head injury.
    [Show full text]
  • Trauma to the Nervous System (Dr. Merchut) 1. Pathophysiology Of
    Trauma to the Nervous System (Dr. Merchut) 1. Pathophysiology of head trauma A more diffuse force applied to the skull typically produces a linear skull fracture, while a more focal or localized force causes a depressed skull fracture. A severe skull fracture may be associated with an underlying contusion (bruise) or laceration of the brain. Fractures at the skull base, face or orbit can entrap or compress cranial nerves. Leakage of cerebrospinal fluid (CSF) from the ear or nose may signal a greater risk of infection developing in the CSF or brain itself. Treatment involves surgical removal of bone fragments and debris, and closure of any dural tears. Brain contusions are superficial hemorrhages at the tops of cortical gyri, near the point of impact (coup) or more remotely in the brain (contrecoup) from movement of the brain within the skull. They occur most often at the basal or ventral surfaces of the frontal and anterior temporal lobes (Figure 1), where the bony skull is roughened (orbital surface of frontal bone) or protuberant (edges of sphenoidal wings). Brain contusions are caused by angular or rotational, not linear, acceleration of the brain (which explains why the woodpecker survives without brain injury). Figure 1. Frequency distribution of brain contusions. Individual cases are outlined and superimposed. (From Gurdjian ES. J Trauma 16[1]:35-51, 1976.) © Dr. Michael P. Merchut Page 1 1/23/2014 Contusions or more severe intracranial hemorrhages are often associated with brain edema, due to local metabolic or ischemic processes in addition to the presence of blood. Increased intracranial pressure (ICP) decreases cerebral blood flow, creating ischemia, and compensatory cerebral autoregulation eventually fails if the edema progresses.
    [Show full text]
  • Cross-Examination of Neuropsychiatric Testimony in Personal Injury Cases
    Vanderbilt Law Review Volume 4 Issue 1 Issue 1 - December 1950 Article 1 12-1950 Cross-Examination of Neuropsychiatric Testimony in Personal Injury Cases Hubert W. Smith Follow this and additional works at: https://scholarship.law.vanderbilt.edu/vlr Part of the Workers' Compensation Law Commons Recommended Citation Hubert W. Smith, Cross-Examination of Neuropsychiatric Testimony in Personal Injury Cases, 4 Vanderbilt Law Review 1 (1950) Available at: https://scholarship.law.vanderbilt.edu/vlr/vol4/iss1/1 This Article is brought to you for free and open access by Scholarship@Vanderbilt Law. It has been accepted for inclusion in Vanderbilt Law Review by an authorized editor of Scholarship@Vanderbilt Law. For more information, please contact [email protected]. VANDERBILT LAW REVIEW VOLUME 4 DECEMBER, 1950 NUMBER 1 CROSS-EXAMINATION OF NEUROPSYCHIATRIC TESTIMONY IN PERSONAL INJURY CASES* HUBERT WINSTON SMITH t INTRODUCTION Need for Astringeiit Principles to Test Claims of Psychic Disability.- Trial lawyers are well aware that fully 50 to 60%y of all civil litigation involves some claim of physical or psychic disability.' Purely physical disabilities are extremely difficult to evaluate 2 but when the allegedly disabling symptoms are of psychic origin, wholly or in part, legal tribunals require the most competent illumination the mental sciences 3 can provide if error and imposi- tion are to be minimized. The purpose of the present presentation is not to impugn the mental sciences but rather to ask whether any astringent prin- ciples exist for shrinking extravagant testimony. The intelligent counsel does not aspire to annihilate and atomize every neuropsychiatric witness.
    [Show full text]