Manual of Traumatic Brain Injury Management Manual of Traumatic Brain Injury Management
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Surgical Management of Parkinson's Disease
SEMINAR PAPER DTM Chan Surgical management of Parkinson’s VCT Mok WS Poon disease: a critical review KN Hung XL Zhu ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ !"#$%&'()*+, Parkinson’s disease is a progressive disabling movement disorder that is characterised by three cardinal symptoms: resting tremor, rigidity, and bradykinesia. Before the availability of effective medical treatment with levodopa and stereotactic neurosurgery, the objective of surgical management was to alleviate symptoms such as tremor at the expense of motor deficits. Levodopa was the first effective medical treatment for Parkinson’s disease, and surgical treatment such as stereotactic thalamo- tomy became obsolete. After one decade of levodopa therapy, however, drug-induced dyskinesia had become a source of additional disability not amenable to medical treatment. Renewed interest in stereotactic functional neurosurgery to manage Parkinson’s disease has been seen since the 1980s. Local experience of deep-brain stimulation is presented and discussed in this paper. Deep-brain stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson’s disease, although evidence from randomised control trials is lacking. !"#$%&'()*+,-!./01$23456789:; Key words: !"#$%&'()*+,-./01'23456789:;< Electric stimulation; !"#$%&'()*+,-./01(23#45+6789: Globus pallidus/surgery; Parkinson disease; !"#$%&'()*+,-./012345678'9:;< Stereotactic techniques; !"#$%&'()*%+,-./0123)456789:; Subthalamic nuclei/surgery; !"#$%&'()*+,-.1980 !"#$%&'()* Thalamus/surgery !"#$%&'()*+,-./0123456789:;<= -
A Rare Case of Penetrating Trauma of Frontal Sinus with Anterior Table Fracture Himanshu Raval1*, Mona Bhatt2 and Nihar Gaur3
ISSN: 2643-4474 Raval et al. Neurosurg Cases Rev 2020, 3:046 DOI: 10.23937/2643-4474/1710046 Volume 3 | Issue 2 Neurosurgery - Cases and Reviews Open Access CASE REPORT Case Report: A Rare Case of Penetrating Trauma of Frontal Sinus with Anterior Table Fracture Himanshu Raval1*, Mona Bhatt2 and Nihar Gaur3 1 Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Gujarat, India Check for updates 2Medical Officer, CHC Dolasa, Gujarat, India 3GAIMS-GK General Hospital, Gujarat, India *Corresponding author: Dr. Himanshu Raval, Resident, Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Elisbridge, Ahmedabad, Gujarat, 380006, India, Tel: 942-955-3329 Abstract Introduction Background: Head injury is common component of any Road traffic accident (RTA) is the most common road traffic accident injury. Injury involving only frontal sinus cause of cranio-facial injury and involvement of frontal is uncommon and unique as its management algorithm is bone fractures are rare and constitute 5-9% of only fa- changing over time with development of radiological modal- ities as well as endoscopic intervention. Frontal sinus inju- cial trauma. The degree of association has been report- ries may range from isolated anterior table fractures causing ed to be 95% with fractures of the anterior table or wall a simple aesthetic deformity to complex fractures involving of the frontal sinuses, 60% with the orbital rims, and the frontal recess, orbits, skull base, and intracranial con- 60% with complex injuries of the naso-orbital-ethmoid tents. Only anterior table injury of frontal sinus is rare in pen- region, 33% with other orbital wall fractures and 27% etrating head injury without underlying brain injury with his- tory of unconsciousness and questionable convulsion which with Le Fort level fractures. -
Traumatic Brain Injury
REPORT TO CONGRESS Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation Submitted by the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention The Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation is a publication of the Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health (NIH). Centers for Disease Control and Prevention National Center for Injury Prevention and Control Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Debra Houry, MD, MPH Director, National Center for Injury Prevention and Control Grant Baldwin, PhD, MPH Director, Division of Unintentional Injury Prevention The inclusion of individuals, programs, or organizations in this report does not constitute endorsement by the Federal government of the United States or the Department of Health and Human Services (DHHS). Suggested Citation: Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA. Executive Summary . 1 Introduction. 2 Classification . 2 Public Health Impact . 2 TBI Health Effects . 3 Effectiveness of TBI Outcome Measures . 3 Contents Factors Influencing Outcomes . 4 Effectiveness of TBI Rehabilitation . 4 Cognitive Rehabilitation . 5 Physical Rehabilitation . 5 Recommendations . 6 Conclusion . 9 Background . 11 Introduction . 12 Purpose . 12 Method . 13 Section I: Epidemiology and Consequences of TBI in the United States . 15 Definition of TBI . 15 Characteristics of TBI . 16 Injury Severity Classification of TBI . 17 Health and Other Effects of TBI . -
Trauma Treating Traumatic Facial Nerve Paralysis
LETTERS TO EDITOR 205 206 LETTERS TO EDITOR In conclusion, the most frequent type of HBV R. Hepatitis B virus genotype A is more often hearing loss, and an impedance audiogram Strands of facial nerve interconnect with genotype in our study was D type, which associated with severe liver disease in northern showed absent stapedial reflex. CT scan cranial nerves V, VIII, IX, X, XI, and XII and usually causes a mild liver disease. Hence India than is genotype D. Indian J Gastroenterol showed no fracture of the temporal bone and with the cervical cutaneous nerves. This free proper vaccination, e ducational programs, 2005;24:19-22. intact ossicles. The patient was prescribed intermingling of Þ bers of the facial nerve with and treatment with lamivudine are efficient 6. Thakur V, Sarin SK, Rehman S, Guptan RC, high-dose steroids, along with vigorous facial Þ bers of other neural structures (particularly Kazim SN, Kumar S. Role of HBV genotype strategies in controlling HBV infection in our nerve stimulation and massages. the cranial nerve V) has been proposed as in predicting response to lamivudine therapy area. the mechanism of spontaneous return of facial in patients with chronic hepatitis B. Indian J After 3 weeks of treatment, the facial nerve nerve function after peripheral injury to the Gastroenterol 2005;24:12-5. stimulation tests were repeated and the ABDOLVAHAB MORADI, nerve.[4] VAHIDEH KAZEMINEJHAD1, readings were compared to those taken prior to GHOLAMREZA ROSHANDEL, treatment. There was negligible improvement. KHODABERDI KALAVI, Early onset/complete palsy indicates disruption EZZAT-OLLAH GHAEMI2, SHAHRYAR SEMNANI The patient was offered an exploratory of continuity of the nerve. -
Pallidotomy and Thalamotomy
Pallidotomy and Thalamotomy Vancouver General Hospital 899 West 12th Avenue Vancouver BC V5Z 1M9 Tel: 604-875-4111 This booklet will provide information about the following Preparing for Surgey surgical procedures: Pallidotomy and Thalamotomy. Before Admission to Hospital What is a Pallidotomy? 1) Anticoagulants and other medications that thin your A pallidotomy is an operation for Parkinson’s disease blood such as Aspirin, Coumadin (Warfarin), Lovenox where a small lesion is made in the globus pallidum (an (Enoxaparin), Ticlid (Ticlopidine), Plavix (Clopidogrel) area of the brain involved with motion control). The lesion and Ginkgo must be discontinued 2 weeks before your is made by an electrode placed in the brain through a small surgery. Pradaxa (Dabigatran), Xarelto (Rivaroxaban) opening in the skull. The beneficial effects are seen on and Eliquis (Apixaban) must be discontinued 5 days the opposite side of the body, i.e. a lesion on the left side before your surgery. of your brain will help to control movement on the right 2) Since you will be having a MRI, it is important to inform side of your body. Pallidotomy will help reduce dyskinesia your neurosurgeon if you are claustrophobic, have metal (medication induced writhing), and will also improve fragments in your eye or have a pacemaker. bradykinesia (slowness). Admission to Hospital Risks Your surgeon’s office will contact you the day before your Risks include a rare chance of death (0.2%) and a low scheduled surgery to confirm the time to report to the Jim chance (7%) of weakness or blindness on the opposite side Pattison Pavilion Admitting Department. -
5 Things to Know About Traumatic Brain Injuries
5 Things to Know About Traumatic Brain Injuries What is a Traumatic Brain Injury? A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. The severity of such an injury may range from: “mild” – i.e., a brief change in mental status or consciousness, to “severe” – i.e., an extended period of unconsciousness or amnesia after the injury. What Causes a Traumatic Brain Injury? A TBI occurs when an outside force impacts the head hard enough to cause the brain to move within the skull, or if the force causes the skull to break and directly hurts the brain. Rapid acceleration/deceleration of the head can also force the brain the move back and forth inside the skull, which pulls apart nerve fibers and causes damage to brain tissue. The most common causes of TBI are: Falls Motor vehicle-traffic crashes Physical violence Sports accidents What are the symptoms of a TBI? A person with a brain injury can experience a variety of symptoms, but not necessarily all of the following symptoms: Lethargy (sluggish, sleepy, gets tired easily) Continuous headache Confusion Ringing in the ears, or changes in ability to hear Vision changes (blurred vision, seeing double, light-sensitive) Dilated pupils Difficulty thinking (memory problems, poor judgment, poor attention span, slow thought process) Dizziness or balance problems Inappropriate emotional responses (irritability, easily frustrated, inappropriate crying or laughing) Difficulty speaking (slurred speech) Respiratory problems (slow or uneven breathing) Vomiting Body numbness or tingling Paralysis (difficulty moving body parts, weakness, poor coordination) Semi-comatose (not alert and unable to respond to others) Loss of consciousness Who is at Highest Risk for TBI? The two age groups at the highest first for TBI are 0-4 year olds and 15-19 year olds. -
Neurocognitive and Psychosocial Correlates of Ventroposterolateral Pallidotomy Surgery in Parkinson's Disease
Neurocognitive and psychosocial correlates of ventroposterolateral pallidotomy surgery in Parkinson's disease Henry J. Riordan, Ph.D., Laura A. Flashman, Ph.D., and David W. Roberts, M.D. Department of Psychiatry and Section of Neurosurgery, Dartmouth Medical School, DartmouthHitchcock Medical Center, Lebanon, New Hampshire The purpose of this study was to characterize the neuropsychological and psychosocial profile of patients with Parkinson's disease before and after they underwent unilateral left or right pallidotomy, to assess specific cognitive and personality changes caused by lesioning the globus pallidus, and to predict favorable surgical outcome based on these measures. Eighteen patients underwent comprehensive neuropsychological assessment before and after left-sided pallidotomy (10 patients) or right-sided pallidotomy (eight patients). The findings support the presence of frontosubcortical cognitive dysfunction in all patients at baseline and a specific pattern of cognitive impairment following surgery, with side of lesion being an important predictor of pattern and degree of decline. Specifically, patients who underwent left-sided pallidotomy experienced a mild decline on measures of verbal learning and memory, phonemic and semantic verbal fluency, and cognitive flexibility. Patients who underwent right-sided pallidotomy exhibited a similar decline in verbal learning and cognitive flexibility, as well as a decline in visuospatial construction abilities; however, this group also exhibited enhanced performance on a delayed facial memory measure. Lesioning the globus pallidus may interfere with larger cognitive circuits needed for processing executive information with disruption of the dominant hemisphere circuit, resulting in greater deficits in verbal information processing. The left-sided pallidotomy group also reported fewer symptoms of depression and anxiety following surgery. -
Middle Ear Disorders
3/2/2014 ENT CARRLENE DONALD, MMS PA-C ANTHONY MENDEZ, MMS PA-C MAYO CLINIC ARIZONA DEPARTMENT OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY No Disclosures OBJECTIVES • 1. Identify important anatomic structures of the ears, nose, and throat • 2. Assess and treat disorders of the external, middle and inner ear • 3. Assess and treat disorders of the nose and paranasal sinuses • 4. Assess and treat disorders of the oropharynx and larynx • 5. Educate patients on the risk factors for head and neck cancers 1 3/2/2014 Otology External Ear Disorders External Ear Anatomy 2 3/2/2014 Trauma • Variety of presentations. • Rule out temporal bone trauma (battle’s sign & hemotympanum). CT head w/out contrast. • Tx lacerations/avulsions with copious irrigation, closure with dissolvable sutures (monocryl), tetanus update, and antibiotic coverage (anti- Pseudomonal). May need to bolster if concerned for a hematoma . Auricular Hematoma • Due to blunt force trauma. • Drain/aspirate, cover with anti- biotics (anti- Pseudomonals), and apply bolster or passive drain if needed. • Infection and/or cauliflower ear may result if not treated. Chondritis • Inflammation and infection of the auricular cartilage. usually due to Pseudomonas aeruginosa. • Cultures • Treat with empiric antibiotics (anti-Pseudomonal) and I&D if needed. • Differentiate from relapsing polychondritis, which is an autoimmune disorder. 3 3/2/2014 External Auditory Canal Foreign Body • Children –Foreign bodies • Adults – Cerumen plugs • May present with hearing loss, ear pain and drainage • Exam under microscopic otoscopy. Check for otitis externa. • Remove under direct visualization. Can try to neutralize bugs with mineral oil. Do not attempt to irrigate organic material with water as this may cause an infection. -
Pallidotomy: Effective and Safe in Relieving Parkinson's Disease Rigidity
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Pakistan Journal Of Neurological Surgery ORIGINAL ARTICLE Pallidotomy: Effective and Safe in Relieving Parkinson’s Disease Rigidity NABEEL CHOUDHARY, TALHA ABBASS, OMAIR AFZAL Khalid Mahmood Department of Neurosurgery, Lahore General Hospital, Lahore ABSTRACT Introduction: Parkinson's Disease (PD) is a progressive neurological disorder caused by a loss of pigmented dopaminergic neurons of the substantia nigra pars compacta. The major manifestations of the disease consist of resting tremor, rigidity, bradykinesia and gait disturbances. Before the advent of Levodopa surgery was main stay of treatment of PD. Medical therapy is still the mainstay of treatment for Parkinson's diseasebut its prolonged use results in side effects like drug induced dyskinesia. In 1952 Dr. Lars Leksell introduced Pallidotomy that was successful in relieving many Parkinsonian symptoms in patients. Later on thalamotomy became widely accepted, replacing pallidotomy as the surgical treatment of choice for Parkinson's Disease. Thalamotomy had an excellent effect on the tremor, was not quite as effective at reducing rigidity rather bradykinesia was often aggravated by the procedure. Objective: Effectiveness of Pallidotomy in rigidity in medically refractory Parkinson’s disease and its complications. Study Design: Descriptive prospective case series. Setting of study: Department of Neurosurgery, Lahore General Hospital, Lahore. Duration: June 2013 to April 2016. Materials and Methods: Patients of Parkinson’s disease with predominant component of muscular rigidity despite maximum medical therapy admitted through outdoor department. Detailed history and physical exami- nation was done. Grading of muscular rigidity was done by applying UPDRS score Rigidity part 22. -
Frontal Stroke: Problem Solving, Decision Making, Impulsiveness
PSYCHOLOGY Psychology & Neuroscience, 2011, 4, 2, 267 - 278 NEUROSCIENCE DOI: 10.3922/j.psns.2011.2.012 Frontal stroke: problem solving, decision making, impulsiveness, and depressive symptoms in men and women Morgana Scheffer1, Janine Kieling Monteiro1 and Rosa Maria Martins de Almeida2 1 - Universidade do Vale do Rio dos Sinos, RS, Brazil 2 - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil Abstract The present study compared men and women who suffered a frontal lobe stroke with regard to problem solving, decision making, impulsive behavior and depressive symptoms and also correlated these variables between groups. The sample was composed of 10 males and nine females. The study period was 6 months after the stroke. The following instruments were used: Wisconsin Card Sort Test (WCST), Iowa Gambling Task (IGT), Barrat Impulsiveness Scale (BIS11), and Beck Depression Inventory (BDI). For the exclusion criteria of the sample, the Mini International Psychiatric Interview (M.I.N.I Plus) and Mini Mental Stage Examination (MMSE) were used. To measure functional severity post-stroke, the Rankin Scale was used. The average age was 60.90 ± 8.93 years for males and 60.44 ± 11.57 years for females. In females, total impulsiveness (p = .013) and lack of planning caused by impulsiveness (p = .028) were significantly higher compared with males, assessed by the BIS11. These data indicate that females in the present sample who suffered a chronic frontal lesion were more impulsive and presented more planning difficulties in situations without demanding cognitive processing. These results that show gender differences should be considered when planning psychotherapy and cognitive rehabilitation for patients who present these characteristics. -
Safety Regulations, Risk Compensation, and Individual Behavior
82 Injury Prevention 2000;6:82–90 HADDON MEMORIAL LECTURE Inj Prev: first published as 10.1136/ip.6.2.82 on 1 June 2000. Downloaded from Risky business: safety regulations, risk compensation, and individual behavior James Hedlund Editors comment: We are Government regulations and industry practices paper, behavioral adaptation describes all be- proud to be able to bring to constrain our behavior in many ways in an havioral change in response to perceived our readers this full text version of the Haddon attempt to reduce injuries. Safety features are changes in risk and risk compensation describes Memorial Lecture delivered designed into products we use: cars now have the special case of behavior change in response at the recent Fifth World airbags; medicine bottles have “childproof” to laws and regulations. The distinction Conference on Injury Pre- vention and Control in caps. Laws require us to act in a safe manner: we becomes murky at times: if a new safety feature New Delhi, India. James must wear seat belts while driving and hard hats appears on all chain saws, any behavioral reac- Hedlund oVers a brilliant in construction areas. But do these measures tion won’t depend on whether the feature is review of one of the most important areas of debate influence our behavior in other ways? Risk com- required by government regulation or adopted in the entire field of injury pensation theory hypothesizes that they do, that voluntarily by all manufacturers. The risk control. This is the most we “use up” the additional safety though more compensation definition adopted here focuses complete, most perceptive, and well balanced apprais- risky actions. -
CIRCUMCISION, INFORMATION, and HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton*
RESPONDING TO RISK: CIRCUMCISION, INFORMATION, AND HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton* Abstract—Understanding behavioral responses to changes in actual or per- In this paper, we study asymmetric responses to informa- ceived risk is important because risk-reduction goals can be undermined by risk-compensating behavior. This paper examines the response to new tion about personal risk in which new information informs information about the risk of HIV infection. Approximately 1,200 circum- individuals of their type, either high or low risk. Individuals cised and uncircumcised men in rural Malawi are randomly informed that learning their type should revise their beliefs about personal male circumcision reduces the HIV transmission rate, predicting asym- metric behavioral responses. We find no evidence that the information risk either upward or downward, predicting opposite beha- induces circumcised men to engage in riskier sex while uncircumcised vioral responses. While the new information may be used men practice safer sex in response to the information. There were no sig- beneficially by one risk type, the same information may nificant effects of the information on child circumcisions after one year. cause the other type to engage in potentially harmful risk- compensating behavior. The theoretical predictions of the behavioral responses to information about risk are straight- I. Introduction forward, yet testing these predictions empirically is more difficult. Access to information about risk is typically corre- EGINNING with the seminal work of Peltzman lated with unobserved characteristics that introduce bias to (1975), economists have sought to understand beha- B causal inference. Moreover, it is difficult to identify a set- vioral responses to changes in actual or perceived risk.