Head Injury- Traumatic Intracranial Hematoma
IP-2-162j patients Rationality for medical and fetal treatment of with head injury V. Ershov ' , V. Peresedov 2 , I. Zavalishin 2 . 1 International Institute of Biological
Medicine, 2 Institute of Neurology, Moscow, Russia Between 1989 and 1996, the authors operated on 589 patients with severe neurotrauma and 189 patients with head injury. They pay special attention to correction of the brain metabolism and the immunostatus and to factors influencing the brain oxygen saturat ion. During the operation they irrigate the injured brain with a cooling fluid containing antibiotics . If necessary, they use external ventricular drainage. They use many drugs such as: immunoglobulins, prednisolon or dexamethason, lidocaine, calciumantagonists, nootropil , etc. They report a mortality rate of 3.5% and a decrease of disability by 48-50%. They believe that treatment should be instituted on an inferable basis.
The recordings of specific pattern of traumatic vasospasm in severe head injury patients
Moriya Takashi, Nariyuki Hayashi , Hidehiko Kushi , Takeshi Saito, Kosaku Kinoshita, Tadashi Shibuya . Department of Emergency and Critical
CareMedicine, Nihon University Schoolof Medicine, Tokyo, Japan Introduction: Cerebral arterial vasospasm may contribute to ischemic changes following head injury and is one of the leading factors in producing a poor outcome . We could obtain good results using Transcran ial Doppler (TCD) and digital subtraction angiography (DSA) on mechanisms of arterial vasospasm following severe head injury. Clinical Material and Methods: 15 patients (10-54 years old) in whom Glasgow Coma Scale (GCS) was below 8 points at admission were evaluated. Focal injury was recognized on CT scan in nine of 15 patients, diffuse injury in six. The obse rvations were made using TCD (GE Yokokawa Medical LOGIO 500MD, 2.5 MHz) from 1st day after trauma and DSA if necessary. Results: In six (66.7%) of 9 patients with focal injury, the mean flow velocity in middle cerebral artery reached or exceeded 120 cmlsecond at least once during monitoring. Five of 6 patients demons trated arterial vasospasm angiographically. Furthermore, four patients had arterial vasospasm on proximal middle cerebral artery ipsilaterall y. On the other hand, these results were not found in diffuse brain injury. Conclusion: The main causes of arterial vasospasm following severe head injury may be direct mechan ical injury. The specific pattern of traumatic arterial vasospasm in severe head injury patients is not similar to that seen in aneurysmal subarachnoid hemorrhage.
IP-2-164I traumatic Excitatory amino acids increased in CSF after brain injury D.Y. Yang , C.S. Yang, L. Liu, M.J . Lee. Divisionof Neurosurgery, Department
of MedicalResearch, Taichung Veterans General Hospital, Taiwan, ROC Glutamate and aspartate conc entrations in cerebrospinal fluid and plasma from 18 head injury patients were measured . The patients were divided into two groups (Group A and B) accord ing to the time length between the head injury and start of surgical procedure (less than 6 hours for Group A and more than 6 hours for Group B). Fourte en Park inson's patients served as control in the present study. Glutamate level in cerebral spinal fluid in Group A (84.11 ± 16.32 11 M) was significantly higher than Group B (11.72 ± 6.31 11M), which was again significantly higher than that in control (2.07 ± 0.34 11M). Glutamate in plasma in Group A (102.47 ± 19.43 11M) was higher than in Group B (79.62 ± 14.32 11M), which was not significantly different from control (68.33 ± 12.61 JLM). Aspart ate levels in spinal tluid in Group A (30.31 ± 7.62 11M) was significantly higher than in group B (5.34 ± 3.21 JLM), which was not significantly different from control (4.07 ± 0.49 11M). Aspartate levels in plasma in Group A (33.03 ± 7.64 11M) was significantly higher than in Group B (15.02 ± 4.84 JLM), which was not significantly different from cont rol (12.26 ± 5.11 JIM). These results suggest that the excitatory amino acid were released after head injury, and these am ino acids may cau se secondary brain damage .
Monda}; 7 July /997
Monday, 7 July 1997
Head Injury - Traumatic Intracranial Hematoma
IP-2-165I fracture, Relationship between loss of consciousness, skull and intracranial hematoma: Analysis of 16,464 cases Shin-Yuan Chen , Wen-Ta Ch iu l , Ching-Chang Hung 2 , Liang-Shong Lee 2 .
Department of Neurosurgery, BuddhistTzu-OtuGeneralHospital, Hualien, Taiwan, 1 Department of Neurosurgery, Taipei Medical CollegeHospital, Taipei, Taiwan, 2 Headand Spinal Cord InjuryResearch Group, Neurological Society, ROC Taiwan This report focuses on the data analysis of 16464 head injured cases in Taipei city from July 1 1989 to June 30 1993. Patient selection and ascertainment procedu res from study hospitals were through standard ized definition s of head injury and associated codes in the Intemational Classification of Disease , 9th edition (ICD-9). Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (Ga S) were used in asses sing the severity and outcome of head injured patients . A total of 2003 cases (12.2%) was found to have intracranial hematoma, and they were significantly related to loss of consciousness and skull fracture (P < 0.0001). The relationsh ip between skul! fracture and intracranial hematoma was especi ally significant in minor head injured group (P < 0.0000001, OR = 5.5). The relationship, of skull fracture and epidural hematoma was significant compared with other site of hematoma. Severity of head injury is closely related to the score of GCS, duration of unconsciousness and the depth of intracranial hemorrhage.
Off line computerised volume estimation of traumatic epidural hematomas
W.A. van den Brink, S. landee, M. Zwienenberg , C.J.J. Avezaa t. Department
of Neurosurgery, Dijkzigt UniversityHospital, Rotterdam, The Netherlands The size of an epidural hematoma (EDH) is usually estimated by the thickness perpendicular to the skull. More accurate analys is is possible with a computer program (NIH-Image 1.27). We retrospectively analysed a group of patients suffering an EDH. 99 consecutive patients were operated upon for an EDH. 64 CT scans were available for analys is. Clinical parameters were: age , GCS, pupils, GaS after 6 months . Scans were evaluated accord ing protocol. Volumes were estimated using a scanner, Macintosh II ci computer, and Image 1.27 software. Volume was calculated by multiplying the surface area with slice thickness. Mean age was 28 yrs. 21 patients were comatose, 14 were posturing , 20 had pupillary disturbances on admiss ion. After 6 month 44 patients had a favourable outcome , 11 unfavourable , and in 9 patients outcome was unknown . CT-analysls : Midline shift was noted in 58 patients , mean shift size was 8.1 mm, mean maximum hematoma thickness 18 mm. Cisterns were obl iterated in 50 and subarachnoid blood was found in 20 patients. Mean hematoma volume was 61 ml (range 2-207). Correlat ion of parameters indicated that pupils and motor score are associated with outcome ; so are midline shift and presence of subarachno id blood. Volume of the EDH does not corre late with motor score , pupils or outcome . Larger hematomas cause qua ntitatively more midl ine shift, there is however no assoc iation with the status of the cisterns . Correlation coefficients of hematoma thickness and volume versus shift were 0.386 and 0.709 respectively. Conclusion: CT analysis gives information towards outcome of patients with an EDH. Clinical parameters are more powerful. In case of an EDH volume does not provide prognostic information.
IP-2-167I intracerebral Criteria for different treatment of traumatic hematomas E. Gaitur " A. Potapov ' . O. lschacov, H. Muhamed janov ', S. Eropkin " V. Leonov ' . Paediatric City Hospital No 20, Moscow, Russia, ' Burdenko Neurosurgical Institute, Moscow, Russia Introduction: The decision to remove a traumatic intracerebral hematoma (ICH) is diffiCUlt, when a patient has only slight mass effects on CT scan and has not deteriorated or developed new neurolog ical deficit. Some neurosurgeons advocate a policy of surgical evacuation for all ICHs that exert "mass-effect", although this is a difficult concept to quantify. Others advocated intracranial pressure monitoring as a basis for decision making.