Sample records for acceleration head injury

  1. Bicycle helmets are highly effective at preventing head injury during head impact: head-form accelerations and injury criteria for helmeted and unhelmeted impacts. (United States)

    Cripton, Peter A; Dressler, Daniel M; Stuart, Cameron A; Dennison, Christopher R; Richards, Darrin


    Cycling is a popular form of recreation and method of commuting with clear health benefits. However, cycling is not without risk. In Canada, cycling injuries are more common than in any other summer sport; and according to the US National Highway and Traffic Safety Administration, 52,000 cyclists were injured in the US in 2010. Head injuries account for approximately two-thirds of hospital admissions and three-quarters of fatal injuries among injured cyclists. In many jurisdictions and across all age levels, helmets have been adopted to mitigate risk of serious head injuries among cyclists and the majority of epidemiological literature suggests that helmets effectively reduce risk of injury. Critics have raised questions over the actual efficacy of helmets by pointing to weaknesses in existing helmet epidemiology including selection bias and lack of appropriate control for the type of impact sustained by the cyclist and the severity of the head impact. These criticisms demonstrate the difficulty in conducting epidemiology studies that will be regarded as definitive and the need for complementary biomechanical studies where confounding factors can be adequately controlled. In the bicycle helmet context, there is a paucity of biomechanical data comparing helmeted to unhelmeted head impacts and, to our knowledge, there is no data of this type available with contemporary helmets. In this research, our objective was to perform biomechanical testing of paired helmeted and unhelmeted head impacts using a validated anthropomorphic test headform and a range of drop heights between 0.5m and 3.0m, while measuring headform acceleration and Head Injury Criterion (HIC). In the 2m (6.3m/s) drops, the middle of our drop height range, the helmet reduced peak accelerations from 824g (unhelmeted) to 181g (helmeted) and HIC was reduced from 9667 (unhelmeted) to 1250 (helmeted). At realistic impact speeds of 5.4m/s (1.5m drop) and 6.3m/s (2.0m drop), bicycle helmets changed the

  2. Head Injuries (United States)

    ... ATV) Safety Balance Disorders Knowing Your Child's Medical History First Aid: Falls First Aid: Head Injuries Preventing Children's Sports Injuries Getting Help: Know the Numbers Concussions Stay Safe: Baseball Concussions Concussions: Getting Better Sports and Concussions Dealing ...

  3. Angular Impact Mitigation system for bicycle helmets to reduce head acceleration and risk of traumatic brain injury. (United States)

    Hansen, Kirk; Dau, Nathan; Feist, Florian; Deck, Caroline; Willinger, Rémy; Madey, Steven M; Bottlang, Michael


    Angular acceleration of the head is a known cause of traumatic brain injury (TBI), but contemporary bicycle helmets lack dedicated mechanisms to mitigate angular acceleration. A novel Angular Impact Mitigation (AIM) system for bicycle helmets has been developed that employs an elastically suspended aluminum honeycomb liner to absorb linear acceleration in normal impacts as well as angular acceleration in oblique impacts. This study tested bicycle helmets with and without AIM technology to comparatively assess impact mitigation. Normal impact tests were performed to measure linear head acceleration. Oblique impact tests were performed to measure angular head acceleration and neck loading. Furthermore, acceleration histories of oblique impacts were analyzed in a computational head model to predict the resulting risk of TBI in the form of concussion and diffuse axonal injury (DAI). Compared to standard helmets, AIM helmets resulted in a 14% reduction in peak linear acceleration (pbicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required.

  4. Quantitative relationship between axonal injury and mechanical response in a rodent head impact acceleration model. (United States)

    Li, Yan; Zhang, Liying; Kallakuri, Srinivasu; Zhou, Runzhou; Cavanaugh, John M


    A modified Marmarou impact acceleration model was developed to study the mechanical responses induced by this model and their correlation to traumatic axonal injury (TAI). Traumatic brain injury (TBI) was induced in 31 anesthetized male Sprague-Dawley rats (392±13 g) by a custom-made 450-g impactor from heights of 1.25 m or 2.25 m. An accelerometer and angular rate sensor measured the linear and angular responses of the head, while the impact event was captured by a high-speed video camera. TAI distribution along the rostro-caudal direction, as well as across the left and right hemispheres, was determined using β-amyloid precursor protein (β-APP) immunocytochemistry, and detailed TAI injury maps were constructed for the entire corpus callosum. Peak linear acceleration 1.25 m and 2.25 m impacts were 666±165 g and 907±501 g, respectively. Peak angular velocities were 95±24 rad/sec and 124±48 rad/sec, respectively. Compared to the 2.25-m group, the observed TAI counts in the 1.25-m impact group were significantly lower. Average linear acceleration, peak angular velocity, average angular acceleration, and surface righting time were also significantly different between the two groups. A positive correlation was observed between normalized total TAI counts and average linear acceleration (R(2)=0.612, plinear and angular acceleration response of the rat head during impact, not necessarily the drop height.

  5. Expression of S100A6 in Rat Hippocampus after Traumatic Brain Injury Due to Lateral Head Acceleration

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    Bo Fang


    Full Text Available In a rat model of traumatic brain injury (TBI, we investigated changes in cognitive function and S100A6 expression in the hippocampus. TBI-associated changes in this protein have not previously been reported. Rat S100A6 was studied via immunohistochemical staining, Western blot, and reverse transcription-polymerase chain reaction (RT-PCR after either lateral head acceleration or sham. Reduced levels of S100A6 protein and mRNA were observed 1 h after TBI, followed by gradual increases over 6, 12, 24, and 72 h, and then a return to sham level at 14 day. Morris water maze (MWM test was used to evaluate animal spatial cognition. TBI- and sham-rats showed an apparent learning curve, expressed as escape latency. Although TBI-rats displayed a relatively poorer cognitive ability than sham-rats, the disparity was not significant early post-injury. Marked cognitive deficits in TBI-rats were observed at 72 h post-injury compared with sham animals. TBI-rats showed decreased times in platform crossing in the daily MWM test; the performance at 72 h post-injury was the worst. In conclusion, a reduction in S100A6 may be one of the early events that lead to secondary cognitive decline after TBI, and its subsequent elevation is tightly linked with cognitive improvement. S100A6 may play important roles in neuronal degeneration and regeneration in TBI.

  6. Pediatric head injury. (United States)

    Tulipan, N


    Pediatric head injury is a public health problem that exacts a high price from patients, their families and society alike. While much of the brain damage in head-injured patients occurs at the moment of impact, secondary injuries can be prevented by aggressive medical and surgical intervention. Modern imaging devices have simplified the task of diagnosing intracranial injuries. Recent advances in monitoring technology have made it easier to assess the effectiveness of medical therapy. These include intracranial pressure monitoring devices that are accurate and safe, and jugular bulb monitoring which provides a continuous, qualitative measure of cerebral blood flow. The cornerstones of treatment remain hyperventilation and osmotherapy. Despite maximal treatment, however, the mortality and morbidity associated with pediatric head injury remains high. Reduction of this mortality and morbidity will likely depend upon prevention rather than treatment.

  7. Economics of head injuries

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    Singh Manmohan


    Full Text Available Summary: Head injuries account for significant proportion of neurosurgical admissions and bed occupancy. Patients with head injuries also consume significant proportions of neurosurgical resources. A prospective 6-month study has been carried out to evaluate the expenditure incurred on head injury patients in a modern neurosurgical center equipped with state of the art infrastructure. Costing areas included wages / salaries of health care personnel, cost of medicines / surgical items / crystalloids, general store items, stationary, all investigation charges, equipment cost, overhead building cost, maintenance cost, electricity and water charges and cost of medical gases, air conditioning and operation theatre expenses. Expenditure in each area was calculated and apportioned to each bed. The statistical analysis was done using X2 test. The cost of stay in ward was found to be Rs. 1062 / bed / day and in neurosurgical ICU Rs. 3082 / bed / day. The operation theatre cost for each surgery was Rs. 11948. The cost of hospital stay per day for minor, moderate and severe head injury group was found to be Rs. 1921, Rs. 2569 and Rs. 2713 respectively. The patients who developed complications, the cost of stay per day in the hospital were Rs. 2867. In the operative group, the cost of hospital stay per day was Rs. 3804. The total expenditure in minor head injury was Rs. 7800 per patient, in moderate head injury was Rs. 22172 per patient, whereas in severe head injury, it was found to be Rs. 32852 per patient. Patients who underwent surgery, the total cost incurred was Rs. 33100 per operated patient.

  8. Neuropsychiatric sequelae of head injuries. (United States)

    McAllister, T W


    Based on the above review several general points can be highlighted: Head injuries are extremely common, affecting probably close to 2,000,000 people in this country each year. The most common are nonmissile, closed-head injuries, the majority of which occur in association with motor vehicle accidents. Virtually all studies of head injury suggest a peak incidence in the 15 to 24 years of age group. Coarse measures of outcome suggest that the very young and the elderly have poorer outcomes. Because of improved acute care, however, a large number of young, otherwise healthy patients are surviving head injuries with a variety of profound neuropsychiatric sequelae. Because of the mechanics of brain injury in acceleration-deceleration injuries, certain brain injury profiles are common including orbitofrontal, anterior and inferior temporal contusions, and diffuse axonal injury. The latter particularly affects the corpus callosum, superior cerebellar peduncle, basal ganglia, and periventricular white matter. The neuropsychiatric sequelae follow from the above injury profiles. Cognitive impairment is often diffuse with more prominent deficits in rate of information processing, attention, memory, cognitive flexibility, and problem solving. Prominent impulsivity, affective instability, and disinhibition are seen frequently, secondary to injury to frontal, temporal, and limbic areas. In association with the typical cognitive deficits, these sequelae characterize the frequently noted "personality changes" in TBI patients. In addition, these changes can exacerbate premorbid problems with impulse control. Marked difficulties with substance use, sexual expression, and aggression often result. The constellation of symptoms, which make up the postconcussive syndrome, are seen across the whole spectrum of brain injury severity. Even in so-called mild or minor head injury, these symptoms are likely to have an underlying neuropathologic, neurochemical, or neurophysiologic cause

  9. Heading and head injuries in soccer. (United States)

    Kirkendall, D T; Jordan, S E; Garrett, W E


    In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the

  10. Clinical trials in head injury

    NARCIS (Netherlands)

    Narayan, RK; Michel, ME


    Traumatic brain injury (TBI) remains a major public health problem globally. In the United States the incidence of closed head injuries admitted to hospitals is conservatively estimated to be 200 per 100,000 population, and the incidence of penetrating head injury is estimated to be 12 per 100,000,

  11. Boxing-related head injuries. (United States)

    Jayarao, Mayur; Chin, Lawrence S; Cantu, Robert C


    Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.

  12. Anaphylaxis Due to Head Injury

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    Bruner, Heather C.


    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  13. Preventing head and neck injury. (United States)

    McIntosh, A S; McCrory, P


    A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.

  14. Biomechanical analysis of padding in child seats and head injury. (United States)

    Kumaresan, Srirangam; Sances, Anthony; Carlin, Fred


    Head injury is a common finding for infants and young children involved in automobile accidents. Although the child restraint seats have increased the level of safety for the pediatric population, skull fracture and/or brain injury occur during the interaction between the child's head and interior of the car seats with no padding. The introduction of effective and sufficient padding may significantly reduce the head injury. The present study was designed to evaluate the biomechanical effects of padding in child seats to reduce the potential for head injury. A head drop test of a six-month old anthropomorphic dummy was conducted. The side of the dummy head impacted the interior wing of child car seats of relatively soft and stiff materials, and a rigid metal plate at velocities of 2.2, 4.5 and 6.7 m/s. In all tests, three types of padding environments were used (no padding, comfort foam, 16 to 19 mm polypropylene padding). All data were collected at 10 kHz and filtered. A total of 39 tests were conducted. The head injury criteria (HIC), and head acceleration, and head angular acceleration were obtained. The HIC was calculated over a 36 ms interval from the resultant tri-axial acceleration. The angular accelerations were derived from the angular velocity data. The head injury biomechanical parameters decreased with the addition of padding. The HIC, peak acceleration, and angular acceleration were reduced up to 91%, 80%, and 61% respectively. The present results emphasize the importance of energy absorbing padding to provide an improved safety environment in child car seats.

  15. Neck forces and moments and head accelerations in side impact

    NARCIS (Netherlands)

    Yoganandan, N.; Pintar, F.A.; Maiman, D.J.; Philippens, M.M.G.M.; Wismans, J.S.H.M.


    Objectives: Although side-impact sled studies have investigated chest, abdomen, and pelvic injury mechanics, determination of head accelerations and the associated neck forces and moments is very limited. The purpose of the present study was therefore to determine the temporal forces and moments at

  16. Effect of clenching with a mouthguard on head acceleration during heading of a soccer ball. (United States)

    Narimatsu, Keishiro; Takeda, Tomotaka; Nakajima, Kazunori; Konno, Michiyo; Ozawa, Takamitsu; Ishigami, Keiichi


    Concussions are acceleration-deceleration injuries that occur when biomechanical forces are transmitted to the cerebral tissues. By limiting acceleration of the head, enhanced cervical muscle activity derived from clenching with a mouthguard (MG) may reduce the incidence or severity of concussions following impact. The purpose of this study was to investigate the effect of voluntary clenching with a proper MG on acceleration of the head during "heading" of a soccer ball. Eleven male high school soccer players (mean age, 16.8 years) participated in the study. Each player was given a customized MG. An automated soccer machine was used to project the ball at the participants at a constant speed. The participants headed the ball under 3 different oral conditions: drill 1, heading freely performed without instruction and without the MG; drill 2, heading performed as the subject was instructed to clench the masseter muscles tightly while not wearing the MG; drill 3, heading performed as the subject was instructed to clench tightly while wearing the MG. Each participant repeated each drill 5 times. Linear acceleration of the head was measured with a 3-axis accelerometer. Activity of the masseter and sternocleidomastoid muscles was measured by wireless electromyography. Weak masseter and sternocleidomastoid muscle activity was observed during drill 1. After the soccer players had been instructed to clench their masseter muscles (drills 2 and 3), statistically significant decreases in head acceleration and increases in masseter and sternocleidomastoid muscle activity were observed (P soccer players to habitually clench while wearing a proper mouthguard to strengthen cervical muscle resistance as a way to mitigate the damage caused by heading.

  17. Outcome after complicated minor head injury.

    NARCIS (Netherlands)

    Smits, M.; Hunink, M.G.; Rijssel, DA van; Dekker, H.M.; Vos, P.E.; Kool, D.R.; Nederkoorn, P.J.; Hofman, P.A.; Twijnstra, A.; Tanghe, H.L.; Dippel, D.W.


    BACKGROUND AND PURPOSE: Functional outcome in patients with minor head injury with neurocranial traumatic findings on CT is largely unknown. We hypothesized that certain CT findings may be predictive of poor functional outcome. Materials and METHODS: All patients from the CT in Head Injury Patients


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    Full Text Available INTRODUCTION: Traumatic brain injury (TBI is one of the main causes of death and disability in young adults, with consequences ranging from physical disabilities to long - term cognitive, behavioural, psychological and social defects. Recently, c linical evidence has demonstrated that TBI may frequently cause hypothalamic – pituitary dysfunction, probably contributing to a delayed or hampered recovery from TBI. CASE REPORT: 32 year s old female presented with a history of fall from two wheeler on back hitting the head on occipital region with no history of vomiting, loss of consciousness, ENT bleed. Her GCS was 15/15. Patient was asymptomatic and was discharged from hospital on fifth day. Seven days after discharge patient again presented with heavine ss in her both breasts associated with pain and whitish discharge from both the nipples and mild fever since last two days. CONCLUSION: TBI is a public health problem that requires more effective strategies to improve the outcome and minimize disability of the affected patients. Changes in pituitary hormone secretion may be observed during the acute phase post - TBI, representing part of the acute adaptive response to the injury. Neuroendocrine disturbances, caused by damage to the pituitary and/or hypothalam us, is a frequent complication of TBI and may occur at any time after the acute event. Pituitary dysfunction presents more frequently as an isolated, and more rarely as a complete, deficiency.

  19. Head motions while riding roller coasters: implications for brain injury. (United States)

    Pfister, Bryan J; Chickola, Larry; Smith, Douglas H


    The risk of traumatic brain injury (TBI) while riding roller coasters has received substantial attention. Case reports of TBI around the time of riding roller coasters have led many medical professionals to assert that the high gravitational forces (G-forces) induced by roller coasters pose a significant TBI risk. Head injury research, however, has shown that G-forces alone cannot predict TBI. Established head injury criterions and procedures were employed to compare the potential of TBI between daily activities and roller coaster riding. Three-dimensional head motions were measured during 3 different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared with published data, using similar analyses of head motions. An 8.05 m/s car crash lead to the largest head injury criterion measure of 28.1 and head impact power of 3.41, over 6 times larger than the roller coaster rides of 4.1 and 0.36. Notably, the linear and rotational components of head acceleration during roller coaster rides were milder than those induced by many common activities. As such, there appears to be an extremely low risk of TBI due to the head motions induced by roller coaster rides.

  20. Heading for a fall? Management of head injury in infants.

    LENUS (Irish Health Repository)

    Williamson, M


    Head injury is one of the commonest reasons for infants (< 1 year) to attend the Emergency Department (ED). Clinical management varies considerably and concern about non accidental injury results in a high admission rate in some hospitals. Information was obtained on 103 children under one year of age presenting to the ED with head injury in a prospective study. The average age was 6.7 months and 57% of patients were male. Twenty eight babies had skull x rays with 1 skull fracture diagnosed. None required CT brain scan. Ninety eight (94%) were discharged home from the ED. There were no unplanned returns, readmissions or adverse events. The incidence of traumatic brain injury in children under one year of age presenting with head injury is low and the majority can be safely discharged home.

  1. Analysis of finite element models for head injury investigation: reconstruction of four real-world impacts. (United States)

    Franklyn, Melanie; Fildes, Brian; Zhang, Liying; Yang, King; Sparke, Laurie


    Previous studies have shown that both excessive linear and rotational accelerations are the cause of head injuries. Although the head injury criterion has been beneficial as an indicator of head injury risk, it only considers linear acceleration, so there is a need to consider both types of motion in future safety standards. Advanced models of the head/brain complex have recently been developed to gain a better understanding of head injury biomechanics. While these models have been verified against laboratory experimental data, there is a lack of suitable real-world data available for validation. Hence, using two computer models of the head/brain, the objective of the current study was to reconstruct four real-world crashes with known head injury outcomes in a full-vehicle crash laboratory, simulate head/brain responses using kinematics obtained during these reconstructions, and to compare the results predicted by the models against the actual injuries sustained by the occupant. Cases where the occupant sustained no head injuries (AIS 0) and head injuries of severity AIS 4, AIS 5, and multiple head injuries were selected. Data collected from a 9-accelerometer skull were input into the Wayne State University Head Injury Model (WSUHIM) and the NHTSA Simulated Injury Monitor (SIMon). The results demonstrated that both models were able to predict varying injury severities consistent with the difference in AIS injury levels in the real-world cases. The WSUHIM predicted a slightly higher injury threshold than the SIMon, probably due to the finer mesh and different software used for the simulations, and could also determine regions of the brain which had been injured. With further validation, finite element models can be used to establish an injury criterion for each type of brain injury in the future.

  2. On Impact: Students with Head Injuries (United States)

    Canto, Angela I.; Chesire, David J.; Buckley, Valerie A.


    Students with head injuries may not be as "low incidence" as previously believed. Recent efforts from the American Academy of Pediatrics (2010), the National Football League, and other agencies are attempting to raise awareness of traumatic brain injury (TBI) among students. Along with awareness, there has been an increased publicity effort via…

  3. Predicting brain acceleration during heading of soccer ball (United States)

    Taha, Zahari; Hasnun Arif Hassan, Mohd; Azri Aris, Mohd; Anuar, Zulfika


    There has been a long debate whether purposeful heading could cause harm to the brain. Studies have shown that repetitive heading could lead to degeneration of brain cells, which is similarly found in patients with mild traumatic brain injury. A two-degree of freedom linear mathematical model was developed to study the impact of soccer ball to the brain during ball-to-head impact in soccer. From the model, the acceleration of the brain upon impact can be obtained. The model is a mass-spring-damper system, in which the skull is modelled as a mass and the neck is modelled as a spring-damper system. The brain is a mass with suspension characteristics that are also defined by a spring and a damper. The model was validated by experiment, in which a ball was dropped from different heights onto an instrumented dummy skull. The validation shows that the results obtained from the model are in a good agreement with the brain acceleration measured from the experiment. This findings show that a simple linear mathematical model can be useful in giving a preliminary insight on what human brain endures during a ball-to-head impact.

  4. Head injury and risk for Parkinson disease

    DEFF Research Database (Denmark)

    Kenborg, Line; Rugbjerg, Kathrine; Lee, Pei-Chen


    OBJECTIVE: To examine the association between head injuries throughout life and the risk for Parkinson disease (PD) in an interview-based case-control study. METHODS: We identified 1,705 patients diagnosed with PD at 10 neurologic centers in Denmark in 1996-2009 and verified their diagnoses...

  5. Closed head injury--an inflammatory disease? (United States)

    Schmidt, Oliver I; Heyde, Christoph E; Ertel, Wolfgang; Stahel, Philip F


    Closed head injury (CHI) remains the leading cause of death and persisting neurological impairment in young individuals in industrialized nations. Research efforts in the past years have brought evidence that the intracranial inflammatory response in the injured brain contributes to the neuropathological sequelae which are, in large part, responsible for the adverse outcome after head injury. The presence of hypoxia and hypotension in the early resuscitative period of brain-injured patients further aggravates the inflammatory response in the brain due to ischemia/reperfusion-mediated injuries. The profound endogenous neuroinflammatory response after CHI, which is phylogenetically aimed at defending the intrathecal compartment from invading pathogens and repairing lesioned brain tissue, contributes to the development of cerebral edema, breakdown of the blood-brain barrier, and ultimately to delayed neuronal cell death. However, aside from these deleterious effects, neuroinflammation has been recently shown to mediate neuroreparative mechanisms after brain injury as well. This "dual effect" of neuroinflammation was the focus of extensive experimental and clinical research in the past years and has lead to an expanded basic knowledge on the cellular and molecular mechanisms which regulate the intracranial inflammatory response after CHI. Thus, head injury has recently evolved as an inflammatory and immunological disease much more than a pure traumatological, neurological, or neurosurgical entity. The present review will summarize the so far known mechanisms of posttraumatic neuroinflammation after CHI, based on data from clinical and experimental studies, with a special focus on the role of pro-inflammatory cytokines, chemokines, and the complement system.

  6. Head injuries and bicycle helmet laws. (United States)

    Robinson, D L


    The first year of the mandatory bicycle helmet laws in Australia saw increased helmet wearing from 31% to 75% of cyclists in Victoria and from 31% of children and 26% of adults in New South Wales (NSW) to 76% and 85%. However, the two major surveys using matched before and after samples in Melbourne (Finch et al. 1993; Report No. 45, Monash Univ. Accident Research Centre) and throughout NSW (Smith and Milthorpe 1993; Roads and Traffic Authority) observed reductions in numbers of child cyclists 15 and 2.2 times greater than the increase in numbers of children wearing helmets. This suggests the greatest effect of the helmet law was not to encourage cyclists to wear helmets, but to discourage cycling. In contrast, despite increases to at least 75% helmet wearing, the proportion of head injuries in cyclists admitted or treated at hospital declined by an average of only 13%. The percentage of cyclists with head injuries after collisions with motor vehicles in Victoria declined by more, but the proportion of head injured pedestrians also declined; the two followed a very similar trend. These trends may have been caused by major road safety initiatives introduced at the same time as the helmet law and directed at both speeding and drink-driving. The initiatives seem to have been remarkably effective in reducing road trauma for all road users, perhaps affecting the proportions of victims suffering head injuries as well as total injuries. The benefits of cycling, even without a helmet, have been estimated to outweigh the hazards by a factor of 20 to 1 (Hillman 1993. Cycle helmets-the case for and against. Policy Studies Institute, London). Consequently, a helmet law, whose most notable effect was to reduce cycling, may have generated a net loss of health benefits to the nation. Despite the risk of dying from head injury per hour being similar for unhelmeted cyclists and motor vehicle occupants, cyclists alone have been required to wear head protection. Helmets for motor

  7. Catastrophic Head Injuries in High School and Collegiate Sports. (United States)

    Mueller, Frederick O.


    Describes the incidence of catastrophic head injuries within high school and college sports. Data from a national surveillance system indicated that a football-related fatality occurred every year except one from 1945-99, mainly related to head injuries. From 1984-99, 69 football head-related injuries resulted in permanent disability. Deaths and…

  8. Regressive language in severe head injury. (United States)

    Thomsen, I V; Skinhoj, E


    In a follow-up study of 50 patients with severe head injuries three patients had echolalia. One patient with initially global aphasia had echolalia for some weeks when he started talking. Another patient with severe diffuse brain damage, dementia, and emotional regression had echolalia. The dysfunction was considered a detour performance. In the third patient echolalia and palilalia were details in a total pattern of regression lasting for months. The patient, who had extensive frontal atrophy secondary to a very severe head trauma, presented an extreme state of regression returning to a foetal-body pattern and behaving like a baby.

  9. CT analysis of missile head injury

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    Besenski, N. [Dept. of Radiology, Zagreb Univ. Hospital Rebro (Croatia); Jadro-Santel, D. [Dept. of Neuropathology, Zagreb Univ. Hospital Rebro (Croatia); Jelavic-Koic, F. [Dept. of Radiology, General Hospital Sveti Duh, Zagreb (Croatia); Pavic, D. [Dept. of Neuropathology, Zagreb Univ. Hospital Rebro (Croatia); Mikulic, D. [Zagreb School of Medicine (Croatia); Glavina, K. [Dept. of Radiology, Clinical Hospital, Osijek (Croatia); Maskovic, J. [Dept. of Radiology, Clinical Hospital, Split (Croatia)


    Between August 1991 and December 1992, CT was performed in 154 patients who had suffered missile head injury during the war in the Republic of Croatia. In 54% CT was performed 1-24 h after injury, and in 27% follow-up CT was also obtained. The wounds were penetrating, tangential or perforating (45%, 34% and 21%, respectively). Haemorrhage was the most frequent lesion in the brain (84%). Follow-up CT evolution of haemorrhage, oedema, cerebritis, abscess, secondary vascular lesions, necrosis, encephalomalacia and hydrocephalus. The most dynamic changes occurred 7-14 days after injury. In 14% of cases, deep cerebral lesions were found in the corpus callosum, septum pellucidum periventricular region and pons, although bone and shell fragments were in a different part of the brain parenchyma. Such lesions were found in penetrating injuries only. CT proved very useful for assessing the extent and type of lesions. Although different mechanisms of brain damage in missile head injury are known, here they are, to the best of our knowledge, shown for the first time by CT. (orig.)

  10. Delayed epidural hematoma after mild head injury

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    Radulović Danilo


    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  11. Survival of social relationships following head injury. (United States)

    Kinsella, G; Ford, B; Moran, C


    A retrospective search through the medical records at a rehabilitation hospital in Melbourne, Australia, identified 38 subjects (within the age range 19-34 years) suffering the effect of a severe closed-head injury 2-10 years post-trauma. In regard to social relationships, availability of post-trauma close attachment figures and looser social networks were markedly reduced for the head-injured group in relation to a matched community control group. However, they did not generally perceive these social relationships as inadequate when compared to a normal control sample. Moreover, within the head-injured group the perception of inadequate social relationships was not significantly associated with minor psychiatric disturbance. The implications of these results in terms of the social bond theory of depression are discussed, and issues in long-term social support of this population are raised.

  12. A Review of Sport-Related Head Injuries. (United States)

    Mizobuchi, Yoshifumi; Nagahiro, Shinji


    We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.

  13. The rate of change of acceleration: implications to head kinematics during rear-end impacts. (United States)

    Hynes, Loriann M; Dickey, James P


    Whiplash is a mechanism of injury commonly associated with rear-impact vehicle collisions. To date, research has focused primarily on changes in velocity and acceleration as key factors for determining injuries due to whiplash mechanisms, but other characteristics of the acceleration pulse may be important. This study assessed whether the head acceleration response to whiplash-like perturbation profiles were affected by a change in the rate of the applied acceleration, or jerk. Twenty-one subjects were exposed to different low-velocity rear-impact whiplash-like perturbations using a precisely controlled robotic platform. The perturbations were divided into two groupings of peak acceleration (approximately 10 (high) and 5.7 (low) m/s2) and three groupings of jerk (approximately 260, 310, and 360 m/s3). These six profiles were repeated twice. Results demonstrated that the jerk magnitude significantly affected forehead acceleration in the vertical and horizontal directions. Increasing the magnitude of the platform acceleration also differentially affected the horizontal and vertical forehead accelerations. This indicates that the level of jerk influences the resulting head kinematics and should be considered when designing or interpreting experiments that are attempting to predict injury from whiplash-like perturbations.

  14. Head injury management guidelines for general practitioners

    Directory of Open Access Journals (Sweden)

    Jeremy C Ganz


    Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

  15. Head injury management guidelines for general practitioners. (United States)

    Ganz, Jeremy C


    A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined.

  16. Imaging in Minor Head Injury: Early complications and late consequences

    NARCIS (Netherlands)

    M. Smits (Marion)


    textabstractHead injury is traditionally divided into minor, moderate or severe head injury, depending on the patient’s presenting level of consciousness as expressed in the Glasgow Coma Scale (GCS) score. Th e vast majority of patients (>90%) present with a normal or nearnormal level of consciousne

  17. Characterizing Discourse Deficits Following Penetrating Head Injury: A Preliminary Model (United States)

    Coelho, Carl; Le, Karen; Mozeiko, Jennifer; Hamilton, Mark; Tyler, Elizabeth; Krueger, Frank; Grafman, Jordan


    Purpose: Discourse analyses have demonstrated utility for delineating subtle communication deficits following closed head injuries (CHIs). The present investigation examined the discourse performance of a large group of individuals with penetrating head injury (PHI). Performance was also compared across 6 subgroups of PHI based on lesion locale. A…

  18. Learning people's names following severe closed-head injury

    NARCIS (Netherlands)

    Milders, M.V.


    Although problems remembering people's names rank highly among the subjective complaints of patients with closed-head injuries, very few studies have examined their memory for people's names by objective measurements. An experiment is reported in which patients with severe closed-head injuries and n

  19. When to suspect head injury or cervical spine injury in maxillofacial trauma?

    Directory of Open Access Journals (Sweden)

    Sajjad A Rahman


    Full Text Available Background: The global status report of the World Health Organization (WHO on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury. Materials and Methods: A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant. Results: Of 124 patients, 59 (47.6% had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001. The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001 and orbital (P = 0.004 regions and higher in the mandibular region (P = 0.010. Conclusion: Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries.

  20. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)


    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  1. Acute arterial infarcts in patients with severe head injuries

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal


    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  2. Biomechanical studies in an ovine model of non-accidental head injury. (United States)

    Anderson, R W G; Sandoz, B; Dutschke, J K; Finnie, J W; Turner, R J; Blumbergs, P C; Manavis, J; Vink, R


    This paper presents the head kinematics of a novel ovine model of non-accidental head injury (NAHI) that consists only of a naturalistic oscillating insult. Nine, 7-to-10-day-old anesthetized and ventilated lambs were subjected to manual shaking. Two six-axis motion sensors tracked the position of the head and torso, and a triaxial accelerometer measured head acceleration. Animals experienced 10 episodes of shaking over 30 min, and then remained under anesthesia for 6h until killed by perfusion fixation of the brain. Each shaking episode lasted for 20s resulting in about 40 cycles per episode. Each cycle typically consisted of three impulsive events that corresponded to specific phases of the head's motion; the most substantial of these were interactions typically with the lamb's own torso, and these generated accelerations of 30-70 g. Impulsive loading was not considered severe. Other kinematic parameters recorded included estimates of head power transfer, head-torso flexion, and rate of flexion. Several styles of shaking were also identified across episodes and subjects. Axonal injury, neuronal reaction and albumin extravasation were widely distributed in the hemispheric white matter, brainstem and at the craniocervical junction and to a much greater magnitude in lower body weight lambs that died. This is the first biomechanical description of a large animal model of NAHI in which repetitive naturalistic insults were applied, and that reproduced a spectrum of injury associated with NAHI.

  3. Validation of a noninvasive system for measuring head acceleration for use during boxing competition. (United States)

    Beckwith, Jonathan G; Chu, Jeffrey J; Greenwald, Richard M


    Although the epidemiology and mechanics of concussion in sports have been investigated for many years, the biomechanical factors that contribute to mild traumatic brain injury remain unclear because of the difficulties in measuring impact events in the field. The purpose of this study was to validate an instrumented boxing headgear (IBH) that can be used to measure impact severity and location during play. The instrumented boxing headgear data were processed to determine linear and rotational acceleration at the head center of gravity, impact location, and impact severity metrics, such as the Head Injury Criterion (HIC) and Gadd Severity Index (GSI). The instrumented boxing headgear was fitted to a Hybrid III (HIII) head form and impacted with a weighted pendulum to characterize accuracy and repeatability. Fifty-six impacts over 3 speeds and 5 locations were used to simulate blows most commonly observed in boxing. A high correlation between the HIII and instrumented boxing headgear was established for peak linear and rotational acceleration (r2= 0.91), HIC (r2 = 0.88), and GSI (r2 = 0.89). Mean location error was 9.7 +/- 5.2 masculine. Based on this study, the IBH is a valid system for measuring head acceleration and impact location that can be integrated into training and competition.

  4. Head Injury- A Maxillofacial Surgeon’s Perspective (United States)

    Choonthar, Muralee Mohan; Raghothaman, Ananthan; Prasad, Rajendra; Pandya, Kalpa


    Injuries and violence are one of the leading causes of mortality worldwide. A substantial portion of these injuries involve the maxillofacial region. Among the concomitant injuries, injuries to the head and cervical spine are amongst those that demand due consideration on account of their life threatening behaviour. Studies have shown that facial fractures have a strong association with traumatic brain injury. Knowledge of the types and mechanisms of traumatic brain injury is crucial for their treatment. Many a times, facial fractures tend to distract our attention from more severe and often life threatening injuries. Early diagnosis of these intracranial haemorrhage leads to prompt treatment which is essential to improve the outcome of these patients. An oral and maxillofacial surgeon should be able to suspect and diagnose head injury and also provide adequate initial management. PMID:26894193

  5. Development of a symptom expectation questionnaire for minor head injury

    Institute of Scientific and Technical Information of China (English)

    Robert FERRARI; Deon LOUW


    Background and objective: Expectations and beliefs are important predictors of outcome following minor head injury. In this paper, the primary purpose is to develop a simple symptom expectation questionnaire for minor head injury for use in future research studies. Methods: An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for minor head injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter (a subject who expected at least one of these symptoms would remain chronic following minor head injury). A total of six of the 56 items were found to be discriminatory, and these were tested in additional subject groups against the original questionnaire. Results: From the original database of 179 subjects completing a 56-item symptom expectation checklist, 135 expected that at least one of the 56 symptoms would be chronic following minor head injury. The 135 expecters, however, all chose at least one of six items: headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain. Using these six items, in two new groups of subjects, all those who endorsed one of the 56 symptoms as likely to be chronic following minor head injury (expecters) could also be identified on the 6-item checklist. Conclusions: A shortened (6-item) symptom expectation checklist of commonly reported symptoms following minor head injury (headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain) correctly identifies subjects who expect that at least one symptom will be chronic following minor head injury (i.e., an expecter).

  6. Automatic annotation of head velocity and acceleration in Anvil

    DEFF Research Database (Denmark)

    Jongejan, Bart


    We describe an automatic face tracker plugin for the ANVIL annotation tool. The face tracker produces data for velocity and for acceleration in two dimensions. We compare the annotations generated by the face tracking algorithm with independently made manual annotations for head movements...

  7. Head Injury as Risk Factor for Psychiatric Disorders

    DEFF Research Database (Denmark)

    Orlovska, Sonja; Pedersen, Michael Skaarup; Benros, Michael Eriksen;


    that the results were not merely due to accident proneness. Head injury between ages 11 and 15 years was the strongest predictor for subsequent development of schizophrenia, depression, and bipolar disorder. The added risk of mental illness following head injury did not differ between individuals with and without....... METHOD The authors used linkable Danish nationwide population-based registers to investigate the incidence of schizophrenia spectrum disorders, unipolar depression, bipolar disorder, and organic mental disorders in 113,906 persons who had suffered head injuries. Data were analyzed by survival analysis...... and adjusted for gender, age, calendar year, presence of a psychiatric family history, epilepsy, infections, autoimmune diseases, and fractures not involving the skull or spine. RESULTS Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1...

  8. Organisation of traumatic head injury management in the Nordic countries

    DEFF Research Database (Denmark)

    Sollid, S; Sundstrøm, T; Ingebrigtsen, T;


    is a synthesis of two cross-sectional surveys. Questionnaires were used to collect data on the annual number of acute head injury operations, the infrastructure, the level of education, the use of trauma protocols and the management of traumatic head injury at Nordic hospitals. RESULTS: The proportion of acute......OBJECTIVE: The aim of this study is to map and evaluate the available resources and the premises of traumatic head injury management in the Nordic countries, before the implementation of a Nordic adaption of the Brain Trauma Foundation guidelines for prehospital management. METHODS: The study...... head injury operations performed outside a neurosurgical department was 0% in Denmark, 16% in Finland, 19% in Norway and 33% in Sweden. Eighty-four per cent of Nordic hospitals had written protocols for the assessment and treatment of trauma patients and 78% had regular training in trauma management...


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION Head injury is very common in modern life. Patients of any age group may have head injury however mechanism of head injury, pathophysiology and outcome of head injury is quite different in adults as compared to children. Road traffic accident is a common mode of head injury in adults while fall from height and household abuse is common mode in children. In Western countries, there is a separate registry system for pediatric head injury but there is no such system exist in india. Our present study is focused on pediatric head injury and evaluation of factors that affect the final outcome in pediatric patients.

  10. On Impact: A Case of a Student with Head Injuries (United States)

    Buckley, Valerie A.; Chesire, David J.; Canto, Angela I.


    This article describes a case of a student with head injuries. While the symptom presentation for students with traumatic brain injury (TBI) can be vastly different, this case represents common symptoms seen in students who are recovering from a concussion. The authors suggest that school psychologists query the teacher and parents about their…

  11. [Head injuries in Duckburg in 1959 and 2009]. (United States)

    Juul, Agnete M; Rasmussen, Mads; Koch, Klaus Ulrik; Juul, Niels


    Comic books have been a part of popular culture through generations. Debates concerning their graphic depictions of violence have been ongoing for nearly as long. Our aim was to examine if the violence in "Donald Duck & Co." (a weekly published Danish comic book), illustrated through the number of head injuries, increased in the period from 1959 to 2009. The comic book vintages from the years 1959 and 2009 were read, and the number of head injuries noted. The head injuries were characterized by severity, in part by a modified Glasgow Coma Scale and in part by a newly developed Comic Book Coma Scale. The number of head injuries were equal in the examined years, however, the number of head injuries per page decreased from 1/10 pages to 1/20 pages. Donald Duck sustained a better part of the injuries increasing from 17% in 1959 to 33% in 2009. The study indicates that we, with peace of mind, can read a comic book while the rest of the family takes care of the dishes at Christmas.

  12. Risk of Parkinson's disease after hospital contact for head injury

    DEFF Research Database (Denmark)

    Rugbjerg, Kathrine; Ritz, Beate; Korbo, Lise;


    OBJECTIVE: To determine whether a hospital contact for a head injury increases the risk of subsequently developing Parkinson's disease. DESIGN: Population based case-control study. SETTING: Denmark. PARTICIPANTS: 13 695 patients with a primary diagnosis of Parkinson's disease in the Danish national...... of history of head injury. RESULTS: An overall 50% increase in prevalence of hospital contacts for head injury was seen before the first registration of Parkinson's disease in this population (odds ratio 1.5, 95% confidence interval 1.4 to 1.7). The observed association was, however, due almost entirely...... to injuries that occurred during the three months before the first record of Parkinson's disease (odds ratio 8.0, 5.6 to 11.6), and no association was found between the two events when they occurred 10 or more years apart (1.1, 0.9 to 1.3). CONCLUSIONS: The steeply increased frequency of hospital contacts...

  13. Unusual head and neck injury in elevator: autopsy study. (United States)

    Eren, B; Türkmen, N; Dokgöz, H


    Industrial injuries related to auto-load-carrying vehicles were not frequently reported in the literature. Presented case was, 31-year-old male furniture worker. Deceased was found in awkward position in furniture workshop. Victim was observed on his knees in front of the elevator, head and neck lodged within openings of the elevator, and head and neck structures compressed-guillotined by the lower platform of the elevator were detected. We presented rare case of head and neck compression by elevator. Key words: head - neck - accidents - elevator - autopsy.

  14. Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Mishra


    Full Text Available Background: Indication of a head computed tomography (CT scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others, duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43% patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h P< 0.001; vomiting odds, ratio (OR 1.89 (1.23, 2.80, P< 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71, P< 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

  15. Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury (United States)

    Mishra, Rakesh Kumar; Munivenkatappa, Ashok; Prathyusha, Vasuki; Shukla, Dhaval P.; Devi, Bhagavatula Indira


    Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P < 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

  16. Penetrating head injury from angle grinder: A cautionary tale

    Directory of Open Access Journals (Sweden)

    S Senthilkumaran


    Full Text Available Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-worker at a distance of five meters. The pathophysiological consequence of penetrating head injuries depends on the kinetic energy and trajectory of the object. In the nearby healthcare center the impacted broken disc was removed without realising the consequences and the wound was packed. As the conscious level declined in both, they were referred. CT brain revealed fracture in skull and changes in the brain in both. Expeditious removal of the penetrating foreign body and focal debridement of the scalp, skull, dura, and involved parenchyma and Watertight dural closure were carried out. The most important thing is not to remove the impacted foreign body at the site of accident. Craniectomy around the foreign body, debridement and removal of foreign body without zigzag motion are needed. Removal should be done following original direction of projectile injury. The neurological sequelae following the non missile penetrating head injuries are determined by the severity and location of initial injury as well as the rapidity of the exploration and fastidious debridement.

  17. Penetrating head injury from angle grinder: A cautionary tale. (United States)

    Senthilkumaran, S; Balamurgan, N; Arthanari, K; Thirumalaikolundusubramanian, P


    Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-worker at a distance of five meters. The pathophysiological consequence of penetrating head injuries depends on the kinetic energy and trajectory of the object. In the nearby healthcare center the impacted broken disc was removed without realising the consequences and the wound was packed. As the conscious level declined in both, they were referred. CT brain revealed fracture in skull and changes in the brain in both. Expeditious removal of the penetrating foreign body and focal debridement of the scalp, skull, dura, and involved parenchyma and Watertight dural closure were carried out. The most important thing is not to remove the impacted foreign body at the site of accident. Craniectomy around the foreign body, debridement and removal of foreign body without zigzag motion are needed. Removal should be done following original direction of projectile injury. The neurological sequelae following the non missile penetrating head injuries are determined by the severity and location of initial injury as well as the rapidity of the exploration and fastidious debridement.

  18. Spinal cord injury and its association with blunt head trauma

    Directory of Open Access Journals (Sweden)

    Paiva WS


    Full Text Available Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.Results: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years. The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%, car crashes (27.7%, and falls (25%. Systemic lesions were present in 80 (44.4% patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8% suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine. In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS < 9 were statistically significant as risk factors (P < 0.05 for spine injury.Conclusion: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.Keywords: head injury, spine trauma, risk factors

  19. Head impact accelerations for brain strain-related responses in contact sports: a model-based investigation. (United States)

    Ji, Songbai; Zhao, Wei; Li, Zhigang; McAllister, Thomas W


    Both linear [Formula: see text] and rotational [Formula: see text] accelerations contribute to head impacts on the field in contact sports; however, they are often isolated in injury studies. It is critical to evaluate the feasibility of estimating brain responses using isolated instead of full degrees-of-freedom (DOFs) accelerations. In this study, we investigated the sensitivities of regional brain strain-related responses to resultant [Formula: see text] and [Formula: see text] as well as the relative contributions of these acceleration components to the responses via random sampling and linear regression using parameterized, triangulated head impacts with kinematic variable values based on on-field measurements. Two independently established and validated finite element models of the human head were employed to evaluate model-consistency and dependency in results: the Dartmouth Head Injury Model and Simulated Injury Monitor. For the majority of the brain, volume-weighted regional peak strain, strain rate, and von Mises stress accumulated from the simulation significantly correlated with the product of the magnitude and duration of [Formula: see text], or effectively, the rotational velocity, but not to [Formula: see text]. Responses from [Formula: see text]-only were comparable to the full-DOF counterparts especially when normalized by injury-causing thresholds (e.g., volume fractions of large differences virtually diminished (i.e., [Formula: see text]1 %) at typical difference percentage levels of 1-4 % on average). These model-consistent results support the inclusion of both rotational acceleration magnitude and duration into kinematics-based injury metrics and demonstrate the feasibility of estimating strain-related responses from isolated [Formula: see text] for analyses of strain-induced injury relevant to contact sports without significant loss of accuracy, especially for the cerebrum.

  20. Development/global validation of a 6-month-old pediatric head finite element model and application in investigation of drop-induced infant head injury. (United States)

    Li, Zhigang; Luo, Xiao; Zhang, Jinhuan


    Drop is a frequent cause for infant head injury. To date, finite element (FE) modeling was gradually used to investigate child head dynamic response under drop impact conditions, however, two shortages still exist on this topic: (1) due to ethical reasons, none of developed 6-month-old (6MO) head FE model was found to be quantitatively validated against child cadaver tests at similar age group; (2) drop height and impact surface stiffness effects on infant head responses were not comprehensively investigated. In this study, motivated by the recently published material properties of soft tissues (skull and suture, etc.) and reported pediatric head global cadaver tests, a 6MO child head FE model was developed and simulated results compared with the child cadaver experimental data under compression and drop conditions. Comparison of results indicated that the FE model showed a fairly good biofidelic behavior in most dynamic responses. The validated FE model was further used to investigate effects of different drop heights and impact surface stiffness on the head dynamic responses. Numerical results show that the pediatric head mechanical parameters (peak acceleration, HIC, maximal vonMises stress and maximal first principal strain of skull) keep increasing with the increase in drop height, and exhibit "logarithmic function" shapes at "fast-slow" trends with increase in impact surface stiffness. Based on above analysis, the regressions were conducted to describe the relationship between drop height and impact surface stiffness and head global injury predictors (head peak acceleration, HIC, etc.). This paper provides a fundamental study of child head injury mechanism and protection under drop conditions.

  1. Radial head fracture associated with posterior interosseous nerve injury

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    Full Text Available ABSTRACT Fractures of the radial head and radial neck correspond to 1.7-5.4% of all fractures and approximately 30% may present associated injuries. In the literature, there are few reports of radial head fracture with posterior interosseous nerve injury. This study aimed to report a case of radial head fracture associated with posterior interosseous nerve injury. CASE REPORT: A male patient, aged 42 years, sought medical care after falling from a skateboard. The patient related pain and limitation of movement in the right elbow and difficulty to extend the fingers of the right hand. During physical examination, thumb and fingers extension deficit was observed. The wrist extension showed a slight radial deviation. After imaging, it became evident that the patient had a fracture of the radial head that was classified as grade III in the Mason classification. The patient underwent fracture fixation; at the first postoperative day, thumb and fingers extension was observed. Although rare, posterior interosseous nerve branch injury may be associated with radial head fractures. In the present case, the authors believe that neuropraxia occurred as a result of the fracture hematoma and edema.

  2. Evoked potentials and head injury. 2. Clinical applications. (United States)

    Rappaport, M; Hopkins, H K; Hall, K; Belleza, T


    The method of rating abnormality of evoked brain potential patterns and assessing the extent and severity of cortical and subcortical brain dysfunction in head injury patients described in Part I is applied in a clinical context. Evoked potential abnormality (EPA) scores are found to be significantly correlated both with admission and outcome disability approximately one year after head injury. Correlations increase with the increase in the number of sensory modalities tested. Correlations between EPA scores and clinical disability (measured by the Disability Rating Scale) decrease with time after injury. Significant correlations, however, persist for about 60 days after onset of injury. It was found that EP pattern abnormalities can reflect specific sensory (and at times motor) deficits in noncommunicative patients and thereby contribute significantly to early treatment and rehabilitation planning.

  3. The profile of head injuries and traumatic brain injury deaths in Kashmir

    Directory of Open Access Journals (Sweden)

    Tabish Amin


    Full Text Available Abstract This study was conducted on patients of head injury admitted through Accident & Emergency Department of Sher-i-Kashmir Institute of Medical Sciences during the year 2004 to determine the number of head injury patients, nature of head injuries, condition at presentation, treatment given in hospital and the outcome of intervention. Traumatic brain injury (TBI deaths were also studied retrospectively for a period of eight years (1996 to 2003. The traumatic brain injury deaths showed a steady increase in number from year 1996 to 2003 except for 1999 that showed decline in TBI deaths. TBI deaths were highest in age group of 21–30 years (18.8%, followed by 11–20 years age group (17.8% and 31–40 years (14.3%. The TBI death was more common in males. Maximum number of traumatic brain injury deaths was from rural areas as compared to urban areas. To minimize the morbidity and mortality resulting from head injury there is a need for better maintenance of roads, improvement of road visibility and lighting, proper mechanical maintenance of automobile and other vehicles, rigid enforcement of traffic rules, compulsory wearing of crash helmets by motor cyclist and scooterists and shoulder belt in cars and imparting compulsory road safety education to school children from primary education level. Moreover, appropriate medical care facilities (including trauma centres need to be established at district level, sub-divisional and block levels to provide prompt and quality care to head injury patients

  4. The profile of head injuries and traumatic brain injury deaths in Kashmir. (United States)

    Yattoo, Gh; Tabish, Amin


    This study was conducted on patients of head injury admitted through Accident & Emergency Department of Sher-i-Kashmir Institute of Medical Sciences during the year 2004 to determine the number of head injury patients, nature of head injuries, condition at presentation, treatment given in hospital and the outcome of intervention. Traumatic brain injury (TBI) deaths were also studied retrospectively for a period of eight years (1996 to 2003).The traumatic brain injury deaths showed a steady increase in number from year 1996 to 2003 except for 1999 that showed decline in TBI deaths. TBI deaths were highest in age group of 21-30 years (18.8%), followed by 11-20 years age group (17.8%) and 31-40 years (14.3%). The TBI death was more common in males. Maximum number of traumatic brain injury deaths was from rural areas as compared to urban areas.To minimize the morbidity and mortality resulting from head injury there is a need for better maintenance of roads, improvement of road visibility and lighting, proper mechanical maintenance of automobile and other vehicles, rigid enforcement of traffic rules, compulsory wearing of crash helmets by motor cyclist and scooterists and shoulder belt in cars and imparting compulsory road safety education to school children from primary education level. Moreover, appropriate medical care facilities (including trauma centres) need to be established at district level, sub-divisional and block levels to provide prompt and quality care to head injury patients.

  5. The Use of Ophthalmic Ultrasonography to Identify Retinal Injuries Associated With Abusive Head Trauma. (United States)

    Riggs, Becky J; Trimboli-Heidler, Carmelina; Spaeder, Michael C; Miller, Marijean M; Dean, Nathan P; Cohen, Joanna S


    Abusive head trauma includes any nonaccidental injury inflicted to a child's head and body. It is often characterized by, but not limited to, the repetitive acceleration-deceleration forces with or without blunt head impact. It has a mortality rate of 30%, and 80% of survivors experience permanent neurologic damage. In this case series, we hypothesize that bedside ultrasonography can be useful in the identification of retinal injuries that are consistent with abusive head trauma. Ocular manifestations of abusive head trauma are identified by dilated ophthalmic examination showing retinal hemorrhages that are too numerous to count, multilayered, and extending to the periphery. Traumatic retinoschisis, splitting of the retinal layers with or without blood accumulating in the intervening space, is exclusive for abusive head trauma in infants without a history of significant cerebral crush injury. Direct visualization of intraocular structures is difficult when the eyelids are swollen shut or when dilatation must be delayed. We present a series of 11 patients with brain injuries who underwent ophthalmic point-of-care ultrasonography that revealed traumatic retinoschisis on average 60 hours earlier than direct ophthalmic visualization. Dilated ophthalmic examinations and autopsy reports confirmed retinoschisis and other forms of retinal hemorrhages that were too numerous to count, multilayered, and extending to the periphery in all 11 patients. One patient did not have a dilated ophthalmic examination; however, traumatic retinoschisis and retinal hemorrhages were confirmed on autopsy. Ocular point-of-care ultrasonography is a promising tool to investigate abusive head trauma through the identification of traumatic retinoschisis and retinal hemorrhages when pupillary dilatation and direct ophthalmic examination is delayed.

  6. Head injuries in skiers: an analysis of injury severity and outcome. (United States)

    Diamond, P T; Gale, S D; Denkhaus, H K


    To examine the incidence, injury severity, and outcomes of persons hospitalized as a result of ski-related head trauma, a cross-sectional survey was carried out from the Colorado traumatic brain injury database. This database is an ongoing population-based statewise surveillance system, compiled by the Department of Public Health and Environment. Participants were Colorado residents who sustained a head injury while skiing at Colorado ski resorts and hospitalized over three full ski seasons (1994--1997). Injury severity measures included GCS, ISS, AIS, and presence/absence of intracranial lesion, skull fracture and amnesia. Outcome measures included GOS and hospital length of stay. Mean injury severity scores were as follows: GCS 14.51 (SD=0.99), AIS 2.98 (0.99) and ISS 13.17 (6.71). Twenty-four per cent sustained skull fracture, 39% had intracranial lesions, and 79% demonstrated amnesia. Mean length of stay was 4.31 days (10.58). Head injury incidence was 0.77 per 100 000 ski visits (age-specific range=0.17--1.91). Males were more likely to have a skull fracture and evidence of intracranial lesion. Finally, children and older adults were at increased risk of ski-related head trauma, suggesting head injury prevention programmes geared toward these age groups should be emphasized.

  7. [Reflection around the return home of a head injury patient]. (United States)

    Mouling, Virginie; Lambert, Marie; Charlier, Nathalie; Fonseca, Dolores


    The rehabilitation of people having suffered a head injury requires an inter-disciplinary perspective. Understanding the family dynamics as well as assessing the patient's resources and limits help professionals organise the necessary support to guide the patient and their family towards social reintegration.

  8. Social Cognition after Head Injury: Sarcasm and Theory of Mind (United States)

    Channon, S.; Pellijeff, A.; Rule, A.


    Closed head injury (CHI) is associated with communication difficulties in everyday social interactions. Previous work has reported impaired comprehension of sarcasm, using sarcastic remarks where the intended meaning is the opposite of the sincere or literal meaning. Participants with CHI in the present study were assessed using two types of…

  9. Accidental and Nonaccidental Head Injuries in Infants: Distinguishing Characteristics

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available One hundred fifty infants hospitalized with head injury over a 3-year period, 57 (38% due to child abuse, were studied prospectively at the Departments of Pediatric Neurosurgery, Neuro-ophthalmology, and Legal Medicine, CHRU de Lille, France.

  10. No impact of early intervention on late outcome after minimal, mild and moderate head injury

    DEFF Research Database (Denmark)

    Heskestad, Ben; Waterloo, Knut; Baardsen, Roald;


    To evaluate the effect of an educational intervention on outcome after minimal, mild and moderate head injury.......To evaluate the effect of an educational intervention on outcome after minimal, mild and moderate head injury....


    Directory of Open Access Journals (Sweden)



    Full Text Available Everyday, men, women and children suffer head injuries. A car accident, a fall from height or sports injury can range in severity from concussion to coma. Traumatic Brain Injury (TBI can be fatal,dangerous and survivors, can show persistent problems that significantly affect their livelihood and well-being. India has rather unenviable distinction of having the highest rate of head injury in the world. In India, more than 100,000 lives are lost every year with over 1 million suffering from serious head injuries, to be addressed by a handful number of craniofacial and neurosurgeons , as craniofacial neurosciences in India is new and rapidly expanding discipline and one has to be competent and razor sharp in applying its cognitive base and principles, and residency as is always described as an island in shades of grey, and in India it means higher pressure, higher stress loads, lesser patience, and longer quantum of time spent at work with sleepless nights and merciless bosses.

  12. Sir Hugh Cairns and World War II British advances in head injury management, diffuse brain injury, and concussion: an Oxford tale. (United States)

    Stone, James L; Patel, Vimal; Bailes, Julian E


    The authors trace the Oxford, England, roots of World War II (WWII)-related advances in head injury management, the biomechanics of concussion and brain injury, and postwar delineation of pathological findings in severe concussion and diffuse brain injury in man. The prominent figure in these developments was the charismatic and innovative Harvey Cushing-trained neurosurgeon Sir Hugh Cairns. Cairns, who was to closely emulate Cushing's surgical and scholarly approach, is credited with saving thousands of lives during WWII by introducing and implementing innovative programs such as helmets for motorcyclists, mobile neurosurgical units near battle zones, and the military usage of penicillin. In addition, he inspired and taught a generation of neurosurgeons, neurologists, and neurological nurses in the care of brain and spinal cord injuries at Oxford's Military Hospital for Head Injuries. During this time Cairns also trained the first full-time female neurosurgeon. Pivotal in supporting animal research demonstrating the critical role of acceleration in the causation of concussion, Cairns recruited the physicist Hylas Holbourn, whose research implicated rotary acceleration and shear strains as particularly damaging. Cairns' work in military medicine and head injury remain highly influential in efforts to mitigate and manage brain injury.

  13. Analysis of pediatric head anthropometry using computed tomography for application to head injury prediction. (United States)

    Loftis, Kathryn L; Geer, Carol P; Danelson, Kerry A; Slice, Dennis E; Stitze, Joel D


    Motor vehicle accidents are the leading cause of death of people between one and thirty-four years of age in the U.S., and head trauma is a significant lethal injury in such cases. During a motor vehicle crash, the head often experiences blunt force trauma from impacts with seat backs, steering wheels, windows, and dashes. The resulting injuries can cause skull fractures, concussions, bleeding and swelling of the brain. Crash test dummies and finite element models are often used to study the nature and likelihood of injury during a crash, but these are currently based on scaled versions of a standard, 50th percentile male. This approach fails to accurately capture the size and shape variation in even the adult population, but may be especially inappropriate for modeling pediatric head injuries where, for instance, infants have fontanelles and reduced bone structure. In this presentation, an approach for modification of a finite element model of the human head based on 50th percentile male dimensions and representing the skull, brain, dura/CSF layer, and Falx Celebri, that will incorporate the anatomical and nonlinear morphological changes observed in pediatric skulls during ontogeny. Using 96 CT scans of normal pediatric skulls, landmark coordinate points are identified to map the changes in skull shape and size as aging occurs. The pediatric skull changes rapidly in size and shape during the first two years of age. Using this information, a pediatric finite element head model will be created, using parametric mesh generation software, to measure head injury in children in a motor vehicle crash.

  14. Severe head injury caused by motorcycle traffic accident

    Institute of Scientific and Technical Information of China (English)



    Objective To explore the characteristic and treatment of the severe head injury due to motorcycle accident.Methods Review and analysis of 27 motorcycle traffic trauma cases who were admitted to our hospital from Oct.1995 to Sep.1997.Results Young men were the main composition of these patients.Multiple injuries associated with brain ste or diffuse axonal injury were common,which were the main factors influencing the consciousness and prognosis of the patients.The wound was usually severely contaminated.Evacuation of hematomas,decompression by depleting skull flap,hypotheymia and artificial hibernation were conducted in this series.Among them,14 cases were cured ,3 cases were seriously disabled,10 cases died.Conclusions Motorcycle's weight is light so it easily loses its balance.The riders and the passengers are exposed and lack protection.Driving against traffic regulations is frquently seen.All these are the reasons why the motorcycle traffic accidents often take place. When the traffic accident happens,the patients' head generally is thrown a long distance and dashed against the barrier or the ground.The psture nd mechanism of injury were complicated and varied.The decelerated injury and rolling injury occurred frequently and they were the main reasons for brain stem or diffuse axonal injury.The patients who have surgical indication should be operated upon as soon as possible.Hibernation and low temoerature therapy are conducive to the protection of the brain function at the early stage of postinjury or postoperation.A careful epluchage is essential to reduce infection of the open injury.

  15. Gradation of Neck Muscle Responses and Head/Neck Kinematics to Acceleration and Speed Change in Rear-end Collisions. (United States)

    Siegmund, Gunter P; Sanderson, David J; Inglis, J Timothy


    Recent epidemiological evidence shows that the potential for whiplash injury varies with both the average acceleration and speed change of a rear-end collision. The goal of this study was to examine the gradation of neck muscle responses and the head and neck kinematics to rear-end collision pulses in which the acceleration and speed change were independently varied. Thirty subjects (15F, 15M) underwent 36 consecutive rear-end collisions consisting of three different average accelerations (ā = 0.5, 0.9 and 1.3 g) and three different speed changes (Deltav = 0.25, 0.50 and 0.75 m/s). Onset and amplitude of the sternocleidomastoid (SCM) and cervical paraspinal (PARA) muscle responses were measured using surface electromyography. Kinematic measures included linear and angular accelerations and displacements of the head and torso. The results showed that the amplitude of the muscle and kinematics responses was graded to both collision acceleration and speed change. The magnitude of early peaks in the head/neck kinematics correlated more strongly with collision acceleration (r(2) = 0.63 to 0.69), whereas the magnitude of later kinematic peaks correlated more strongly with collision speed change (r(2) = 0.59 to 0.95). Onset of the SCM muscle response correlated only weakly with collision acceleration and speed change (r(2) acceleration and speed change (āDeltav) yielded the strongest and most consistent correlations with neck muscle (r(2) = 0.48 to 0.58) and head/neck kinematic responses (r(2) = 0.78 to 0.94). This measure of collision severity is also consistent with the recent epidemiological evidence that whiplash symptom intensity and duration increases with both average acceleration and speed change.

  16. Working toward exposure thresholds for blast-induced traumatic brain injury: thoracic and acceleration mechanisms

    CERN Document Server

    Courtney, Michael; 10.1016/j.neuroimage.2010.05.025


    Research in blast-induced lung injury resulted in exposure thresholds that are useful in understanding and protecting humans from such injury. Because traumatic brain injury (TBI) due to blast exposure has become a prominent medical and military problem, similar thresholds should be identified that can put available research results in context and guide future research toward protecting warfighters as well as diagnosis and treatment. At least three mechanical mechanisms by which the blast wave may result in brain injury have been proposed - a thoracic mechanism, head acceleration and direct cranial transmission. These mechanisms need not be mutually exclusive. In this study, likely regions of interest for the first two mechanisms based on blast characteristics (positive pulse duration and peak effective overpressure) are developed using available data from blast experiments and related studies, including behind-armor blunt trauma and ballistic pressure wave studies. These related studies are appropriate to in...

  17. Cerebral Salt-Wasting Syndrome Caused by Minor Head Injury. (United States)

    Fukuoka, Toshiki; Tsurumi, Yuko; Tsurumi, Arihito


    A 34-year-old woman was admitted to hospital after sustaining a head injury in a motor vehicle accident (day 1). No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. She was discharged without symptoms on day 4. However, headache and nausea worsened on day 8, at which time serum sodium level was noted to be 121 mEq/L. Treatment with sodium chloride was initiated, but serum sodium decreased to 116 mEq/L on day 9. Body weight decreased in proportion to the decrease in serum sodium. Cerebral salt-wasting syndrome was diagnosed. This case represents the first illustration of severe hyponatremia related to cerebral salt-wasting syndrome caused by a minor head injury.

  18. Cerebral Salt-Wasting Syndrome Caused by Minor Head Injury

    Directory of Open Access Journals (Sweden)

    Toshiki Fukuoka


    Full Text Available A 34-year-old woman was admitted to hospital after sustaining a head injury in a motor vehicle accident (day 1. No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. She was discharged without symptoms on day 4. However, headache and nausea worsened on day 8, at which time serum sodium level was noted to be 121 mEq/L. Treatment with sodium chloride was initiated, but serum sodium decreased to 116 mEq/L on day 9. Body weight decreased in proportion to the decrease in serum sodium. Cerebral salt-wasting syndrome was diagnosed. This case represents the first illustration of severe hyponatremia related to cerebral salt-wasting syndrome caused by a minor head injury.

  19. Neurogenic pulmonary edema in head injuries: analysis of 5 cases

    Institute of Scientific and Technical Information of China (English)

    QIN Shi-qiang; SUN Wei; WANG Han-bin; ZHANG Qing-lin


    Objective: To review the pathophysiology and study the diagnosis and clinical management of neurogenic pulmonary edema (NPE). Methods: The data of 5 patients who developed NPE after head injury treated in our hospital form December 1995 to May 2003 were collected and analyzed.Results: The patients developed dyspnea and respiratory failure 2-8 hours after neurologic event. Four of the 5 patients presented with pink frothy sputum. Chest radiography showed bilateral diffuse infiltrations in all the 5 patients. After supportive measures such as oxygen support and pharmacologic therapy, 4 patients recovered in 72 hours and one patient died. Conclusions: The pathophysiologic mechanisms of NPE is unclear. In acute respiratory failure following head injury, NPE must be given much attention and timely and effective measures should be taken.

  20. Postconcussive symptom report: the relative influence of head injury and depression. (United States)

    Suhr, Julie A; Gunstad, John


    The present study explored whether any subset of self-reported postconcussion (PCS) symptoms or specific PCS symptom is sensitive and/or specific to head injury in non-self-selected samples of individuals aged 18-21 with head injury and depression (n = 32), head injury without depression (n = 31), depression without head injury (n = 25), and controls (n = 50). All participants completed a self-report PCS symptom scale based on their current symptoms. Results showed that depression, not head-injury status, largely accounted for elevation in PCS symptom reports, including cognitive symptoms. Thus, report of cognitive PCS symptoms is not specific to head injury, raising concerns about using such items to screen for head injury in the general population.

  1. Wernicke-Korsakoff syndrome in head injury: a missed insult. (United States)

    Ferguson, R K; Soryal, I N; Pentland, B


    A survey of the use of thiamine in patients at risk from Wernicke-Korsakoff syndrome (WKS) in Scottish specialist neurosurgical units, and a 2-year retrospective study of 218 at-risk patients admitted to a regional neurosurgical unit with a head injury were undertaken. Although responses to the survey indicated otherwise, the study revealed that there was no consistent practice regarding thiamine administration. Overall, 20.6% of patients received thiamine, with an alcohol history being the only factor correlating with thiamine administration. Of known alcoholics and heavy drinkers, 56.1% and 26.2% respectively received thiamine as in-patients; 44.5% of patients received additional carbohydrate loads in the form of i.v. dextrose or parenteral nutrition, but only 28.9% of these received thiamine as well. Although the actual thiamine status of these patients was not known, given the difficulties of diagnosing WKS in the presence of a head injury, the conclusion is that written protocols are needed in units to ensure that head injury patients at risk of WKS receive appropriate thiamine treatment or prophylaxis.

  2. Conventional vs accelerated fractionation in head and neck cancer. (United States)

    Dobrowsky, W; Dobrowsky, E; Naudé, J; Millesi, W; Pavelka, R; Kautzky, M; Grasl, M; Köhler, W; Wilson, G D; Reichel, M


    From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range 37-76 years) were treated. Patients were randomised to one of three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks or continuous hyperfractionated accelerated radiation therapy (Vienna-CHART) or Vienna-CHART with administration of a single dose of mitomycin C on day 5 of treatment (V-CHART + MMC). By the accelerated regimen a total dose of 55.3 Gy was given in 33 fractions within 17 consecutive days. Acute mucositis was the main toxicity recorded in those patients treated by accelerated fractionation, although the overall duration of mucosal reaction did not differ in the three treatment groups. There was no influence on local toxicity if MMC was added to radiation therapy or not. Those patients treated with additional MMC experienced a grade III/IV haematological toxicity in 4/28 cases. Complete remission (CR) was recorded in 48% following CF, 79% after Vienna-CHART (P < 0.05) and 71% after Vienna-CHART + MMC. The overall local failure rates were 73%, 59% and 42% (P = NS) for patients treated by CF, Vienna-CHART and Vienna-CHART + MMC respectively.

  3. Relationship between hyperventilation and intracranial pressure in patients with severe head injury

    Institute of Scientific and Technical Information of China (English)


    @@With high fatality rate and disability rate, the pathophysiologic changes of severe head injury are complicated. But the method of lowering intracranial pressure (ICP) through artificial hyperventilation is called in question recently. To understand the related changes of the partial pressure of carbon dioxide in artery (PaCO2) and the ICP at the acute period of severe head injury, a total of 64 patients with severe head injury were monitored and analyzed on the 3rd day after injury.

  4. Isolated traumatic head injury in children: Analysis of 276 observations

    Directory of Open Access Journals (Sweden)

    Bahloul Mabrouk


    Full Text Available Background : To determine predictive factors of mortality among children after isolated traumatic brain injury. Materials and Methods : In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU of Habib Bourguiba University Hospital (Sfax, Tunisia. Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. Results : There were 276 patients with 196 boys (71% and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%. Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4% died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98, neurovegetative disorder (OR: 7.1, meningeal hemorrhage (OR: 2.74, and lesion type VI according to Marshall tomographic grading (OR: 13.26. Conclusion : In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

  5. Damage control of multiple injuries headed by cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    LIU Si-hai; WANG Ai-min; DU Quan-yin; ZHAO Yu-feng; WANG Zi-ming; GUO Qing-shan; SHEN Yue


    Objective: To explore the strategy of damage control in clinical treatment of multiple injuries headed by cervical spinal cord injury.Methods: A retrospective analysis was performed in 32 patients. Cervical fractures associated with tetraplegia occurred in 18 patients, traumatic intervertebral disk hernia associated with tetraplegia in 2 patients, and cervical fractures and dislocation associated with tetraplegia in 12 patients. Seventeen cases were combined with craniocerebral injury, 7 combined with pulmonary contusion, multi-fractures of rib or hemopneumothorax, 2 combined with pelvic fracture and other 8 combined with fracture of limbs. The neural function was assessed by the American Spinal Injury Association (ASIA) scale.Results:Thirty-one patients were followed up for an average of 14 months. Of them, 10 got complete recovery, 13 obtained improvement of more than one ASIA grade, 8 did not improve, and 1 died.Conclusions: For the emergency treatment of multiple injuries headed by cervical spinal cord injury, the damage control strategy is the principle to follow. The final operations are preferably performed within 5 to 10 days after injury so as to raise the successful rate of remedy.

  6. Similar head impact acceleration measured using instrumented ear patches in a junior rugby union team during matches in comparison with other sports. (United States)

    King, Doug A; Hume, Patria A; Gissane, Conor; Clark, Trevor N


    OBJECTIVE Direct impact with the head and the inertial loading of the head have been postulated as major mechanisms of head-related injuries, such as concussion. METHODS This descriptive observational study was conducted to quantify the head impact acceleration characteristics in under-9-year-old junior rugby union players in New Zealand. The impact magnitude, frequency, and location were collected with a wireless head impact sensor that was worn by 14 junior rugby players who participated in 4 matches. RESULTS A total of 721 impacts > 10g were recorded. The median (interquartile range [IQR]) number of impacts per player was 46 (IQR 37-58), resulting in 10 (IQR 4-18) impacts to the head per player per match. The median impact magnitudes recorded were 15g (IQR 12g-21g) for linear acceleration and 2296 rad/sec(2) (IQR 1352-4152 rad/sec(2)) for rotational acceleration. CONCLUSIONS There were 121 impacts (16.8%) above the rotational injury risk limit and 1 (0.1%) impact above the linear injury risk limit. The acceleration magnitude and number of head impacts in junior rugby union players were higher than those previously reported in similar age-group sports participants. The median linear acceleration for the under-9-year-old rugby players were similar to 7- to 8-year-old American football players, but lower than 9- to 12-year-old youth American football players. The median rotational accelerations measured were higher than the median and 95th percentiles in youth, high school, and collegiate American football players.

  7. Accelerated hyperfractionated irradiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Kazuo; Sekiya, Yuichi; Araki, Hitoshi; Sakai, Mitsuhiro; Togawa, Takashi [Chiba Cancer Center (Japan)


    From May 1994 to May 1997, 52 patients with locally advanced head and neck cancer were treated with accelerated hyperfractionated irradiation (1.6 Gy, twice daily, 10 times a week, with minimum interval of 6 hours between fractions and the total dose to 67.2-70.4 Gy) and concomitant use of daily low-dose Carboplatin. The median follow-up period was 19.8 months with a range of 2-44 months. Complete response rate was 73% (38/52). Cumulative survival rate at 3 years was 46.7% and the relapse rate was 21.1% (8/38). The relapse sites were as follows, primary site; 2 cases, lymphnodes; 4 cases and distant metastases; 2 cases. The major acute toxicity was stomatitis. Grade 3-4 late sequelae was observed in 7 cases. Grade 3 xerostomia was observed in 2 cases, esophageal stenosis was observed in 2 cases and arytenoid necrosis was observed in 2 cases. There were no fatal sequelae. Acute sequelae are very variable and it will be necessary to individualize the treatment time according to the state of their stomatitis. (author)

  8. Psychogenic Nonepileptic Seizures after Head Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    Laura Scévola


    another medical illness. The gold standard for PNES diagnosis is video electroencephalogram (Video-EEG. PNESs are defined by modern psychiatry as conversion and dissociative disorders but these disorders may coexist with many others psychiatric disorders, including depression, posttraumatic stress disorder, and personality disorders. It is well known that epileptic seizures are a frequent and well-studied complication of traumatic head injury (THI. However, THI may also generate psychic symptoms including PNES. In this paper we describe a patient who developed PNES after THI in a bus accident and received a diagnosis of refractory epilepsy for 24 years until she underwent Video-EEG.

  9. Incidence of hospital referred head injuries in Norway: a population based survey from the Stavanger region

    DEFF Research Database (Denmark)

    Rommer, Bertil Roland; Heskestad, Ben; Baardsen, Roald;


    BACKGROUND: In three previous Norwegian studies conducted between 1974 and 1993, the annual incidence rates of hospital admitted head injuries were 236, 200 and 169 per 100,000 population. The aim of this study was to describe the incidence of head injury in the Stavanger region and to compare......,317 inhabitants (2003). RESULTS: The annual incidence rate was 207/100,000 population for hospital referred head injury and 157/100,000 population for hospital admitted head injury. High age- and sex specific incidence rates were observed among the oldest, and the highest rate (882/100,000) among men above 90...

  10. The relation between mechanical impact parameters and most frequent bicycle related head injuries

    NARCIS (Netherlands)

    Monea, A.G.; Perre, G. van der; Baeck, K.; Delye, H.H.; Verschueren, P.; Forausebergher, E.; Lierde, C. van; Verpoest, I.; Sloten, J. van der; Goffin, J.; Depreitere, B.


    The most frequent head injuries resulting from bicycle accidents include skull fracture acute subdural hematoma (ASDH), cerebral contusions, and diffuse axonal injury (DAI). This review includes epidemiological studies, cadaver experiments, in vivo imaging, image processing techniques, and computer

  11. [Thromboprophylaxis in multiple trauma and head injury patients]. (United States)

    Colomina, M J; Mora, L; Ciércoles, E


    Venous thromboembolic disease (VTD) is a frequent condition with serious clinical consequences and elevated mortality related to underdiagnosis or undertreatment, especially in patients with multiple trauma. The incidence of VTD in these patients ranges from 5% to 58% and thromboprophylaxis is considered essential for proper management. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been cited as risk factors for VTD; however, how these factors combine with others to predict high risk is still unclear. The best way to approach VTD prophylaxis in multiple trauma patients is currently unclear. Both mechanical and pharmacologic means are available. The main clinical practice guidelines recommend thromboprophylaxis with low-molecular weight heparin, which can be started 48 hours after trauma, unless patients are still bleeding, in which case mechanical compression is recommended in spite of the limited effectiveness of that measure. Compression is maintained until the risk of hemorrhage has diminished. There is insufficient evidence to support routine use of ultrasound imaging or venography. In patients with head injury who are at risk for intracranial bleeding, the use of low-molecular weight heparin should be delayed until risk disappears but mechanical prophylaxis (compression) can be considered according to clinical status.

  12. Evaluation of the traumatic coma data bank computed tomography classification for severe head injury

    NARCIS (Netherlands)

    Vos, P E; van Voskuilen, A C; Beems, T; Krabbe, P F; Vogels, O J


    This study determines the interrater and intrarater reliability of the Traumatic Coma Data Bank (TCDB) computed tomography (CT) scan classification for severe head injury. This classification grades the severity of the injury as follows: I = normal, II = diffuse injury, III = diffuse injury with swe

  13. Head, Neck, Face, and Shoulder Injuries in Female and Male Rugby Players. (United States)

    Havkins, Sabina B.


    Injuries to 150 players in the Southern California Rugby Football Union were studied in order to compare head, neck, face, and shoulder injury rates for female and male players. While overall rates did not differ significantly, women received fewer disabling injuries. Ways to decrease injuries are recommended. (Author/MT)

  14. The neurobehavioural rating scale: assessment of the behavioural sequelae of head injury by the clinician. (United States)

    Levin, H S; High, W M; Goethe, K E; Sisson, R A; Overall, J E; Rhoades, H M; Eisenberg, H M; Kalisky, Z; Gary, H E


    To investigate the inter-rater reliability and validity of the Neurobehavioural Rating Scale at various stages of recovery after hospitalisation for closed head injury, we studied 101 head trauma patients who had no antecedent neuropsychiatric disorder. The results demonstrated satisfactory inter-rater reliability and showed that the Neurobehavioural Rating Scale reflects both the severity and chronicity of closed head injury. A principal components analysis revealed four factors which were differentially related to severity of head injury and the presence of a frontal lobe mass lesion. Although our findings provide support for utilising clinical ratings of behaviour to investigate sequelae of head injury, extension of this technique to other settings is necessary to evaluate the distinctiveness of the neurobehavioural profile of closed head injury as compared with other aetiologies of brain damage. PMID:3572433

  15. Effect of mild head injury on intelligence in Zahedan, Iran

    Institute of Scientific and Technical Information of China (English)

    Mohammad Hadi Shorooei; Mahdi Sharif-Alhoseini; Soheil Saadat; Arya Sheikh-Mozaffari; Vafa Rahimi-Movaghar


    Objective: To investigate the effects of mild head injury (HI) on the victims' intelligence by measuring their intelligence quotient (IQ).Methods: This cohort study was performed in Khatamol-Anbia Hospital, Zahedan, Iran and the IQs of 30 mild HI patients were measured right after the injury (IQ0) and six months later (IQ6). The IQs of 90 close relatives of the patients were also measured at the same period of time as the non-exposure group. The IQs were measured with Wechsler adult intelligence scale-revised (WAIS-R). The IQ0, IQ6 and their differences (IQ change) were compared in HI patients and their relatives using the Student's t test.Results: The mean IQ0 of the HI patients was similar to their relatives. The IQ6 of HI patients appeared to be less than those of their relatives. Moreover, the IQ6 of the HI patients appeared to be less than their initial scores. HI was associated with more decrease in IQ6 compared with IQ0and the female subjects showed more decrease in IQ6 compared with their IQ0.Conclusion: HI seems to be associated with decrease in IQ six months after the injury and it is more evident in female HI patients.

  16. Demographic Profile and Pathological Patterns of Head Injury in Albania

    Directory of Open Access Journals (Sweden)

    Sabri Hoxha


    Full Text Available Introduction: Head injury (HI is a serious morbid state caused by structural changes of the scalp, skull, and/or its contents, due to mechanical forces. Generally, the most frequent cause of HI is road traffic accident (RTA, followed by homicidal and falling injuries. The aim of present study is to assess epidemiology data, causes and patterns responsible for HI among Albanian subjects. Methodology: All HI cases (1000 are collected by the Forensic Institute of Albania, based on medical and forensic records of traumatized subjects between 2007- 2012. The prospectively-collected and descriptive information is focused on demographic data, responsible factors, type and level of cranial and brain injury, as well as their outcome. Results: The majority of HI victims were male (84% of age range of 15yrs -35yrs (70%. RTA was the HI cause in 88%, followed by homicides (3.8%, falling (3% etc. With respect to injury mechanisms, extra-dural hematoma was found in 93% of cases, followed by cerebral edema (61%, cerebral contusion (37%, skull bone fractures (35%, etc. Severe alteration of the consciousness was observed in 57% of the cases, while amnesia lasted longer than 4 weeks in 44% of the subjects included in our study. Discussion: This survey demonstrates that the majority of HI victims' is young and middle age males target group exposed to RTA. The increase of vehicles' use in placecountry-regionAlbania is more evident than RTA-related HI, indicating that driving newer vehicles with safer technology or helmets use while motorcycling can potentially decline the fatal outcome.

  17. Missile injuries in head — neck and maxillo-facial region — an experience in eastern nepal



    Ballistic injuries to head-neck and maxillofacial region is quite common problem nowadays. Most of the time the injuries seem to be dreadful but the mechanism of the injuries caused by ballistics and the anatomical conditions of maxillofacial and head-neck region mitigate the severity of the injuries. Proper primary management followed by reconstruction and management of associated injuries decreases the mortality and morbidity of missile injuries in head-neck and maxillofacial region. Eleven...

  18. Head injury predictors in sports trauma--a state-of-the-art review. (United States)

    Fernandes, Fábio A O; de Sousa, Ricardo J Alves


    Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds.

  19. Head Injury Secondary to Suspected Child Maltreatment: Results of a Prospective Canadian National Surveillance Program (United States)

    Bennett, Susan; Ward, Michelle; Moreau, Katherine; Fortin, Gilles; King, Jim; MacKay, Morag; Plint, Amy


    Objective: We sought to determine the incidence, clinical features, and demographic profile of head injury secondary to suspected child maltreatment (abuse or neglect) in Canada to help inform the development and evaluation of prevention programs for abusive head injuries. Methods: From March 1, 2005 to February 28, 2008, an average of 2,545…

  20. Chronic post-traumatic headache after mild head injury

    DEFF Research Database (Denmark)

    Kjeldgaard, Dorte; Forchhammer, Hysse; Teasdale, Tom


    to or above the cut-off score for having post-traumatic stress disorder (PTSD) according to the HTQ. In terms of demographics and headache, the groups were comparable except the CPTH group were more often without affiliation to the labour market ( P ...BACKGROUND: The aetiology behind chronic post-traumatic headache (CPTH) after mild head injury is unclear and management is complicated. In order to optimize treatment strategies we aimed to characterize a CPTH population. METHODS: Ninety patients with CPTH and 45 patients with chronic primary...... headaches were enrolled from the Danish Headache Center. All patients were interviewed about demographic and headache data. They completed the Harvard Trauma Questionnaire (HTQ), Rivermead Post Concussion Symptoms Questionnaire, SF-36 and a headache diary. RESULTS: The CPTH group experienced more cognitive...

  1. Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

    Directory of Open Access Journals (Sweden)

    Dara Oliver Kavanagh


    Full Text Available Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

  2. Variations in the presentation of aphasia in patients with closed head injuries.

    LENUS (Irish Health Repository)

    Kavanagh, Dara Oliver


    Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

  3. Why most traumatic brain injuries are not caused by linear acceleration but skull fractures are.

    Directory of Open Access Journals (Sweden)

    Svein eKleiven


    Full Text Available Injury statistics have found the most common accident situation to be an oblique impact. An oblique impact will give rise to both linear and rotational head kinematics. The human brain is most sensitive to rotational motion. The bulk modulus of brain tissue is roughly five to six orders of magnitude larger than the shear modulus so that for a given impact it tends to deform predominantly in shear. This gives a large sensitivity of the strain in the brain to rotational loading and a small sensitivity to linear kinematics. Therefore, rotational kinematics should be a better indicator of traumatic brain injury risk than linear acceleration. To illustrate the difference between radial and oblique impacts, perpendicular impacts through the center of gravity of the head and 45o oblique impacts were simulated. It is obvious that substantially higher strain levels in the brain are obtained for an oblique impact, compared to a corresponding perpendicular one, when impacted into the same padding using an identical impact velocity. It was also clearly illustrated that the radial impact causes substantially higher stresses in the skull with an associated higher risk of skull fractures, and traumatic brain injuries secondary to those.

  4. Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury

    DEFF Research Database (Denmark)

    Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira;


    acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography...... mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P ....1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury....

  5. Epidemiological features of 1 281 patients with head injuries arising from the 2008 Wenchuan earthquake

    Directory of Open Access Journals (Sweden)

    YANG Chao-hua


    Full Text Available 【Abstract】Objective: To analyze the epidemiologi-cal features of patients with head injuries in the 2008 Wenchuan earthquake. Methods: Medical records of patients with head inju-ries who were admitted to 14 hospitals in Deyang, Mianyang and Chengdu cities after the earthquake were retrospec-tively analyzed. The patients’ age, gender, cause of injury, diagnosis, and outcome were analyzed retrospectively. Results: A total of 1 281 patients with 807 males and 474 females were included. According to Glasgow Coma Scale score at admission, 1 029 patients presented with mild injury, 161 moderate injury and 91 severe injury. The major cause of injuries (83% was bruise by collapsed buildings. Open head injuries accounted for 60.8%. A total of 720 pa-tients underwent surgical treatment. Good recovery was achieved in 1 056 patients, moderate disability in 106, se-vere disability in 71, coma in 29 and death in 19. Conclusions: In this series, male patients were more than female patients. The main cause of injury was hit by falling objects due to building collapse. Minor and open craniocerebral injuries were most common. The epidemio-logical features of head injuries in Wenchuan earthquake may be helpful to preparation for future rescue. Key words: Brain injuries; Epidemiology; Earthquakes; Rescue work

  6. Epidemiology of head injury in Malaysian children: a hospital-based study. (United States)

    Rohana, J; Ong, L C; Abu Hassan, A


    A prospective observational study was carried out at the Emergency Department, Hospital Kuala Lumpur to determine the proportion of accidental head injury among children and the circumstances of injury. The study was carried out from November 1993 to January 1994 on all children below 14 years who presented to the Emergency Department with accidental head injury. Accidental head injury made up (4.75%) of all cases seen at the Casualty Department. The ratio of boys to girls was 2:1. The mean age of head injured children was 5.2 (S.D. 3.63) years. The leading cause of head injury was fall (63%) followed by road traffic accidents (RTA) in (30.7%) while the rest were due to 'impact' (injury caused by flying object or missiles) injuries. More than half (54.4%) of those injured in RTA were pedestrians. Pedestrian injury was particularly important in the 5-< 14 years age group, where adult supervision was lacking in two thirds of the children. None of the patients who were involved in vehicle-related injuries had used a suitable protective or restraining device. All three patients who died were from this group. This study emphasises the need for stricter enforcement of laws related to the use of protective devices and measures to decrease child pedestrian injury. The issues of lack of adult supervision, both in and outside the home need to be addressed.

  7. Neck Flexion Induces Larger Deformation of the Brain Than Extension at a Rotational Acceleration, Closed Head Trauma

    Directory of Open Access Journals (Sweden)

    Hans-Arne Hansson


    Full Text Available A closed head trauma induces incompletely characterized temporary movement and deformation of the brain, contributing to the primary traumatic brain injury. We used the pressure patterns recorded with light-operated miniature sensors in anaesthetized adult rabbits exposed to a sagittal plane rotational acceleration of the head, lasting 1 ms, as a measure of brain deformation. Two exposure levels were used and scaled to correspond to force levels reported to cause mild and moderate diffuse injury in an adult man, respectively. Flexion induced transient, strong, extended, and predominantly negative pressures while extension generated a short positive pressure peak followed by a minor negative peak. Low level flexion caused as strong, extended negative pressures as did high level extension. Time differences were demonstrated between the deformation of the cerebrum, brainstem, and cerebellum. Available X-ray and MRI techniques do not have as high time resolution as pressure recordings in demonstrating complex, sequential compression and stretching of the brain during a trauma. The exposure to flexion caused more protracted and extensive deformation of the brain than extension, in agreement with a published histopathological report. The severity and extent of the brain deformation generated at a head trauma thus related to the direction at equal force.

  8. Epidemiological features of 1281 patients with head injuries arising from the 2008 Wenchuan earthquake

    Institute of Scientific and Technical Information of China (English)

    YANG Chao-hua; LI Qiang; LAN Zhi-gang; LIU Jia-gang


    Objective:To analyze the epidemiological features of patients with head injuries in the 2008Wenchuan earthquake.Methods: Medical records of patients with head injuries who were admitted to 14 hospitals in Deyang,Mianyang and Chengdu cities after the earthquake were retrospectively analyzed.The patients' age,gender,cause of injury,diagnosis,and outcome were analyzed retrospectively.Results: A total of 1 281 patients with 807 males and 474 females were included.According to Glasgow Coma Scale score at admission,1 029 patients presented with mild injury,161 moderate injury and 91 severe injury.The major cause of injuries (83%) was bruise by collapsed buildings.Open head injuries accounted for 60.8%.A total of 720 patients underwent surgical treatment.Good recovery was achieved in 1 056 patients,moderate disability in 106,severe disability in 71,coma in 29 and death in 19.Conclusions: In this series,male patients were more than female patients.The main cause of injury was hit by falling objects due to building collapse.Minor and open craniocerebral injuries were most common.The epidemiological features of head injuries in Wenchuan earthquake may be helpful to preparation for future rescue.

  9. Microwave Hematoma Detector for the Rapid Assessment of Head Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Hadded, W.; Chang, J.; Rosenbury, T.; Dallum, G.; Welsch, P.; Scott, D.; Duarte, D.; Acevedo-Bolton, V.


    A non-invasive microwave device for the detection of epi/subdural hemorrhaging (hematoma) is under current development. The final device will be highly portable and allow real time assessment of head injuries, thereby satisfying early detection needs of the field technician as well as providing a tool for repetitious monitoring of high-risk individuals. The device will adopt the advanced technology of micropower impulse radar (MIR) which is a state of the art low cost ultra wide band (UWB) microwave radar developed here at LLNL. It will consist of a MIR transmitting and receiving module, a computer based signal processing module, and a device-to-patient signal coupling module--the UWB antenna. The prototype design is being guided by the needs of the patient and the practitioner along with the prerequisites of the technology including issues such as the specificity of the device, efficacy of diagnosis, accuracy, robustness, and patient comfort. The prototype development follows a concurrent approach which .includes experiments designed to evaluate requirements of the radar and antenna design, phantom development to facilitate laboratory investigations, and investigation into the limits of adapting pre-existing non-medical MIR devices to medical applications. This report will present the accomplishments and project highlights to date in the fiscal year 1999. Future project projections will also be discussed.

  10. Curative effect of wilsonii injecta on severe head injury

    Institute of Scientific and Technical Information of China (English)

    陈礼刚; 曾凡俊; 杨立斌; 柴建康; 李开慧; 卢敏; 匡永勤


    Objective: To study the curative effect of wilsoniiinjecta on severe head injury (SHI).Methods: A total of 120 patients with SHI weredivided randomly into 2 groups, the patients treated withconventional methods as Group A (n = 60) and the patientstreated with wilsonii injecta as Group B (n = 60). Thechanges of neural function indexes were evaluated withGlasgow Coma Scale (GCS) before treatment and withGlasgow Outcome Scale ( GOS ) after treatment,simultaneously, the paramneters of hemorrheological indexes(HI), brain electrical activity map ( BEAM ) andtranscranial Doppler sonography (TCD) were observedbefore and after treatment.Results: In Group B, the clinical GCS, the HI, theBEAM and the prognosis GOS were improved much morethan those in Group A. And the TCD parameters in GroupB decreased, which had significant difference comparedwith that in Group A (P <0.01).Conclusions: Wilsonii injecta can rapidly improve theinjured persons' conscious states, the abnormal BEAM and the surviving quality. It suggests that the improvement of the HI is related to the relief of the vasospasm of thearterial blood vessels in the brain, which may be one of theimportant mechanisms of wilsonii injecta in improving theprognosis.

  11. Cognitive dysfunction in young men following head injury in childhood and adolescence: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W


    OBJECTIVES: To examine the prevalence of cognitive dysfunction among young men who had suffered a head injury during childhood or adolescence, in particular focusing upon the effects of age and the severity of the injury. METHODS: By cross linkage of Danish national registers for hospital.......0, irrespective of age at injury. For cases of two concussions, all odds ratios were > 1.4 but were not significant for all age groupings. CONCLUSIONS: For milder forms of single head injury before age 12 there is no evidence of enduring cognitive dysfunction. The apparent effect at later ages may reflect...

  12. Conventional vs accelerated fractionation in head and neck cancer.



    From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range ...

  13. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients

    Directory of Open Access Journals (Sweden)

    Usman Tariq Siddiqui


    Conclusions: In patients with severe TBI, ET decreases total days of ventilation and ICU stay, and is associated with a decrease in the frequency of VAP. ET should be considered in severe head injury patients requiring prolong ventilatory support.

  14. A case of organic brain syndrome following head injury successfully treated with carbamazepine. (United States)

    Bouvy, P F; van de Wetering, B J; Meerwaldt, J D; Bruijn, J B


    A case of organic brain syndrome occurring in relation to psychological stress 2 years after a severe head injury is described. Treatment with haloperidol resulted only in slight improvement. A dramatic improvement was achieved with carbamazepine.

  15. Cerebral Salt Wasting Syndrome following Head Injury in a Child Managed Successfully with Fludrocortisone

    Directory of Open Access Journals (Sweden)

    Nagendra Chaudhary


    Full Text Available Cerebral salt wasting (CSW syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone (SIADH. Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions. Fludrocortisone can help in managing CSW where alone saline infusion does not work. We report a 17-month-old female child with head injury managed successfully with saline infusion and fludrocortisone.

  16. Cerebral Salt Wasting Syndrome following Head Injury in a Child Managed Successfully with Fludrocortisone. (United States)

    Chaudhary, Nagendra; Pathak, Santosh; Gupta, Murli Manohar; Agrawal, Nikhil


    Cerebral salt wasting (CSW) syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone (SIADH). Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions. Fludrocortisone can help in managing CSW where alone saline infusion does not work. We report a 17-month-old female child with head injury managed successfully with saline infusion and fludrocortisone.

  17. Pseudoaneurysm of the occipital artery: an unusual cause of persisting headache after minor head injury.

    LENUS (Irish Health Repository)

    Aquilina, K


    Post-traumatic pseudoaneurysms of the extracranial arteries in the scalp are uncommon sequelae of head injury. We report on a patient who presented four weeks after a minor head injury with a tender, pulsating and enlarging mass in the course of the left occipital artery. There was associated headache radiating to the vertex. Computed tomographic angiography confirmed the lesion to be a pseudoaneurysm of the occipital artery. The lump was resected with complete resolution of symptoms.

  18. S-100B and neuron specific enolase in outcome prediction of severe head injury

    Institute of Scientific and Technical Information of China (English)

    李宁; 沈建康; 赵卫国; 蔡瑜; 李云峰; 詹世坤


    Objective: To elucidate the role of S-100B and neuron specific enolase (NSE) in predicting the outcomes of patients with severe head injury.Methods: Forty patients with severe head injury were included in this study. The serum concentrations of S-100B and NSE were measured within 12 hours after head injury to investigate the correlation between serum levels of S-100B and NSE and outcome. Validity of both S-100B and NSE in outcome prediction was assessed with Receiver Operator Characteristic (ROC) curve.Results: The serum concentrations of S-100B and NSE of both groups, with favorable or unfavorable outcomes, were significantly higher than those of the normal group. The serum concentrations within 12 hours after head injury were closely correlated with the prognosis. Furthermore, according to the ROC curves of 100B and NSE, S-100B was found better in predicting outcomes than NSE.Conclusions: S-100B and NSE may play important roles in outcome prediction after severe head injury.Moreover, S-100B is clearly superior to NSE in terms of predictive value and appears to be a more promising serum marker in outcome prediction after severe head injury.

  19. Characteristics of Syntactic Comprehension Deficits Following Closed Head Injury versus Left Cerebrovascular Accident. (United States)

    Butler-Hinz, Susan; And Others


    Two studies examined the ability to assign thematic roles and to coindex referentially dependent noun phrases in closed head injured adults (N=20), adult stroke patients (N=20), and normal adults (N=20). Results suggested that syntactic comprehension disturbances are similar following left cerebral hemisphere infarction and closed head injury.…

  20. Forensic medical study on morphology and formative mechanism of blunt head injury

    Directory of Open Access Journals (Sweden)

    LI Hong-wei


    Full Text Available 【Abstract】 Objective: To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise. Methods: The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries. Results: Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%, followed by suicide (49, 24.3% and accident (44, 21.8%. The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants. Conclusion: Studies on the morphology and its forma-tive rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury. Key words: Brain; Head injuries, closed; Cranioce-rebral trauma; Forensic medicine

  1. Perfusion Computed Tomography in the Acute Phase of Mild Head Injury : Regional Dysfunction and Prognostic Value

    NARCIS (Netherlands)

    Metting, Zwany; Rodiger, Lars A.; Stewart, Roy E.; Oudkerk, Matthijs; De Keyser, Jacques; van der Naalt, Joukje


    Objective: Traumatic brain injury is a major Cause of disability and death. Most patients sustain a mild head injury with a subgroup that experiences disabling symptoms interfering with return to work. Brain imaging in the acute phase is not predictive of outcome, as 20% of noncontrast computed tomo

  2. Computerised tomography after recent severe head injury in patients without acute intracranial haematoma

    NARCIS (Netherlands)

    Snoek, Jos; Jennett, Bryan


    Sixty patients with severe head injury who did not have an acute intracranial haematoma on CAT scanning are reviewed. The scans are correlated with the level of consciousness at the time of scanning and with the outcome six months after injury. The initial scan was interpreted as being normal in 38%

  3. Chronic Post-Traumatic Headache after Head Injury in Children and Adolescents (United States)

    Kirk, Charlotte; Nagiub, George; Abu-Arafeh, Ishaq


    This was a prospective, observational study of children aged 3 to 15 years admitted to hospital with head injury (HI). Demographic data and information on the nature of the HI, and history of premorbid headache were collected. A structured telephone questionnaire was used to interview parents and children 2 months after injury and at 4-monthly…

  4. Head linear and rotational accelerations and craniocervical loads in lateral impact

    NARCIS (Netherlands)

    Yoganandan, N.; Pintar, F.A.; Maiman, D.; Phillippens, M.M.G.M.; Wismans, J.S.H.M.


    The objective of the study was to determine lateral impact-induced three-dimensional temporal head center of gravity linear and angular accelerations, and craniocervical forces and moments from post mortem human subject (PMHS) sled tests and compare with the European side impact dummy, ES-II, respon

  5. Hyperfractionated accelerated radiochemotherapy (HFA-RCT) with mitomycin C for advanced head and neck cancer

    NARCIS (Netherlands)

    Widder, J; Dobrowsky, W; Schmid, R; Pokrajac, B; Selzer, E; Potter, R


    To investigate efficacy and feasibility of hyperfractionated accelerated radiotherapy combined with mitomycin C, patients with locally advanced unresectable squamous cell carcinomas of the head and neck region were administered 64-66 Gy in four weeks and mitomycin C (20 mg/m(2)) on day five. Twenty-

  6. Continuous hyperfractionated accelerated radiotherapy with/without mitomycin C in head and neck cancer

    NARCIS (Netherlands)

    Dobrowsky, W; Naude, J; Widder, J; Dobrowsky, E; Millesi, W; Pavelka, R; Grasl, C; Reichel, M


    Purpose: To evaluate the effect of mitomycin C to an accelerated hyperfractionated radiation therapy. The aim was to test a very short schedule with/without mitomycin C (MMC) with conventional fractionation in histologically verified squamous cell carinoma of the head and neck region. Methods and Ma

  7. The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia. (United States)

    Walter, Scott R; Olivier, Jake; Churches, Tim; Grzebieta, Raphael


    The study aimed to assess the effect of compulsory cycle helmet legislation on cyclist head injuries given the ongoing debate in Australia as to the efficacy of this measure at a population level. We used hospital admissions data from New South Wales, Australia, from a 36 month period centred at the time legislation came into effect. Negative binomial regression of hospital admission counts of head and limb injuries to cyclists were performed to identify differential changes in head and limb injury rates at the time of legislation. Interaction terms were included to allow different trends between injury types and pre- and post-law time periods. To avoid the issue of lack of cyclist exposure data, we assumed equal exposures between head and limb injuries which allowed an arbitrary proxy exposure to be used in the model. As a comparison, analyses were also performed for pedestrian data to identify which of the observed effects were specific to cyclists. In general, the models identified a decreasing trend in injury rates prior to legislation, an increasing trend thereafter and a drop in rates at the time legislation was enacted, all of which were thought to represent background effects in transport safety. Head injury rates decreased significantly more than limb injury rates at the time of legislation among cyclists but not among pedestrians. This additional benefit was attributed to compulsory helmet legislation. Despite numerous data limitations, we identified evidence of a positive effect of compulsory cycle helmet legislation on cyclist head injuries at a population level such that repealing the law cannot be justified.

  8. Capabilities of Helmets for Preventing Head Injuries Induced by Ballistic Impacts

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    D.V. Balandin


    Full Text Available The limiting performance of ballistically loaded helmets designed to reduce head injuries is studied analytically. The projectile does not penetrate the helmet. This analysis evaluates the absolute minimum of the peak displacement of the helmet shell relative to the head, provided that criteria measuring the severity of head injuries lie within prescribed limits. Rather than optimize a specific design configuration, e.g. a viscoelastic foam liner, characteristics of a time-dependent force representing the helmet liner are calculated. The formulation reduces the limiting performance analysis to an optimal control problem.

  9. Resultant linear acceleration of an instrumented head form does not differ between junior and collegiate taekwondo athletes’ kicks

    Institute of Scientific and Technical Information of China (English)

    David O’Sullivan; Gabriel P. Fife; Willy Pieter; Taehee Lim; Insik Shin


    Objective: The purpose of this study was to compare the effects of various taekwondo kicks and age (school level) in absolute terms and relative body mass on the resultant linear acceleration (RLA) of an instrumented head form. Methods: Forty-eight male (middle school: 16; high school: 16; university: 16) taekwondo athletes were recruited for this study. Subjects performed 10 turning, 10 jump spinning hook, and 10 jump back kicks on a Hybrid II head mounted on a height-adjustable frame. Results: A 2-way (School × Kick) MANOVA was used to determine the differences in RLA between schools (age groups) by type of kick. There was no univariate School main effect for absolute RLA (η2=0.06) and RLA relative to body mass (η2=0.06). No univariate Kick main effects were found for absolute (η2=0.06) and relative RLA (η2=0.06). Conclusion: It is of concern that RLA did not significantly differ between school levels, implying that young taekwondo athletes generate similar forces to their adult counterparts, possibly exposing young athletes to an increased risk for head injuries.

  10. Severe head injuries and intracranial pressure monitoring outcome in Southern Iran

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    Majid Reza Farrokhi


    Full Text Available BACKGROUND: Head injury is still a major cause of death and disability. Despite advances in intensive monitoring and clinical practice, little data is available to show the predictive value of intracranial pressure monitoring in assessment of the outcome of head injuries. This study was undertaken to evaluate this predictive value and is the first Iranian study in which ICP monitoring has been included. METHODS: In a prospective study from September 1999 to September 2003, all head- injured patients (53 patients with GCS of 4-8 who were admitted to Nemazee Hospital of Shiraz University of Medical Sciences were included in this study. Subarachnoid screw method or ventricular catheter via ventriculostomy was used to determine intracranial pressure. Patients were monitored for 3 days and were followed for two years at 6-month intervals. RESULTS: Car accidents were the most common cause of head injury (43.3% and 43.3% of patients had GCS of 8. Sixty percent of patients had abnormal intracranial pressure. The patients were most commonly in their first decade of life (18.8% and 81% of patients were male. Controlling increased intracranial pressure was successful in 60% of patients and resulted in a decrease of mortality rate from 60% to 15%. CONCLUSIONS: Early treatment of increased intracranial pressure in head injury patients would be beneficial in reducing mortality and morbidity rates. KEY WORDS: Southern Iran, head injury, outcome, intracranial pressure.

  11. Pattern of head injuries in Malta (EU): a small Mediterranean island. (United States)

    Agius, Shawn; Ansari, Sohail; Zrinzo, Antoine


    We have reviewed all acute neurosurgical admissions between December 2007 and December 2009. Hundred and nine (46.6%) of our admissions were head injuries. A subdural haematoma(SDH) was found in 51.4%(56) of the head injuries. Of these, 50/56 presented with a Glasgow Coma Scale(GCS) of 14 to 15, 41.1% (23) of these SDH needed surgery. The commonest mode of injury was falls [67.9%(74) of head injuries]. Risk factors for falls are co-morbidities which are particular to an elderly population, these include osteoarthritis and audio/ visual impairment. Falls are more common in rural areas where elderly are more likely to feel comfortable to walk and sustain trivial falls resulting in chronic subdural heamatomas.

  12. Tau hyperphosphorylation in apolipoprotein E-deficient and control mice after closed head injury. (United States)

    Genis, L; Chen, Y; Shohami, E; Michaelson, D M


    Apolipoprotein E (apoE)-deficient mice have learning and memory impairments that are associated with specific neurochemical changes and hyperphosphorylation of distinct epitopes of the cytoskeletal protein tau. Furthermore, such mice are highly susceptible to the sequelae of brain trauma and their ability to recover from head injury is impaired. In the present study we investigated the extent that the neuronal maintenance and repair impairments of apoE-deficient mice are related to aberrations at the tau phosphorylation level. This was pursued by subjecting control and apoE-deficient mice to closed head injury (CHI) and examination, utilizing immunoblot assays, of the resulting effects on tau phosphorylation. The results thus obtained revealed that tau of apoE-deficient mice is hyperphosphorylated before CHI and that this insult results in transient tau hyperphosphorylation, whose extent and time course in the two mouse groups varied markedly. Tau hyperphosphorylation in the injured controls was maximal by about 4 hr after injury and reverted to basal levels by 24 hr. In contrast, almost no head injury-induced tau hyperphosphorylation was observed in the apoE-deficient mice at 4 hr after injury. Some tau hyper-phosphorylation was detected in the head-injured apoE-deficient mice after longer time intervals, but its extent was markedly lower than the maximal values obtained in the head injured controls. These findings show that the chronic neuronal impairments brought about by apoE deficiency and the acute response to head injury are both associated with hyperphosphorylation of the same tau domain and that the ability of apoE-deficient mice to mount the acute tau hyperphosphorylation response to head injury is impaired.

  13. Acceleration-caused injury of the cervical spine. Whiplash injury; Beschleunigungsverletzung der Halswirbelsaeule. HWS-Schleudertrauma

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    Wedig, Hans-Dieter (eds.) [Kanzlei Dr. W.G. Schmidt, Sonthofen (Germany); Graf, Michael; Grill, Christian


    Acceleration injuries of the cervical spine are mostly caused by car accidents. Due to the high traffic density and the increasing number of car accidents with personal injuries the number of concerned persons is also increasing. A large percentage of injured persons suffer ongoing troubles following ineffective therapy trials up to occupational disability. Therefore the whiplash injury is a significant medical and legal problem. The book includes contributions of international experts on the latest state of research and the actual knowledge on the controversial discussed field. An interdisciplinary forum discusses medical, injury-mechanical, consultant-related and legal questions and therapeutic approaches that might be successful. [German] Beschleunigungsverletzungen der Halswirbelsaeule treten ueberwiegend nach Autounfaellen auf. Aufgrund der hohen Verkehrsdichte und der steigenden Anzahl an Verkehrsunfaellen mit Personenschaeden steigt auch die Zahl der Betroffenen stetig an. Einer grossen Zahl von Unfallgeschaedigten, die nach kurzer Zeit beschwerdefrei leben koennen, steht leider eine wachsende Zahl von Betroffenen mit anhaltenden Beschwerden, erfolglosen Therapieversuchen bis hin zur Berufsunfaehigkeit gegenueber. Das 'HWS-Schleudertrauma' stellt nach wie vor ein erhebliches medizinisches und rechtliches Problem dar. In diesem Buch beschreiben international ausgewiesene Experten den neuesten Forschungsstand, das aktuelle Wissen und die Lehrmeinungen auf diesem kontrovers diskutierten und komplexen Gebiet. In einem interdisziplinaeren Ansatz werden medizinische, verletzungsmechanische, gutachterliche und gerichtliche Fragestellungen diskutiert und Erfolg versprechende Therapieansaetze eroertert. Aerzte, Juristen, Versicherungen und Betroffene werden in einen gemeinsamen Dialog gebracht, mit dem Ziel, konstruktive Loesungen zu erarbeiten. Eine praktische Arbeitshilfe - das Buch fuer alle, die mit dieser Problematik befasst sind. (orig.)

  14. Head Injuries in School-Age Children Who Play Golf (United States)

    Reuter-Rice, Karin; Krebs, Madelyn; Eads, Julia K.


    Traumatic brain injury (TBI) is the leading cause of death and disability in children. We conducted a prospective study, which examined injury characteristics and outcomes of school-age children of 5.0-15.0 years (N = 10) who were admitted to hospital for a TBI. This study evaluated the role of age, gender, the Glasgow Coma Scale, mechanisms and…

  15. Cognitive contributions to theory of mind ability in children with a traumatic head injury. (United States)

    Levy, Naomi Kahana; Milgram, Noach


    The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7-13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other's characteristics based on motive and outcome, Raven's Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children - Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other's thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.

  16. A Heading and Flight-Path Angle Control of Aircraft Based on Required Acceleration Vector (United States)

    Yoshitani, Naoharu

    This paper describes a control of heading and flight-path angles of aircraft to time-varying command angles. The controller first calculates an acceleration command vector (acV), which is vertical to the velocity vector. acV consists of two components; the one is feedforward acceleration obtained from the rates of command angles, and the other is feedback acceleration obtained from angle deviations by using PID control law. A bank angle command around the velocity vector and commands of pitch and yaw rates are then obtained to generate the required acceleration. A roll rate command is calculated from bank angle deviation. Roll, pitch and yaw rate commands are put into the attitude controller, which can be composed of any suitable control laws such as PID control. The control requires neither aerodynamic coefficients nor online calculation of the inverse dynamics of the aircraft. A numerical simulation illustrates the effects of the control.

  17. Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury.

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    Christian Gunge Riberholt

    Full Text Available Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001. Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.

  18. ‘Studying Injured Minds’ - The Vietnam Head Injury Study and 40 years of brain injury research

    Directory of Open Access Journals (Sweden)

    Vanessa eRaymont


    Full Text Available The study of those who have sustained traumatic brain injuries (TBI during military conflicts has greatly facilitated research in the fields of neuropsychology, neurosurgery, psychiatry, neurology and neuroimaging. The Vietnam Head Injury Study (VHIS is a prospective, long-term follow-up study of a cohort of 1,221 Vietnam veterans with mostly penetrating brain injuries, which has stretched over more than 40 years. The scope of this study, both in terms of the types of injury and fields of examination, has been extremely broad. It has been instrumental in extending the field of TBI research and in exposing pressing medical and social issues that affect those who suffer such injuries. This review summarizes the history of conflict-related TBI research and the VHIS to date, as well as the vast range of important findings the VHIS has established.

  19. Cerebral sinodural thrombosis following minor head injury in children. (United States)

    Pikis, Stylianos; Moscovici, Samuel; Itshayek, Eyal; Cohen, José E


    Cerebral sinodural thrombosis (CSDT) is a rare complication of minor head trauma in children. Despite recommendations, anticoagulation is frequently withheld. We aimed to evaluate the etiology, clinical presentation, risk factors, diagnosis, treatment, and outcome of pediatric CSDT following minor head trauma, and specifically to evaluate factors associated with anticoagulation use following minor head trauma in pediatric patients with CSDT. A literature search from 1990 to 2012 identified manuscripts discussing epidemiology, risk factors, clinical presentation, management, and outcome in pediatric patients with CSDT subsequent to minor head trauma. One pediatric patient diagnosed with CSDT following minor head trauma in our institution was also included in the study. There were 18 pediatric patients with CSDT following minor trauma, including the current patient. Mean patient age was 7.8years (range 23months-15years). There was a strong female predominance (2.4:1). Vomiting and headache were the most common symptoms. Five patients had pre-existing risk factors (gastroenteritis, protein S deficiency, estroprogestenic medication, elevated antiphospholipid antibodies, malnutrition). Anticoagulation was administered to six patients with additional risk factors, severe symptoms, or deterioration. There was no mortality, 12 patients recovered fully, and four patients improved with residual symptoms. One patient required lumboperitoneal shunt placement. Pediatric CSDT is a rare complication of minor head trauma, with variable presentation. Anticoagulation has generally been reserved for patients suffering from severe symptoms, for those who deteriorate neurologically during observation, and for those who suffer from a concomitant prothrombotic disorder.

  20. [Penetrating head and brain injuries with nonmetal foreign bodies]. (United States)

    Potapov, A A; Okhlopkov, V A; Latyshev, Ya A; Serova, N K; Eolchiyan, S A


    Penetrating brain injuries (PBI) are common in neurosurgical practice. Most of them are civil or war-time missile and blast injuries. This type of trauma is widely presented in neurosurgical publication, textbooks and clinical evidence-based guidelines. At the same time, PBI by non-metallic foreign bodies are very rare. All the data are limited to case reports and small series of cases. Moreover, there are no clinical consideration on diagnosis, treatment, complication, outcome and prognosis of PBI by non-metallic penetrating brain injuries. In this review all the data are summarized to provide recommendations on the diagnosis and treatment of PBI by non-metallic foreign bodies.

  1. Forensic medical study on morphology and formative mechanism of blunt head injury

    Institute of Scientific and Technical Information of China (English)

    LI Hong-wei; CHANG Hong-fa; YU Yong-min; DAI Guo-xin; YIN Zhi-yong


    Objective:To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise.Methods:The statistical analysis was done in terms of gender,age,as well as the nature,pattern,location,and feature of the injuries.Results:Among the 202 cases of head injury-induced death,124 were male and 78 female with the age ranging from 1-81 years.Death caused by homicide was dominant (106,52.5%),followed by suicide (49,24.3%) and accident (44,21.8%).The majority of suicide-induced death were by falling from height,and traffic crash was responsible for majority of unexpected death cases.The morphology and pathogenesis of the injuries varied according to differences on the mode,magnitude,and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants.Conclusion:Studies on the morphology and its formative rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury.

  2. Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss

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    Brors, D. [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Schaefers, M. [Dept. of Neurology, University Hospital Wuerzburg (Germany); Schick, B.; Draf, W. [Dept. of Ear, Nose and Throat Diseases, Head, Neck and Facial Plastic Surgery, Klinikum Fulda (Germany); Dazert, S. [Univ. Hospital Wuerzburg (Germany). Dept. of Oto-Rhino-Laryngology, Head- and Neck-Surgery; Kahle, G. [Department of Radiology, Hospital Fulda (Germany)


    Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible. (orig.)

  3. [Intracranial occlusion of the internal carotid artery after minor closed head injury]. (United States)

    Nakashima, S; Tomokiyo, M; Koga, H; Furukawa, Y; Nomura, S; Shimokawa, S; Nakagawa, S; Anegawa, S; Hayashi, T


    Thrombosis of the extracranial portion of the internal carotid artery as a result of nonpenetrating head and neck injury is not uncommon. However, intracranial occlusion of the internal carotid artery after minor head and neck injury without skull fracture is rare. We report a case of 14-year-old male who suffered a minor head injury during an athletic meeting of his school and developed a right hemiparesis and a lethargy state resulting from thrombosis of the supraclinoid portion of the left internal carotid artery. On admission, skull films and a CT scan revealed no abnormality. One hour later, he fully recovered. One day later, no definite lesions were detected on T1-weighted and T2-weighted image of MRI, but an abnormal high signal lesion in the left frontal lobe was detected on diffusion-weighted image of MRI. On additional MR angiography, intracranial occlusion of the internal carotid artery due to dissection was demonstrated.

  4. Resultant linear acceleration of an instrumented head form does not differ between junior and collegiate taekwondo athletes' kicks

    Directory of Open Access Journals (Sweden)

    David O'Sullivan


    Conclusion: It is of concern that RLA did not significantly differ between school levels, implying that young taekwondo athletes generate similar forces to their adult counterparts, possibly exposing young athletes to an increased risk for head injuries.

  5. Epidemiologic features of lethal head injury caused by highway traffic accidents

    Institute of Scientific and Technical Information of China (English)


    Objective:To study the epidemiologic features of highway traffic accidents by analyzing the clinical data of the patients died of head injury.Methods:The reatures of the cases' age,occupation,status of head injury and complications.and the rescue procedures were retrospectively analyzed based on the data of 214 patients died of head injury.Results:The main victime were adults(78%)and peasants(52.8%).And the ost common head injuries were severe cerebral contusion with intracranial hematomas(73.4%).The mean arrival time from the accident spots to hospitals was(2.2±1.9)h.And the mean interval time between the arrival and operation was(1.9±0.9)h.Primary and secondary brainstem damage were the main causes of early death.Yet pulmonary infection and multiple organs failure were the common reasons for late death.Conclusions:Enhancing the propaganda for traffic regulations,establishing perfect pre-hospital and in-hospital EMS(emergency medical service)system,catching the opportunity of operation,and preventing complications are essential to reduce the mortality of traffic accidents induced head trauma.

  6. Traumatic pneumorrachis after isolated closed head injuries: An up-to-date review. (United States)

    Hadjigeorgiou, Georgios F; Singh, Ranjodh; Stefanopoulos, Panagiotis; Petsanas, Adamantios; Hadjigeorgiou, Fivos G; Fountas, Kostas


    Pneumorrachis (PR) is characterized by the presence of air within the spinal canal. It can be classified descriptively into internal or intradural and external or epidural. The causes of PR can be divided as iatrogenic, nontraumatic and traumatic. In the present study, a comprehensive literature search was conducted to identify all previous cases of PR after an isolate head injury. Two additional cases were also reported. We concluded, that PR after isolated head injuries is a rare but likely an underdiagnosed entity. It is a marker of severe injury and the majority of such patients have a poor outcome. Although, PR is usually asymptomatic and reabsorbs spontaneously, prompt recognition and management of the underlying cause is essential. Therefore, clinicians should maintain a high level of suspicion for serious underlying injury in cases where initial radiological imaging reveals intraspinal air.

  7. Efficacy of Family Intervention in Acquired Head-Injury Cases in India

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    Mysore Narasimha Vranda


    Full Text Available Purpose: In India, there are few studies on interventions for families of persons with acquired or traumatic brain injuries. This study aimed to test the efficacy of the Family Intervention Package (FIP with caregivers of persons with head injuries.Method: The study was carried out at the Neuro-Surgery Department of the National Institute for Mental Health and Neuro Sciences (NIMHANS, Bangalore, India. Ninety persons with severe head injuries and their caregivers were included in the study using the socio-demographic schedule and family interaction pattern scale.Results: The findings revealed that the Family Intervention Package (FIP was effective in bringing about changes in the functioning of persons with head injuries, and interactions among their families in the experimental group, as compared to the control group.Conclusion: The multi-disciplinary team dealing with persons with head injury need to recognise the importance of multi-component FIP for this group and their families. The current FIP should be made a part of treatment in clinical settings.doi: 10.5463/dcid.v23i3.120

  8. Deep intracerebral (basal ganglia) haematomas in fatal non-missile head injury in man.


    Adams, J H; Doyle, D.; Graham, D I; Lawrence, A E; McLellan, D R


    Deep intracerebral (basal ganglia) haematomas were found post mortem in 63 of 635 fatal non-missile head injuries. In patients with a basal ganglia haematoma, contusions were more severe, there was a reduced incidence of a lucid interval, and there was an increased incidence of road traffic accidents, gliding contusions and diffuse axonal injury than in patients without this type of haematoma. Intracranial haematoma is usually thought to be a secondary event, that is a complication of the ori...

  9. Acute cervical spinal subdural hematoma not related to head injury. (United States)

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won


    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  10. Spasm of the near reflex associated with head injury. (United States)

    Knapp, Christopher; Sachdev, Arun; Gottlob, Irene


    Spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.

  11. Deficits of attention after closed-head injury : Slowness only?

    NARCIS (Netherlands)

    Spikman, JM; vanZomeren, AH; Deelman, BG


    The performance of a group of 60 severely closed-head-injured patients in the subacute stage of recovery on a series of tests addressing focused, divided, and sustained attention, and supervisory attentional control was compared to the performance of a matched group of 60 healthy controls. Patients

  12. A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency

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    Igor Khalin


    Full Text Available Traumatic brain injury (TBI is a leading cause of death and disability in individuals worldwide. Producing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.

  13. Accelerated Life Structural Benchmark Testing for a Stirling Convertor Heater Head (United States)

    Krause, David L.; Kantzos, Pete T.


    For proposed long-duration NASA Space Science missions, the Department of Energy, Lockheed Martin, Infinia Corporation, and NASA Glenn Research Center are developing a high-efficiency, 110 W Stirling Radioisotope Generator (SRG110). A structurally significant limit state for the SRG110 heater head component is creep deformation induced at high material temperature and low stress level. Conventional investigations of creep behavior adequately rely on experimental results from uniaxial creep specimens, and a wealth of creep data is available for the Inconel 718 material of construction. However, the specified atypical thin heater head material is fine-grained with a heat treatment that limits precipitate growth, and little creep property data for this microstructure is available in the literature. In addition, the geometry and loading conditions apply a multiaxial stress state on the component, far from the conditions of uniaxial testing. For these reasons, an extensive experimental investigation is ongoing to aid in accurately assessing the durability of the SRG110 heater head. This investigation supplements uniaxial creep testing with pneumatic testing of heater head-like pressure vessels at design temperature with stress levels ranging from approximately the design stress to several times that. This paper presents experimental results, post-test microstructural analyses, and conclusions for four higher-stress, accelerated life tests. Analysts are using these results to calibrate deterministic and probabilistic analytical creep models of the SRG110 heater head.

  14. Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture.

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    Joseph Jonathan Lee

    Full Text Available OBJECTIVES: To determine the predictive value and sensitivity of demographic features and injuries (indicators for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture. METHODS: STUDY DESIGN: Population-based, cross sectional study. SETTING: NHS hospitals in England. SUBJECTS: Children under five years old admitted acutely to hospital with head or neck injury or fracture. DATA SOURCE: Hospital Episodes Statistics, 1997 to 2009. MAIN OUTCOME MEASURE: Maltreatment-related injury admissions, defined by ICD10 codes, were used to calculate for each indicator (demographic feature and/or type of injury: i the predictive value (proportion of injury admissions that were maltreatment-related; ii sensitivity (proportion of all maltreatment-related injury admissions with the indicator. RESULTS: Of 260,294 childhood admissions for fracture or head or neck injury, 3.2% (8,337 were maltreatment-related. With increasing age of the child, the predictive value for maltreatment-related injury declined but sensitivity increased. Half of the maltreatment-related admissions occurred in children older than one year, and 63% occurred in children with head injuries without fractures or intracranial injury. CONCLUSIONS: Highly predictive injuries accounted for very few maltreatment-related admissions. Protocols that focus on high-risk injuries may miss the majority of maltreated children.

  15. Nuclear Medicine Imaging in Concussive Head Injuries in Sports

    NARCIS (Netherlands)

    Vállez Garcia, David; Otte, Andreas; Glaudemans, Andor WJM; Dierckx, Rudi AJO; Gielen, Jan LMA; Zwerver, Johannes


    Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American

  16. Head Injury by Pneumatic Nail Gun: A Case Report. (United States)

    Kim, Tae Woo; Shim, Yu Shik; Oh, Se Yang; Hyun, Dong Keun; Park, Hyeon Seon; Kim, Eun Young


    A 56-year-old man had five nail gun-shots on his skull due to attempted suicide and was transferred to the emergency room. Because the nail head played a role as a brake, the launched nail made a hole in the skull but did not entirely pass through it. If major artery or sinuses are not involved, cautious retrieval after a small scalp incision can be performed and prophylactic antibiotics be administered for treatment.

  17. Field Marshal Erwin Rommel: the head injury that may have prolonged the Second World War. (United States)

    Fuhrman, Heather A; Mullin, Jeffrey P; Sloffer, Chris A


    War-related head injury, indeed neurological injury in general, has been a part of the history of humankind for as long as there has been warfare. Such injuries can result in the removal of the individual from combat, thus eliminating any subsequent contribution that he or she might have made to the battle. However, at times, the injuries can have more wide-reaching effects. In the case of commanders or leaders, the impact of their injuries may include the loss of their influence, planning, and leadership, and thus have a disproportionate effect on the battle, or indeed the war. Field Marshal Erwin Rommel was a talented military strategist and leader who was respected by friends and foes alike. He held an honored reputation by the German people and the military leadership. His head injury on July 17, 1944, resulted in his being removed from the field of battle in northern France, but also meant that he was not able to lend his stature to the assassination attempt of Adolph Hitler on July 20. It is possible that, had he been able to lend his stature to the events, Hitler's hold on the nation's government might have been loosened, and the war might have been brought to an end a year earlier. The authors review Rommel's career, his injury, the subsequent medical treatment, and his subsequent death.

  18. An Occupational Therapy Work Skills Assessment for Individuals with Head Injury. (United States)

    Chappell, Irene; Higham, Julie; McLean, Alison M.


    Describes an occupational therapy skills assessment protocol developed and used to evaluate physical, cognitive, and behavioral abilities for persons seeking to return to work following head injuries. It measures them within the framework of productivity, interpersonal skills, and safety. (Contains 48 references.) (Author/JOW)

  19. Prediction of outcome in mild to moderate head injury : A review

    NARCIS (Netherlands)

    van der Naalt, J


    This paper reviews the functional outcome of patients sustaining mild and moderate head injury (HI). Discrepancies across studies in the definition of minor, mild, and moderate HI are discussed in terms of hindering the interpretation of recovery. The predictive value of acute severity indices, neur


    NARCIS (Netherlands)



    Based upon a review of the literature, a theory is developed that in whiplash injury the primary mechanism of the trauma is not hyperretroflexion but hypertranslation of the head backwards. Thus a hyperanteflexion (not hyperretroflexion) of the upper cervical spine, probably especially of the atlant

  1. A mathematical outcome prediction model in severe head injury : a pilot study.

    Directory of Open Access Journals (Sweden)

    Mukherjee K


    Full Text Available 103 patients of head injury, with a Glasgow coma scale (GCS score of 8 or less, were studied prospectively. GCS score, brain stem reflexes, motor score, reaction level scale, and Glasgow Liege scale were evaluated as prognostic variables. Linear logistic regression analysis was used to obtain coefficients of these variables and mathematical formulae developed to predict outcome in individual patients.

  2. Divided attention years after severe closed head injury : The effect of dependencies between the subtasks

    NARCIS (Netherlands)

    Brouwer, W; Verzendaal, M; van der Naalt, J; Smit, J; van Zomeren, E


    Lesions of white matter which connects distant brain areas are characteristic for closed head injury (CHI). It was predicted that this impairs divided attention only if dependent subtasks are used which require communication between corresponding brain processes. Fourteen chronic severe CHI patients

  3. Retrieving familiar people's names in patients with severe closed-head injuries

    NARCIS (Netherlands)

    Milders, M; Deelman, B; Berg, [No Value


    Patients with closed-head injury frequently complain about difficulties with retrieving the names of familiar people, bur very few studies have investigated these complaints by objective measurements. Three experiments are reported that compared personal name retrieval in patients with severe closed

  4. Fatal head injury: a sequelae to electric shock - a case report. (United States)

    Jayanth, S H; Hugar, Basappa S; Chandra, Y P Girish; Krishnan, A Gokula


    Deaths due to electric shock are increasing despite stringent laws and preventive measures. These shocks are a leading cause of death amongst construction workers. In about 20% of the cases, no visible injury due to electricity can be seen. In some cases, non-electrical injuries are present and at times there are no eyewitnesses to provide a detailed account of events. In such circumstances, examination of scene of death, autopsy and accident reconstruction with the help of an electrical expert are all necessary to determine the cause of death. Here, we report one such case where a mason working on the second floor of a building under construction sustained an electrical injury, following which he was thrown to the ground sustaining a fatal traumatic injury. After careful consideration, his death was attributed to the head injury.

  5. Six nails in the head: multiple pneumatic nail gun head injury. (United States)

    Lee, Chang Sub; Park, Kyung Hye


    A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.

  6. Effect of sub-hypothermia therapy on coagulopathy after severe head injury

    Institute of Scientific and Technical Information of China (English)

    LI Gang; XU Ru-xiang; KE Yi-quan; JIANG Xiao-dan; ZHANG Shu-fen; DENG Bi-lan; YU Xing


    @@ Sub-hypothermia therapy is one of the treatments for patients with severe head injury.The objective of the therapy is to treat traumatic brain injury (TBI) by alleviating brain edema,protecting blood brain barrier (BBB),and preventing subsequent damage to neurons.It can protect brain function by depressing metabolism,reducing the release of excitatory amino acids and free radicals,reducing the level of lactic acid,and lowering the damage of cytoskeletal structure.1 However,sub-hypothemia may-affect patients' coagulatory function including amendment to hypercoagulation state or hyperfibrinolysis and platelet (PLT) functional disturbance.2,3 This study aimed to observe how sub-hypothermia therapy exerts effects on coagulopathy of patients after head injury.

  7. Skull fracture and hemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis

    Directory of Open Access Journals (Sweden)

    Chandrabhal Tripathi


    Full Text Available BACKGROUND: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial hemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial hemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. METHODS: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. RESULTS: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. CONCLUSIONS: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.

  8. Therapeutic effect of mild hypothermia on severe traumatic head injury

    Institute of Scientific and Technical Information of China (English)

    裘五四; 刘伟国; 沈宏; 王卫民; 章志量; 张瑛; 江素君; 杨小锋


    Objective: To investigate the therapeutic effect of mild hypothermia on severe traumatic brain injury.Methods: Eighty-six in-patients with severe traumatic brain injury treated ordinarily were consecutively randomized into two groups: a hypothermia group (n=43) and a normothermia group (the control group, n=43). In the hypothermia group, the core temperature (i.e., nasopharyngeal or brain temperature) of the patient was reduced to and maintained at 33-35℃ with a systemic cooling blanket. Natural rewarming began after 3-5 days (mean: 4.3 days) of hypothermia treatment. In the control group, the patient received no hypothermia treatment. The vital sign, extradural pressure and serum superoxide dismutase were observed and measured during treatment, and the complications as well as the Glasgow outcome scale were evaluated at 2 years after injury.Results: The mean extradural pressure in the hypothermia group (27.38 mm Hg±4.88 mm Hg at 24 hours, 29.40 mm Hg±4.50 mm Hg at 48 hours and 26.40 mm Hg±4.13 mm Hg at 72 hours after injury) was much lower than that in the control group (32.63 mm Hg±3.00 mm Hg, 34.80 mm Hg±6.00 mm Hg and 31.81 mm Hg±4.50 mm Hg respectively at 24, 48 and 72 hours, P<0.05). The mean serum superoxide dismutase levels in the hypothermia group on days 3 and 7 (583.7 μg/L±99.6 μg/L and 699.4 μg/L±217.3 μg/L, respectively) were much higher than those in the control group at the same time period (446.6 μg/L±79.5 μg/L and 497.1 μg/L±101.2 μg/L, respectively, P<0.01). The recovery rates at 2 years after injury were 65.1% in the hypothermia group and 37.2% in the control group (P<0.05). The mortality rates were 25.6% in the hypothermia group and 51.2% in the control group (P<0.05). The complications, including pulmonary infections, thrombocytopenia (platelet count <100×109/L), hemorrhage in the digestive tract, electrolyte disorders and renal malfunction, were managed without severe sequelae .Conclusions: Mild hypothermia is a safe and

  9. Development of Medical Adjunctive Treatment for Acute Penetrating Head Injury (United States)


    severity of an injury will increase if certain out- comes are noted. For example, Lung Contusion AIS 3 vs. Lung Contusion with bilat- eral hemothorax ...organisms on the gram stain specimen or culture. Lung abscesses and empyemas are coded under "Pulmonary Complications". 440N. WOUND DEHScENCE. 45N...Patient on Ventilator 0 No I Yes U Unknown 43U. Seizure Type (Choose one ) 0 None 3 Suspected 1 General 4 Type unknown 2 Focal 5 Combination 44U. Number

  10. Interleukin (IL)-8 immunoreactivity of injured axons and surrounding oligodendrocytes in traumatic head injury. (United States)

    Hayashi, Takahito; Ago, Kazutoshi; Nakamae, Takuma; Higo, Eri; Ogata, Mamoru


    Interleukin (IL)-8 has been suggested to be a positive regulator of myelination in the central nervous system, in addition to its principal role as a chemokine for neutrophils. Immunostaining for beta-amyloid precursor protein (AβPP) is an effective tool for detecting traumatic axonal injury, although AβPP immunoreactivity can also indicate axonal injury due to hypoxic causes. In this study, we examined IL-8 and AβPP immunoreactivity in sections of corpus callosum obtained from deceased patients with blunt head injury and from equivalent control tissue. AβPP immunoreactivity was detected in injured axons, such as axonal bulbs and varicose axons, in 24 of 44 head injury cases. These AβPP immunoreactive cases had survived for more than 3h. The AβPP immunostaining pattern can be classified into two types: traumatic (Pattern 1) and non-traumatic (Pattern 2) axonal injuries, which we described previously [Hayashi et al. Int. J. Legal Med. 129 (2015) 1085-1090]. Three of 44 control cases also showed AβPP immunoreactive injured axons as Pattern 2. In contrast, IL-8 immunoreactivity was detected in 7 AβPP immunoreactive and in 2 non-AβPP immunoreactive head injury cases, but was not detected in any of the 44 control cases, including the 3 AβPP immunoreactive control cases. The IL-8 immunoreactive cases had survived from 3 to 24 days, whereas those cases who survived less than 3 days (n=29) and who survived 90 days (n=1) were not IL-8 immunoreactive. Moreover, IL-8 was detected as Pattern 1 axons only. In addition, double immunofluorescence analysis showed that IL-8 is expressed by oligodendrocytes surrounding injured axons. In conclusion, our results suggest that immunohistochemical detection of IL-8 may be useful as a complementary diagnostic marker of traumatic axonal injury.

  11. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, Alexander M.; Thompson, Linda R.; Truwit, Charles L.; Velders, Scott; Karagulle, Ayse; Kiragu, Andrew [University of Minnesota Medical School, Department of Radiology, Hennepin County Medical Center, Minneapolis, MN (United States)


    Abusive head trauma (AHT) in young children usually has a severe outcome when associated with hypoxic-ischemic encephalopathy (HIE), which is best characterized by MRI in the acute or subacute phase utilizing diffusion-weighted imaging (DWI). HIE in this setting has been hypothesized to result from stretching of the spinal cord, brainstem, or vasculature. To provide clinical correlation in patients with unilateral HIE and to postulate a mechanism in the setting of suspected AHT. IRB approval was obtained. Over a 5-year period, the medical records and images were reviewed of the 53 children {<=}3 years of age who presented with acute head trauma according to the hospital registry. The children were subselected in order to determine how many suffered either HIE or AHT, and to detect those with unilateral HIE. In 11 of the 53 children, the etiology of the head trauma was highly suspicious for abuse. In 38 the head trauma was accidental and in 4 the trauma was of unknown etiology and at the time of this report was unresolved legally. Of the 53, 4 suffered HIE confirmed by CT or MRI. In three of these four with HIE the trauma was considered highly suspicious for AHT. Two of these three were the only patients with unilateral HIE, and both (7 months and 14 months of age) presented with early subacute phase HIE seen on DW MRI (range 4-7 days) and are described in detail with clinical correlation. The third child with AHT and HIE had bilateral findings. In the fourth patient the HIE was bilateral and was considered accidental. The work-up for both patients with unilateral HIE included head CT, craniocervical MRI, and craniocervical MR angiography (MRA). In both, there was mostly unilateral, deep white matter restricted diffusion, with subdural hematomas that were small compared to the extent of hypoxic-ischemic insult, and no skull fracture. Craniocervical MRA and axial thin-section fat-saturation images were negative for dissection, brainstem, or cord injury. Legal

  12. Prognosis in children with head injury: An analysis of 340 patients

    Directory of Open Access Journals (Sweden)

    Suresh H


    Full Text Available Background: The outcome in children with head injury is distinctive because of the different biophysical properties of the child's skull and brain, and their reaction to injury. Methods: In this retrospective study of three hundred and forty children with head injury, managed from January 1993 to December 1998, at NIMHANS, the factors influencing outcome were analyzed. Results: On admission there were 40 children in GCS 3-5, 55 children in GCS 6-8, 96 in GCS 9-12 and 152 children in GCS 13-15. Eleven patients were under 2 years of age, 53 were between 3-5 years, 140 were between 6-10 years and 156 were between 11-15 years of age. The prognosis in various intracranial pathologies due to head injury was evaluated and outcome assessed at discharge. There were 95 children with EDH and 8.4% had poor outcome (vegetative state or death. There were 85 patients with contusion and poor outcome was noted in 18.8%. One hundred patients had diffuse cerebral oedema on CT scan and outcome was poor in 25% of these patients. The clinical features associated with poor prognosis were, absence of ocular movements (50%, abnormal pupillary size and reaction (49% and age less than 2 years (27%.

  13. Head and Maxillofacial Injuries in Child and Adolescent Victims of Automotive Accidents

    Directory of Open Access Journals (Sweden)

    Alessandro Leite Cavalcanti


    Full Text Available Background. Victims of motor vehicle accidents may suffer multiple lesions, including maxillofacial injuries. The aim of this study was to evaluate the prevalence and factors associated with head, facial, and maxillofacial injuries in child and adolescent victims of automobile accidents. A cross-sectional study was carried out with analysis of forensic medical reports from the Legal Medical Institute of Campina Grande, Brazil, between January 2008 and December 2011. Descriptive and inferential statistical analysis was conducted using the chi-square test (α = 0.05. From 1613 medical reports analyzed, the sample is composed 232 (14.4% reports referring to child and adolescent victims of automobile accidents aged 0–19 years of both sexes. Victims were mostly adolescents aged from 15 to 19 years (64.2%, males (73.7%, and motorcyclists (51.3%. More than half of the victims had single lesions (54.3% located in the head (20.7% and face (21.6%. Head injuries occurred more frequently in children aged 0–4 years (53.8%, PR = 5.065, 95% CI = 1.617–5.870 and pedestrians (30.4%, PR = 2.039, 95% CI = 1.024–4.061, while facial and maxillofacial injuries occurred in higher proportion among females (31.1%, PR = 0.489, 95% CI = 0.251–0.954. Our findings suggest that accidents involving motorcyclists are the most prevalent, affecting male adolescents aged from 15 to 19 years, resulting in a high frequency of injuries in the head and face regions.

  14. Intensive care management of head injury patients without routine intracranial pressure monitoring

    Directory of Open Access Journals (Sweden)

    Santhanam R


    Full Text Available Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome. Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve strategies to improve outcome. Setting and Design: Retrospective study in a tertiary hospital where intracranial pressure monitoring (ICPM is not routinely practiced. Materials and Methods: All patients with head injury managed in the intensive care unit in a two-year period were included. The factors evaluated were age, vital signs, Glasgow Coma scale score (GCS at admission, pupillary light reflex (PR, oculocephalic reflex (OCR, hemodynamic stability, computerized tomography (CT findings, diabetes mellitus, anemia, infections and abnormalities of serum sodium. Results: We analyzed 208 patients (202 without ICPM. In-hospital mortality was 64 (31%. Only 24 (11.5% patients were admitted within one hour of injury, while one-third arrived after six hours. The clinical factors (at admission that influenced mortality included age, GCS, PR, OCR and diastolic blood pressure (DBP. Effacement of the basal cisterns in the initial and repeat CT scans, hyperglycemia, hemodynamic instability and serum sodium imbalances were associated with higher mortality. The independent predictors of mortality by logistic regression were initial GCS, DBP, hemodynamic instability and effacement of cisterns on repeat CT. Conclusions: Mortality following head injury is high. Pre-hospital emergency medical services are disorganized. The key to reducing mortality within the limitations of our current trauma system is maintenance of DBP>70 mmHg and SBP> 90 mmHg from the time of first contact.

  15. Functional Data Analysis of Spaceflight-Induced Changes in Coordination and Phase in Head Pitch Acceleration During Treadmill Walking (United States)

    Miller, Christopher; Peters, Brian; Feiveson, Alan; Bloomberg, Jacob


    Astronauts returning from spaceflight experience neurovestibular disturbances during head movements and attempt to mitigate them by limiting head motion. Analyses to date of the head movements made during walking have concentrated on amplitude and variability measures extracted from ensemble averages of individual gait cycles. Phase shifts within each gait cycle can be determined by functional data analysis through the computation of time-warping functions. Large, localized variations in the timing of peaks in head kinematics may indicate changes in coordination. The purpose of this study was to determine timing changes in head pitch acceleration of astronauts during treadmill walking before and after flight. Six astronauts (5M/1F; age = 43.5+/-6.4yr) participated in the study. Subjects walked at 1.8 m/sec (4 mph) on a motorized treadmill while reading optotypes displayed on a computer screen 4 m in front of their eyes. Three-dimensional motion of the subject s head was recorded with an Inertial Measurement Unit (IMU) device. Data were recorded twice before flight and four times after landing. The head pitch acceleration was calculated by taking the time derivative of the pitch velocity data from the IMU. Data for each session with each subject were time-normalized into gait cycles, then registered to align significant features and create a mean curve. The mean curves of each postflight session for each subject were re-registered based on their preflight mean curve to create time-warping functions. The root mean squares (RMS) of these warping functions were calculated to assess the deviation of head pitch acceleration mean curves in each postflight session from the preflight mean curve. After landing, most crewmembers exhibited localized shifts within their head pitch acceleration regimes, with the greatest deviations in RMS occurring on landing day or 1 day after landing. These results show that the alteration of head pitch coordination due to spaceflight may be

  16. Accelerating image reconstruction in dual-head PET system by GPU and symmetry properties.

    Directory of Open Access Journals (Sweden)

    Cheng-Ying Chou

    Full Text Available Positron emission tomography (PET is an important imaging modality in both clinical usage and research studies. We have developed a compact high-sensitivity PET system that consisted of two large-area panel PET detector heads, which produce more than 224 million lines of response and thus request dramatic computational demands. In this work, we employed a state-of-the-art graphics processing unit (GPU, NVIDIA Tesla C2070, to yield an efficient reconstruction process. Our approaches ingeniously integrate the distinguished features of the symmetry properties of the imaging system and GPU architectures, including block/warp/thread assignments and effective memory usage, to accelerate the computations for ordered subset expectation maximization (OSEM image reconstruction. The OSEM reconstruction algorithms were implemented employing both CPU-based and GPU-based codes, and their computational performance was quantitatively analyzed and compared. The results showed that the GPU-accelerated scheme can drastically reduce the reconstruction time and thus can largely expand the applicability of the dual-head PET system.

  17. Acute severe head injury resulted from road traffic accidents:a report on 231 cases

    Institute of Scientific and Technical Information of China (English)

    刘敬业; 张赛; 等


    Objective:To analyze the epidemiology and clinical outcome of acute severe head injurey induced by road traffic accidents.Methods:The data of 231 patients with acute severe head injury induced by road traffic accidents were retrospectively studied.Results:The major victim-maker was automobiles (98.8%).The first three common types of traffic accidents were automobiles crashing into automobiles,automobiles crashing into bicycles(42.9%),and automobiles crashing pedestrians(40.3%).Eighty-seven patients out of 231 died,with the mortality of 37.7%.Conclusions:It suggests tat improving traffic administration and traffic safety consciousness may significantly reduce traffic trauma.

  18. Study Of 50 Cases With Craniofacial Trauma Who Experienced Head Injuries

    Directory of Open Access Journals (Sweden)

    Ali Mesgarzadeh


    Full Text Available Background: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Aims and objectives: Study of the features of facial injuries associated with head injuries, discussing the management options and detecting the outcomes following craniofacial trauma. Methods: This is a retrospective study carried out at Imam reza and Shohada Hospitals. Radiographs and hospital data of 50 patients with craniofacial trauma between January 2013 and December 2014, managed at the Oral and Maxillofacial surgery department were gathered and analyzed. Results: The greatest number of the patients had 20 to 50 years old (68% and most of them were male. (M/F ratio was 6.09:1. The most prevalent causes of the trauma in this study were the motor vehicle accidents (44% and falling from height (36%, respectively. The most common bone fracture among the patients was the zygomatic bone fx (38.2%. Among the symptoms which the patients presented, Loss of the consciousness (52% and headache (43% showed the highest prevalence. Compound depressed fractures, contusions and intracranial hematoma were the leading causes of the surgical intervention for intracranial lesions. A high number of patients who have died in this study had associated systemic injuries. Displaced facial bone fracture were the indications for operation in facial fractures. Conclusions: The majority of the patients with craniofacial trauma were the adult males and the leading cause of trauma were road traffic accidents. A high number of the patients had mild head injuries and required only a conservational therapy.     Keywords:  head injury; craniofacial trauma; facial fracture

  19. Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases

    Directory of Open Access Journals (Sweden)

    Rajendra Prasad


    Full Text Available Background: Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. Aims and Objectives: To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma. Methods: This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed. Results: Majority of the patients were in the 2nd to 4th decade (79% with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54% followed by fall from height (30%. Loss of consciousness was the most common clinical symptom (62% followed by headache (33%. Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%. Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries. Conclusion: Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.

  20. Accelerating the development of emotion competence in Head Start children: effects on adaptive and maladaptive behavior. (United States)

    Izard, Carroll E; King, Kristen A; Trentacosta, Christopher J; Morgan, Judith K; Laurenceau, Jean-Philippe; Krauthamer-Ewing, E Stephanie; Finlon, Kristy J


    Separate studies of rural and urban Head Start systems tested the hypothesis that an emotion-based prevention program (EBP) would accelerate the development of emotion and social competence and decrease agonistic behavior and potential precursors of psychopathology. In both studies, Head Start centers were randomly assigned to treatment and control/comparison group conditions. In Study 1 (rural community), results of hierarchical linear modeling analyses showed that compared to the control condition (Head Start as usual), EBP produced greater increases in emotion knowledge and emotion regulation and greater decreases in children's negative emotion expressions, aggression, anxious/depressed behavior, and negative peer and adult interactions. In Study 2 (inner city), compared to the established prevention program I Can Problem Solve, EBP led to greater increases in emotion knowledge, emotion regulation, positive emotion expression, and social competence. In Study 2, emotion knowledge mediated the effects of EBP on emotion regulation, and emotion competence (an aggregate of emotion knowledge and emotion regulation) mediated the effects of EBP on social competence.

  1. Multivariate head injury threshold measures for various sized children seated behind vehicle seats in rear impacts. (United States)

    Saczalski, Kenneth; Sances, Anthony; Kumaresan, Srirangam; Pozzi, Mark; Saczalski, Todd; Burton, J L; Lewis, P


    Government recommendations to place children into the rear areas of motor vehicles to avoid airbag induced injuries have been complicated by the fact that most adult occupied front seats will collapse into the rear area during rear-impacts, and thus pose another potentially serious injury hazard to rear-seated children. Many variables affect whether or not a front seat occupant will collapse into the rear child, and whether that interaction could be injurious to the child. For instance, the severity of rear impact, coupled with front and rear occupant sizes (mass and stature), and the level of front seat strength, all interrelate to influence whether or not a rear seated child is likely to be impacted and possibly injured. The most common types of child injuries in these instances are head and chest injuries. In this study, a "high-low" experimental method was employed with a multi-level "factorial analysis" technique to study "multivariate" biomechanics of child head injury potential determined from rear-seated 3 and 6 year-old child surrogates in different types of vehicle bodies mounted to a sled system. The sled-buck systems were towed rearward into crushable barriers that matched the crash pulses of the vehicle types being tested. Various sizes of adult surrogates (i.e. 50 kg up to 110 kg), seated in both the "typical" low strength "single recliner" collapsing type front seat (i.e. 3.2 kN) and a much stronger "belt-integrated" seat design (i.e. up to 14.5 kN), were tested in the two different "sled body-buck" set-ups at various impact levels (i.e. 22.5 to 50 kph). One set-up used a popular minivan vehicle body with "built-in booster" seats for the 3 year-old. The other used a 4-door family sedan vehicle body with the 6 year-old in a standard rear bench seat. The parameters of the tests enabled the experimental data to be combined into polynomial "head injury" functions of the independent variables so the "likelihood" of rear child head-injury potential could

  2. Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury

    DEFF Research Database (Denmark)

    Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira;


    acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography......, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery...

  3. Combat body armor and injuries to the head, face, and neck region: a systematic review. (United States)

    Tong, Darryl; Beirne, Ross


    There has been a reported increase in combat-related head, face, and neck (HFN) injuries among service personnel wearing combat body armor (CBA) that have deployed to Iraq and Afghanistan. Modern ceramic plate CBA has decreased the incidence of fatal-penetrating injuries to the torso but offers no protection to the limbs and face which remain exposed to gunshot wounds and fragments from explosive devices. The aim of this review was to systematically summarize the literature reporting on HFN injuries sustained by combat personnel wearing CBA and to highlight recommendations for increased protection to the facial region. Three major contributing factors were identified with this proportional increase in HFN injuries, namely the increased survivability of soldiers because of CBA, fragments injuries from explosive devices, and the lack of protection to the face and limbs. There appears to be no evidence to suggest that by virtue of wearing CBA the likelihood of sustaining an HFN injury increases as such, but a higher incidence of fragment injuries to the HFN region may be due to the more common use of improvised explosive devicess and other explosive devices. Further development of lightweight protection for the face is needed.


    Directory of Open Access Journals (Sweden)

    G. V. Agafonov


    Full Text Available Summary. Nowadays purification of ethanol from the head and intermediate impurities is done with the selection of fractions of fusel alcohol and fusel oil from the distillation column and head and intermediate fractions impurities from condenser Epuration column operating accord-ing to the hydro-selection method. Due to this the fraction contains at least 13% ethyl alcohol, resulting in a reduced yield of the final product. Distillation of these fractions in the known acceleration columns requires increased consumption of heating steam for 6-8 kg / dal and increasing installation metal content. In this paper we investigate the process of distillation fraction from the condenser of Epura-tion column, fusel alcohol from the distillation column and subfusel liquid layer from the decanter, which is fed on a plate of supply of new accelerating column (AC, which operates on Epuration technology with the supply of hydro-selection water on the top plate and has in its composition concentration, boiling and stripping parts, a dephlagmator, a condenser, a boiler. Material balance equations of the column were obtained and ethyl alcohol concentration on its plates were determined by them. Having converted the material balance equations, we determined the dependences for the impurities ratio being drawn from the accelerating column with the Luther flows and ethyl alcohol fraction. Then we received the equation for determining the proportion of impurities taken from the column condenser with fraction. These calculations proved that the studied impurities are almost completely selected with this faction, ethyl alcohol content of it being 0.14% of the hourly output.

  5. Cerebrovascular Time Constant in Patients with Head Injury. (United States)

    Trofimov, Alex; Kalentiev, George; Gribkov, Alexander; Voennov, Oleg; Grigoryeva, Vera


    The cerebrovascular time constant (τ) theoretically estimates how fast the cerebral arterial bed is filled by blood volume after a sudden change in arterial blood pressure during one cardiac cycle. The aim of this study was to assess the time constant of the cerebral arterial bed in patients with traumatic brain injury (TBI) with and without intracranial hematomas (IH). We examined 116 patients with severe TBI (mean 35 ± 15 years, 61 men, 55 women). The first group included 58 patients without IH and the second group included 58 patients with epidural (7), subdural (48), and multiple (3) hematomas. Perfusion computed tomography (PCT) was performed 1-12 days after TBI in the first group and 2-8 days after surgical evacuation of the hematoma in the second group. Arteriovenous amplitude of regional cerebral blood volume oscillation was calculated as the difference between arterial and venous blood volume in the "region of interest" of 1 cm(2). Mean arterial pressure was measured and the flow rate of the middle cerebral artery was recorded with transcranial Doppler ultrasound after PCT. The time constant was calculated by the formula modified by Kasprowicz. The τ was shorter (p = 0.05) in both groups 1 and 2 in comparison with normal data. The time constant in group 2 was shorter than in group 1, both on the side of the former hematoma (р = 0.012) and on the contralateral side (р = 0.044). The results indicate failure of autoregulation of cerebral capillary blood flow in severe TBI, which increases in patients with polytrauma and traumatic IH.


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    Full Text Available Road traffic accident is the leading cause of serious injuries with associated head trauma especially in youth and middle age persons. Head injury is the most common cause of mortality and major health problem all over the world The Incidence of RTAs was higher in males and in 3rd to 4th decade of life owing to increase risk exposure to males due to more outdoor activities. Incidence of deaths due to RTAs was maximum (45.67% in two wheeler riders followed by pedestrians in 33.33% cases. The present study was conducted on dead bodies, died of accidents involving two wheeler, four wheeler and bicycle. The rate of incidence is higher in India because of bad traffic patterns and possibly the lack of awareness about traffic rules and also lack of good hospital services to our victims of RTAs

  7. [An autopsy case of head injury with a manic-depressive states (author's transl)]. (United States)

    Deshimaru, M; Miyakawa, T; Suzuki, T


    M. M. a man aged 49. He suffered from a head injury at the aged of 41. At that time he lost consciousness for a few minutes and he was diagnosed as a consquassatio cerebri. The sequelaes of his head injury were a change of character and a disturbance of autonomic nerve function. The changes of character were decreased of activity, lie-down for all day, decrease of speech and depressive mode, and occasionally he was ill-humored, restless and irritative. Periodically he became euphoris, talkative and childisch. He had a disturbance of autonomic nerve function which became worse in parallel to the depressive states. We speculated that character changes, such as manic-depressive states and disturbances of autonomic nerve function were due to the bruising of the bilateral orbital surfaces of frontal lobes.

  8. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition). (United States)

    Shima, Katsuji; Aruga, Tohru; Onuma, Takehide; Shigemori, Minoru


    The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients. The JSNT-guidelines are of practical nature accounting for the difference in the medical system and conditions in Japan, but in their essence they are similar to those of Western countries. Reports on the application of these guidelines indicate their positive affect on the results of management of severe head injury.

  9. Nitric oxide accelerates interleukin-13 cytotoxin-mediated regression in head and neck cancer animal model. (United States)

    Kawakami, Koji; Kawakami, Mariko; Puri, Raj K


    Receptors for interleukin-13 (IL-13R) are overexpressed on several types of solid cancers including gliobastoma, renal cell carcinoma, AIDS Kaposi's sarcoma, and head and neck cancer. Recombinant fusion proteins IL-13 cytotoxin (IL13-PE38QQR or IL13-PE38) have been developed to directly target IL-13R-expressing cancer cells. Although it has been found that IL-13 cytotoxin has a direct potent antitumor activity in vivo in nude mice models of human cancers, the involvement of indirect antitumor effecter molecules such as nitric oxide (NO) is unknown. To address this issue, we assessed the effect of NO inhibiter N(omega)-monomethyl-l-arginine on IL-13 cytotoxin-mediated cytotoxicity and NO2/NO3 production in HN12 head and neck cancer cells. In addition, antitumor effects and NO levels in HN12 and KCCT873 head and neck tumors xenografted s.c. in nude mice when treated with IL-13 cytotoxin were evaluated by tumor measurement, Western blot, and immunohistochemistry analyses. Pretreatment of animals with N(omega)-monomethyl-l-arginine significantly decreased the NO levels and IL-13 cytotoxin-mediated antitumor effects. In addition, depletion of macrophages, known to produce NO, also decreased antitumor activity of IL-13 cytotoxin. Based on these studies, we concluded that NO accelerates antitumor effect of IL-13 cytotoxin on head and neck tumor cells. Because IL-13 cytotoxin is currently being tested in the clinic for the treatment of patients with recurrent glioblastoma maltiforme, our current findings suggest maintaining macrophage and NO-producing cellular function for optimal therapeutic effect of this targeted agent.

  10. AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury (United States)

    Mason, Suzanne; Kuczawski, Maxine; Teare, M Dawn; Stevenson, Matt; Goodacre, Steve; Ramlakhan, Shammi; Morris, Francis; Rothwell, Joanne


    Objectives Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome. Design Multicentre, observational study using routine patient records. Setting 33 emergency departments in England and Scotland. Participants 3566 adults (aged ≥16 years) who had suffered blunt head injury and were currently taking warfarin. Main outcome measures Primary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses. Results Clinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2). Conclusions In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15

  11. Occupant accelerations and injury potential during an ambulance-to-curb impact. (United States)

    Lee, Ellen L; Hayes, Wilson C


    This paper presents real world acceleration data for an ambulance driving up and over a curb. A full scale reenactment was performed for a litigated case in which a patient on a gurney in an ambulance claimed a variety of bodily injuries after the ambulance struck a curb. A height and weight matched surrogate rode on the gurney during the tests. Results demonstrated that peak vehicle and occupant accelerations never exceeded 1.1g's. To address the claimed injuries, the accelerations likely sustained by the patient were compared to those experienced during daily life. Since ambulances are wide vehicles that travel fast on potentially narrow arterial, collector or local roadways, curb or median impacts may occur during the normal course of driving. Thus, these results may be useful for forensic experts in dealing with similar cases involving claimed injuries following curb impacts.

  12. [The hardness of the traumatic object and the extent of injury (as exemplified by head injuries)]. (United States)

    Shadymov, A B; Kazymov, M A


    The objective of the present work was to study the influence of the surface hardness of a traumatic agent on the extent and character of the injury to the soft and bone tissues of the cranial vault associated with various forms of injurious exposure. The authors evaluated forensic medical significance of the hardness as one of the most important properties of the major injurious agents involved in the formation of skull fractures and soft tissue ruptures under effect of an impact action or compression. The objects differing in the hardness of the contact element (striking pin) were studied in comparison with the hardness of the bone tissue. The extent and morphological features of the injuries to the bones and soft tissues in different parts of the skull were compared with reference to deformation and strength characteristics developing in response to a blow and compression.

  13. Imaging of spinal injury in abusive head trauma: a retrospective study

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    Choudhary, Arabinda K. [Nemours A.I. DuPont Children Hospital, Department of Radiology, Wilmington, DE (United States); Ishak, Ramsay; Zacharia, Thomas T. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)


    Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

  14. Hemodynamic and morphologic responses in mouse brain during acute head injury imaged by multispectral structured illumination (United States)

    Volkov, Boris; Mathews, Marlon S.; Abookasis, David


    Multispectral imaging has received significant attention over the last decade as it integrates spectroscopy, imaging, tomography analysis concurrently to acquire both spatial and spectral information from biological tissue. In the present study, a multispectral setup based on projection of structured illumination at several near-infrared wavelengths and at different spatial frequencies is applied to quantitatively assess brain function before, during, and after the onset of traumatic brain injury in an intact mouse brain (n=5). For the production of head injury, we used the weight drop method where weight of a cylindrical metallic rod falling along a metal tube strikes the mouse's head. Structured light was projected onto the scalp surface and diffuse reflected light was recorded by a CCD camera positioned perpendicular to the mouse head. Following data analysis, we were able to concurrently show a series of hemodynamic and morphologic changes over time including higher deoxyhemoglobin, reduction in oxygen saturation, cell swelling, etc., in comparison with baseline measurements. Overall, results demonstrates the capability of multispectral imaging based structured illumination to detect and map of brain tissue optical and physiological properties following brain injury in a simple noninvasive and noncontact manner.

  15. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

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    Kadom, Nadja [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Boston University Medical Center, Boston, MA (United States); Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Rice, Amy [Independent Consultant (Biostatistics), Chevy Chase, MD (United States); Hinds, Tanya [Children' s National Medical Center, Child and Adolescent Protection Center, Washington, DC (United States)


    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

  16. Diffuse optical monitoring of hemodynamic changes in piglet brain with closed head injury (United States)

    Zhou, Chao; Eucker, Stephanie A.; Durduran, Turgut; Yu, Guoqiang; Ralston, Jill; Friess, Stuart H.; Ichord, Rebecca N.; Margulies, Susan S.; Yodh, Arjun G.


    We used a nonimpact inertial rotational model of a closed head injury in neonatal piglets to simulate the conditions following traumatic brain injury in infants. Diffuse optical techniques, including diffuse reflectance spectroscopy and diffuse correlation spectroscopy (DCS), were used to measure cerebral blood oxygenation and blood flow continuously and noninvasively before injury and up to 6 h after the injury. The DCS measurements of relative cerebral blood flow were validated against the fluorescent microsphere method. A strong linear correlation was observed between the two techniques (R=0.89, p<0.00001). Injury-induced cerebral hemodynamic changes were quantified, and significant changes were found in oxy- and deoxy-hemoglobin concentrations, total hemoglobin concentration, blood oxygen saturation, and cerebral blood flow after the injury. The diffuse optical measurements were robust and also correlated well with recordings of vital physiological parameters over the 6-h monitoring period, such as mean arterial blood pressure, arterial oxygen saturation, and heart rate. Finally, the diffuse optical techniques demonstrated sensitivity to dynamic physiological events, such as apnea, cardiac arrest, and hypertonic saline infusion. In total, the investigation corraborates potential of the optical methods for bedside monitoring of pediatric and adult human patients in the neurointensive care unit.

  17. Intention tremor after head injury. Clinical features and computed tomographic findings

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    Iwadate, Yasuo; Saeki, Naokatsu; Namba, Hiroki; Odaki, Masaru; Oka, Nobuo.


    Eight cases of intention tremor as a late complication of head injury were investigated. The patients ranged in age from 3 to 24 years. All received severe head injuries and lapsed into coma immediately afterward (Glasgow Coma Scale scores /le/8). Six patients exhibited decerebration or decortication. Hemiparesis was present in six cases and oculomotor nerve palsy in four. In the chronic stage, all patients displayed some degree of impairment of higher cortical function and five had dysarthria and/or ataxia. Initial computed tomography (CT) scans within 3 hours after the injury were obtained in five cases, of which four showed a hemorrhagic lesion in the midbrain or its surroundings. Other CT findings were diffuse cerebral swelling (four cases), intraventricular hemorrhage (three), and multiple hemorrhagic lesions (two). In the chronic stage, generalized cortical atrophy or ventricular enlargement was noted in five cases. These clinical features and CT findings indicate diffuse brain damage as well as midbrain damage and may reflect shearing injury. (author).

  18. Brain and head injury in infancy and childhood; Schaedel- und Hirntrauma im Kindesalter

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    Struffert, T. [Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, Homburg, Saar (Germany); Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, 66421, Homburg, Saar (Germany); Grunwald, I.; Reith, W. [Abteilung fuer Neuroradiologie, Radiologische Klinik, Universitaet des Saarlandes, Homburg, Saar (Germany)


    This article describes typical head injuries in infants and children. In comparison with adults there are distinct differences in the etiology of trauma and in the kind of reaction of the skull and brain. In infants and children there are three different types of trauma: birth trauma, accidental and non-accidental injury. The typical injuries in these three groups are described. (orig.) [German] In diesem Beitrag werden die typischen Schaedel- und Hirnverletzungen bei Kindern zusammengefasst. Bei diesen bestehen im Vergleich zu Erwachsenen deutliche Unterschiede in der Aetiologie und der Reaktion der Kalotte und des Gehirns auf ein Trauma. Bezueglich der Aetiologie kann unterschieden werden in Geburtstrauma, akzidentelles und nichtakzidentelles Trauma. Die typischen Verletzungen dieser 3 Gruppen werden ausfuehrlich beschrieben. (orig.)

  19. Influence of elevator acceleration induced loading on injury levels

    NARCIS (Netherlands)

    Funai, K.; Schijndel-de Nooij, M. van; Nunen, E. van


    The influence on human body of the acceleration caused by the elevator emergency stop has been studied. Experiments were performed with an automotive dummy in an elevator. The study is furthermore based on numerical simulations in MADYMO with an active human model. Kinematics and contact forces of v

  20. Can glasgow score at discharge represent final outcome in severe head injury?

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    Deepak Agrawal


    Full Text Available Background: Patients with head injury continue to improve over time and a minimum follow-up of six months is considered necessary to evaluate outcome. However, this may be difficult to assess due to lack of follow-up. It is also well known that operated patients who return for cranioplasty usually have the best outcome. Aims and Objectives: To assess the outcome following severe head injury using cranioplasty as a surrogate marker for good outcome. Materials and Methods: This was a retrospective study carried out from January 2009 to December 2010. All patients with severe head injury who underwent decompressive craniectomy (DC in the study period were included. Patients who came back for cranioplasty in the same period were also included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score (GCS on admission and Glasgow Outcome Score (GOS at discharge were assessed. Observations and Results: Of the 273 patients, 84.25% (n=230 were males and 15.75% (n= 43 were females. The mean age was 34.3 years (range 2-81 years, SD 16.817. The mean GCS on admission was 5.615 (range 3-8, SD 1.438. The in-hospital mortality was 54% (n=149. Good outcome (GOS of 4 or 5 at discharge was attained in 22% (n=60 patients. Sixty five patients returned for cranioplasty (with a GOS of 4 or 5 during the study period. There was no statistical difference in the number of patients discharged with good outcome and those coming back for cranioplasty in the study period (P>0.5. Patients who came back for cranioplasty were younger in age (mean age 28.815 years SD 13.396 with better admission GCS prior to DC (mean GCS 6.32 SD1.39. Conclusions: In operated severe head injury patients significant number of patients (24% in our study have excellent outcome. However, insignificant number of patients had further improvement to GOS 4 or 5 (good outcome from the time of initial discharge. This suggests that due to lack of intensive

  1. Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries

    DEFF Research Database (Denmark)

    Harr, Marianne Efskind; Heskestad, Ben; Ingebrigtsen, Tor;


    In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate...... whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol....

  2. Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries

    DEFF Research Database (Denmark)

    Harr, Marianne Efskind; Heskestad, Ben; Ingebrigtsen, Tor;


    In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate...

  3. An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury

    DEFF Research Database (Denmark)

    Heskestad, Ben; Waterloo, Knut; Ingebrigtsen, Tor;


    The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low...

  4. Exploring the King’s outcome scale for childhood head injury in children attending a rehabilitation hospital

    DEFF Research Database (Denmark)

    Rumney, Peter; Hung, Ryan; McAdam, Laura;


    Objective: Few tools exist to assess and monitor impairment and disability in children with acquired brain injury. The King’s Outcome Scale for Childhood Head Injury (KOSCHI) was developed as an alternative to the Glasgow Outcome Scale. However, limited information is available to support its rel...

  5. [Determination of head scatter factors released from a scanning-type therapeutic accelerator]. (United States)

    Sato, Tomoharu


    The MM50 is a racetrack microtron capable of taking out photon beams and electron beams with energies of up to 50 MeV. It flattens the beam by the beam-scanning method, while the microtron MM22 utilizes a flattening filter. The head-scatter factors (hereafter called S(h)), which are important for evaluating the output of the photon beam of the MM50 and MM22, were measured using a mini-phantom and build-up cap. S(h) measured with the build-up cap showed the influence of contaminated electrons, whereas S(h) measured with the mini-phantom showed less influence, even for 50 MV photon beams. Compared with the MM22, the MM50 showed less change in S(h) according to field size and energy. The reason for this seemed to be that the MM50 has a smaller extra-focal region than other accelerators equipped with flattening filters and, therefore, can essentially be considered a point source by using the beam-scanning method without a flattening filter. This study demonstrated that photons scattered by the flattening filter used for beam flattening in typical medical accelerators mainly contribute to S(h).

  6. Correlation between egfr expression and accelerated proliferation during radiotherapy of head and neck squamous cell carcinoma

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    Pedicini Piernicola


    Full Text Available Abstract Purpose To investigate the correlation between the expression of Epidermal Growth Factor receptor (EGFr and the reduction of the effective doubling time (TD during radiotherapy treatment and also to determine the dose per fraction to be taken into account when the overall treatment time (OTT is reduced in accelerated radiotherapy of head and neck squamous cell carcinoma (HNSCC. Methods A survey of the published papers comparing 3-years of local regional control rate (LCR for a total of 2162 patients treated with conventional and accelerated radiotherapy and with a pretreatment assessment of EGFr expression, was made. Different values of TD were obtained by a model incorporating the overall time corrected biologically effective dose (BED and a 3-year clinical LCR for high and low EGFr groups of patients (HEGFr and LEGFr, respectively. By obtaining the TD from the above analysis and the sub-sites’ potential doubling time (Tpot from flow cytometry and immunohistochemical methods, we were able to estimate the average TD for each sub-site included in the analysis. Moreover, the dose that would be required to offset the modified proliferation occurring in one day (Dprolif, was estimated. Results The averages of TD were 77 (27-9095% days in LEGFr and 8.8 (7.3-11.095% days in HEGFr, if an onset of accelerated proliferation TK at day 21 was assumed. The correspondent HEGFr sub-sites’ TD were 5.9 (6.6, 5.9 (6.6, 4.6 (6.1, 14.3 (12.9 days, with respect to literature immunohistochemical (flow cytometry data of Tpot for Oral-Cavity, Oro-pharynx, Hypo-pharynx, and Larynx respectively. The Dprolif for the HEGFr groups were 0.33 (0.29, 0.33 (0.29, 0.42 (0.31, 0.14 (0.15 Gy/day if α = 0.3 Gy-1 and α/β = 10 Gy were assumed. Conclusions A higher expression of the EGFr leads to enhanced proliferation. This study allowed to quantify the extent of the effect which EGFr expression has in terms of reduced TD and Dprolif for each head and neck

  7. Specificities of prosthetic and orthotic rehabilitation in amputees with head injury

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    Teofilovski Mirko


    Full Text Available Background/Aim. The prosthetic-orthotic rehabilitation (POR of amputees with head injury within the polytrauma presents a specific entity. The number of traumas caused by the traffic and the low-intensity war conflicts, increases constantly. The aim of our study was to examine the influence of complications on the POR duration and outcome in polytrauma amputees with head injury (PTAHI recording complications at the beginning and during the POR. Methods. The study was carried out on the patients divided into two groups of 35 polytrauma male patients each of corresponding age with unilateral transfemoral amputation caused by the war injury. The experimental group consisted of the amputees with head injury. Standard clinical techniques and procedures, as well as special functional evaluation techniques were used. Results. The PATHI started POR with a greater number of complications (average rate 7.29 vs 5.11 per patient; W = 928.000: Z = 3.730: p = 0.000. There was a highly significant positive correlation between this number and the Barthel Score value change (Fx, H, p < 0.01, and negative significant correlation considering prosthetic use and functional capacity test values (Fx, H p < 0.05. On admision, the amount of complications defined for the value 4 of POR outcome was significantly higher than values 2 and 3, respectively (H = 8.948; df = 2; p = 0.011. The PTAHI developed significantly more frequently complications during rehabilitation (X2 = 1.061; df = 1; p < 0.01. The proportion of the examinees with the value 4 who developed complications during rehabilitations was significantly higher than those with value 2 (Fp = 3.406; df1 = 2; df2 = 67; p = 0.038. The rehabilitation of the PTAHI lasted significantly longer (average 259.09 vs 183.63 days; W = 923.500; Z = -3.748; p = 0.000. Conclusion. The PTAHI including head injuries started prostheticorthotic rehabilitation with more prosthetic complications and their psychological status was worse

  8. Simulative investigation on head injuries of electric self-balancing scooter riders subject to ground impact. (United States)

    Xu, Jun; Shang, Shi; Qi, Hongsheng; Yu, Guizhen; Wang, Yunpeng; Chen, Peng


    The safety performance of an electric self-balancing scooter (ESS) has recently become a main concern in preventing its further wide application as a major candidate for green transportation. Scooter riders may suffer severe brain injuries in possible vehicle crash accidents not only from contact with a windshield or bonnet but also from secondary contact with the ground. In this paper, virtual vehicle-ESS crash scenarios combined with finite element (FE) car models and multi-body scooter/human models are set up. Post-impact kinematic gestures of scooter riders under various contact conditions, such as different vehicle impact speeds, ESS moving speeds, impact angles or positions, and different human sizes, are classified and analyzed. Furthermore, head-ground impact processes are reconstructed using validated FE head models, and important parameters of contusion and laceration (e.g., coup or contrecoup pressures and Von Mises stress and the maximum shear stress) are extracted and analyzed to assess the severity of regional contusion from head-ground contact. Results show that the brain injury risk increases with vehicle speeds and ESS moving speeds and may provide fundamental knowledge to popularize the use of a helmet and the vehicle-fitted safety systems, and lay a strong foundation for the reconstruction of ESS-involved accidents. There is scope to improve safety for the use of ESS in public roads according to the analysis and conclusions.

  9. Clinical manifestations that predict abnormal brain computed tomography (CT in children with minor head injury

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    Nesrin Alharthy


    Full Text Available Background: Computed tomography (CT used in pediatric pediatrics brain injury (TBI to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative. Objectives: The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT. Materials and Methods: Retrospective cross-sectional study was undertaken in patients (1-14 years with blunt head injury and having a Glasgow Coma Scale (GCS of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury. Results: No statistically significant association between parameteres such as Loss of Consciousness, ′fall′ as mechanism of injury, motor vehicle accidents (MVA, more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury. Conclusion: Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.

  10. Beneficial effect of cerebrolysin on moderate and severe head injury patients: result of a cohort study. (United States)

    Wong, G K C; Zhu, X L; Poon, W S


    Cerebrolysin is used as a neurotrophic agent for the treatment of ischemic stroke and Alzheimer's Disease. Exploratory studies in patients with post-acute traumatic brain injury have shown that this treatment might help improve recovery. Aim of this study was to investigate whether addition of Cerebrolysin to the initial treatment regimen of moderate and severe head injury patients would improve their outcome. At 6 months, 67% of the patients (Cerebrolysin group) attained good outcome (GOS 3-5). The study group was compared with the historical cohort of patients from the hospital trauma data bank, with age, sex and admitting GCS matching. More patients tended to a good outcome in the Cerebrolysin group (P = 0.065). No significant side-effect requiring cessation of Cerebrolysin was noted. It can be concluded that the use of Cerebrolysin as part of the initial management of moderate and severe head injury is safe and well tolerated. The results suggest that Cerebrolysin is beneficial in regard to the outcome in these patients, especially in elderly patients.

  11. Traumatic Brain Injury: Imaging Spectrum from Mild to Severe Closed Head Injury (United States)


    methemoglobin, which corresponds with the area of contusion on CT (Fig. 5C). The constellation of these findings are consistent with diffuse axonal injury...paucity of interoperability of RIS-HIS (Radiology and Hospital Information Systems ) between PACS (Picture Archiving and Communications) and the EHR...falltbi.html. 17 Meagher, R.J., W.F. Young, Subdural hematoma, eMedicine, Nov 2, 2006. NEURO /topic575.htm 18 Ingebrigsten


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    Anjeev Kumar


    Full Text Available SUMMARY: Electrolyte abnormalities are common in patients with traumatic brain injury. Disturbances of serum sodium levels are among the most common and frequently occur in neurologically morbid patients and exacerbate their severity. Hypernatremia usually results from diabetes insipidus syndr ome, whereas hyponatremia develops due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH or cerebral salt - wasting syndrome (CSWS and contribute to the high morbidity and mortality rates observed in these patients. The aim of this stud y is to measure the serum levels of Na + , K + , Ca ++ , PO 4 --- in head injury patients and find the range & compare the levels in severe and moderate head injury patients with mild head injury patients. METHOD: Na + , K + , Ca ++ , PO 4 --- levels of patients in age group 13 - 60 years were estimated by ion selective electrode method. RESULTS: it was found that most common electrolyte imbalance found is hyperphosphotemia (87% followed by hyponatremia (62.90%. In case of hyperelectrolytemia, h yperkalemia (46.6% to be the most common electrolyte imbalance in mild type of head injury whereas in severe and moderate cases hyperphosphotemia (28.40% is most common dyselectrolytemia. CONCLUSION: hyponatremia is the most common electrolyte disbalanc e among Na+, K+, Ca++, PO4 --- in patients of traumatic head injury which is also very dangerous and need to be correct promptly.

  13. Catalase Deficiency Accelerates Diabetic Renal Injury Through Peroxisomal Dysfunction (United States)

    Hwang, Inah; Lee, Jiyoun; Huh, Joo Young; Park, Jehyun; Lee, Hi Bahl; Ho, Ye-Shih; Ha, Hunjoo


    Mitochondrial reactive oxygen species (ROS) play an important role in diabetes complications, including diabetic nephropathy (DN). Plasma free fatty acids (FFAs) as well as glucose are increased in diabetes, and peroxisomes and mitochondria participate in FFA oxidation in an interconnected fashion. Therefore, we investigated whether deficiency of catalase, a major peroxisomal antioxidant, accelerates DN through peroxisomal dysfunction and abnormal renal FFA metabolism. Diabetes was induced by multiple injections of low-dose streptozotocin into catalase knock-out (CKO) and wild-type (WT) C57BL/6 mice. Murine mesangial cells (MMCs) transfected with catalase small interfering RNA followed by catalase overexpression were used to further elucidate the role of endogenous catalase. Despite equivalent hyperglycemia, parameters of DN, along with markers of oxidative stress, were more accelerated in diabetic CKO mice than in diabetic WT mice up to 10 weeks of diabetes. CKO mice and MMCs showed impaired peroxisomal/mitochondrial biogenesis and FFA oxidation. Catalase deficiency increased mitochondrial ROS and fibronectin expression in response to FFAs, which were effectively restored by catalase overexpression or N-acetylcysteine. These data provide unprecedented evidence that FFA-induced peroxisomal dysfunction exacerbates DN and that endogenous catalase plays an important role in protecting the kidney from diabetic stress through maintaining peroxisomal and mitochondrial fitness. PMID:22315314

  14. Refractory Intracranial Hypertension due to Fentanyl Administration Following Closed Head Injury

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    Sara E Hocker


    Full Text Available BackgroundAlthough the effects of opioids on intracranial pressure have long been a subject of controversy, they are frequently administered to patients with severe head trauma. We present a patient with an uncommon paradoxical response to opioids.Case ReportA patient with refractory intracranial hypertension after closed head injury was managed with standard medical therapy with only transient decreases in the intracranial pressure. Only after discontinuation of opiates did the intracranial pressure become manageable without metabolic suppression and rescue osmotic therapy, implicating opiates as the etiology of refractory intracranial hypertension in this patient. ConclusionsClinicians should consider opioids as a contributing factor in malignant intracranial hypertension when findings on neuroimaging do not explain persistent and refractory intracranial hypertension.

  15. Differential reading recovery in patients with severe to moderate closed head injury. (United States)

    Kaplan, C P


    A differential recovery was seen when alternate forms of a nationally standardized test of Reading Vocabulary, Literal Reading Comprehension and Inferential Reading Comprehension was administered serially to 10 consecutive closed head injury admissions to a university rehabilitation hospital. Inferential Reading Comprehension was the most impaired and had the fastest recovery rate. Subtle cognitive deficits in Inferential Reading Comprehension were detected when Reading Vocabulary was at or better than a twelfth grade level. Maximal recovery of all three reading functions occurred within 4 months after trauma, with most occurring in the first 3 months. The reading recovery pattern parallels the recovery of intelligence scores in the literature.

  16. Therapeutic effectiveness of epicranial nerve blocks on post-traumatic syndrome from head injury

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    C. A. Caputi


    Full Text Available The autor describes the case of a 53-year-old woman suffering from headache and dizziness, sometimes nausea, tinnitus in the right ear, and diffuse scalp allodynia following an occupational accident involving a head injury. Hyposensitizing treatment by anesthetic blockade at the emergence points of the epicranial nerves, which were hyperalgesic to fi nger pressure, rapidly controlled the allodynia and eventually the headache. Unexpectedly, the patient also reported reduced dizziness and resolution of the tinnitus. The unforeseen outcome highlights the unpredictable therapeutic potential of a simple and modestly invasive procedure. The neuropathophysiological interpretation is consequently very interesting.

  17. Computed tomography following paediatric head injury. Computertomographische Verlaufskontrollen nach Schaedel-Hirn-Trauma im Kindesalter

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    Dietrich, U. (Klinikum Essen (Germany, F.R.). Roentgendiagnostisches Zentralinstitut); Lins, E.; Rembrink, K. (Duesseldorf Univ. (Germany, F.R.). Neurochirurgische Klinik)


    38 children with moderate and severe head injuries had CT follow-ups. On initial scans combined lesions dominated over diffuse (diffuse swelling, subarachnoid haemorrhage) and focal lesions (focal swelling, contusions). Contusion showed up until the 6th day after the accident. Two cases of focal lesions could be demonstrated only after intravenous contrast. Up to 40% of the children developed hypodense extracerebral accumulations. Long-term CT follow-ups showed ventricular (84%) and sulcal enlargement (63%) as well as hypodense parenchymal lesions (50%). Combined and diffuse lesions showed a correlation of initial scans and long-term follow-up which could not be demonstrated in case of focal lesions. (orig.).

  18. Evoked potentials and head injury. 1. Rating of evoked potential abnormality. (United States)

    Rappaport, M; Hall, K; Hopkins, H K; Belleza, T


    This paper describes a method for rating the degree of abnormality of auditory, visual and somatosensory evoked potential patterns in head injury (HI) patients. Criteria for judging degree of EP abnormality are presented that allow assessment of the extent and severity of subcortical and cortical dysfunction associated with traumatic brain damage. Interrater reliability data based upon blind ratings of normal and HI patients are presented and shown to be highly significant. Tables of normative values of peak latencies and amplitudes are given and illustrations of EP patterns of different degrees of abnormality are presented.

  19. NIR light propagation in a digital head model for traumatic brain injury (TBI). (United States)

    Francis, Robert; Khan, Bilal; Alexandrakis, George; Florence, James; MacFarlane, Duncan


    Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring.

  20. Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact. (United States)

    Rafaels, Karin A; Cutcliffe, Hattie C; Salzar, Robert S; Davis, Martin; Boggess, Brian; Bush, Bryan; Harris, Robert; Rountree, Mark Steve; Sanderson, Ellory; Campman, Steven; Koch, Spencer; Dale Bass, Cameron R


    Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed "behind armor blunt trauma" (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400-460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear.

  1. Translational Research in Enteral and Parenteral Nutrition Support for Patients with Severe Head Injury

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    LIN Fa-liang; CHI Nan; LI Wei; XIE Lin; WANG Xue-xin


    Objective:To explore the key points of the translational research in enteral and pareenteral nutrition support for patients with severe head injury (SHI), and to analyze the influence of different nutritional support routes on the prognosis of SHI patients. Methods: Totally 141 patients with severe craniocerebral injury were selected as study subjects, 47 cases for each group, and were given early enteral nutrition (EEN), delayed enteral nutrition (DEN), and parenteral nutrition (PN), respectively. The effect of different nutritional support routes on SHI patients was observed. Results: After 14 d of treatment, Glasgow comascale (GCS) scores of 3 groups were higher than treatment before (P Conclusion: EEN support is more conductive to the improvement of the nutrition status, reduction of the incidence of complications, and promotion of the prognosis of SHI patients than DEN and PN.

  2. The relationship between social skill and family problem-solving following very severe closed head injury. (United States)

    Godfrey, H P; Knight, R G; Bishara, S N


    This study examined the relationship between level of social skill and family problem-solving behaviour in a group of 18, community dwelling, very severe closed head injury (CHI) patients who had suffered their injury at least 18 months previously, and who were still in contact with rehabilitation services. The main findings of this study were a positive relationship between CHI patients' level of social skill and their rate of positive effect, and an inverse relationship between the CHI patients' level of social skill and the rate of facilitative behaviour displayed by relatives during problem-solving interactions. It is suggested that socially unskilled CHI patients may be more demanding to interact with, and that this may cause a significant burden for their relatives.

  3. Age related outcome in acute subdural haematoma following traumatic head injury.

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    Hanif, S


    Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH\\'s) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland\\'s national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.

  4. Spillway-induced salmon head injury triggers the generation of brain alphaII-spectrin breakdown product biomarkers similar to mammalian traumatic brain injury. (United States)

    Miracle, Ann; Denslow, Nancy D; Kroll, Kevin J; Liu, Ming Cheng; Wang, Kevin K W


    Recent advances in biomedical research have resulted in the development of specific biomarkers for diagnostic testing of disease condition or physiological risk. Of specific interest are alphaII-spectrin breakdown products (SBDPs), which are produced by proteolytic events in traumatic brain injury and have been used as biomarkers to predict the severity of injury in humans and other mammalian brain injury models. This study describes and demonstrates the successful use of antibody-based mammalian SBDP biomarkers to detect head injury in migrating juvenile Chinook salmon (Oncorhynchus tshawytscha) that have been injured during passage through high-energy hydraulic environments present in spillways under different operational configurations. Mortality and injury assessment techniques currently measure only near-term direct mortality and easily observable acute injury. Injury-based biomarkers may serve as a quantitative indicator of subacute physical injury and recovery, and aid hydropower operators in evaluation of safest passage configuration and operation actions for migrating juvenile salmonids. We describe a novel application of SBDP biomarkers for head injury for migrating salmon. To our knowledge, this is the first documented cross-over use of a human molecular biomarker in a wildlife and operational risk management scenario.

  5. Spillway-induced salmon head injury triggers the generation of brain alphaII-spectrin breakdown product biomarkers similar to mammalian traumatic brain injury.

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    Ann Miracle

    Full Text Available Recent advances in biomedical research have resulted in the development of specific biomarkers for diagnostic testing of disease condition or physiological risk. Of specific interest are alphaII-spectrin breakdown products (SBDPs, which are produced by proteolytic events in traumatic brain injury and have been used as biomarkers to predict the severity of injury in humans and other mammalian brain injury models. This study describes and demonstrates the successful use of antibody-based mammalian SBDP biomarkers to detect head injury in migrating juvenile Chinook salmon (Oncorhynchus tshawytscha that have been injured during passage through high-energy hydraulic environments present in spillways under different operational configurations. Mortality and injury assessment techniques currently measure only near-term direct mortality and easily observable acute injury. Injury-based biomarkers may serve as a quantitative indicator of subacute physical injury and recovery, and aid hydropower operators in evaluation of safest passage configuration and operation actions for migrating juvenile salmonids. We describe a novel application of SBDP biomarkers for head injury for migrating salmon. To our knowledge, this is the first documented cross-over use of a human molecular biomarker in a wildlife and operational risk management scenario.


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    P. A. Sheeju


    Full Text Available BACKGROUND Motor vehicle crashes are a major cause of fatality all over the world. By 2020, motor vehicle injury is projected to become the third leading contributor to the global burden of disease in the world. Motor cyclists are about 25 times more likely than car occupants to die in Road Traffic Accidents. Data on the incidence and types of crashes is required to guide safety policy. Knowledge of how injuries are caused and of what type they are of valuable instrument for identifying interventions and monitoring the effectiveness of intervention. The present study was done to find out the factors that contribute for motor cycle crashes and to study the injury pattern seen in helmeted and non-helmeted victims. MATERIAL AND METHODS Victims of two wheeler accidents brought for autopsy in a Govt. Medical College were studied from October 2010 to August 2011. Two wheelers include motor cycles, scooters and mopeds. Bicycles were excluded from the study. Accidents include all types; against all types of vehicles running on the road, collision with any object, surface or any animal or fall from vehicle. The details of the accident were collected in a printed proforma from relative/witnesses and from police officials. The injuries were entered in the specific columns of proforma. Data was analysed with MS Excel. RESULTS Death due to head injury is more in non-helmeted (52.5% compared to helmeted drivers (43.8 % whereas injury to chest and abdomen and limbs are more in helmeted. Combination of injuries (Head+Chest+Abdomen predominated in helmeted drivers (18.8% compared to 5% in non-helmeted drivers. Spinal injuries were more in helmeted than in non-helmeted. CONCLUSION The pattern of head injury was analysed in detail in helmeted and non-helmeted drivers. This will help in detailing of pattern of head injury in both groups.

  7. How soccer players head the ball: a test of Optic Acceleration Cancellation theory with virtual reality. (United States)

    McLeod, Peter; Reed, Nick; Gilson, Stuart; Glennerster, Andrew


    We measured the movements of soccer players heading a football in a fully immersive virtual reality environment. In mid-flight the ball's trajectory was altered from its normal quasi-parabolic path to a linear one, producing a jump in the rate of change of the angle of elevation of gaze (alpha) from player to ball. One reaction time later the players adjusted their speed so that the rate of change of alpha increased when it had been reduced and reduced it when it had been increased. Since the result of the player's movement was to regain a value of the rate of change close to that before the disturbance, the data suggest that the players have an expectation of, and memory for, the pattern that the rate of change of alpha will follow during the flight. The results support the general claim that players intercepting balls use servo control strategies and are consistent with the particular claim of Optic Acceleration Cancellation theory that the servo strategy is to allow alpha to increase at a steadily decreasing rate.

  8. Profile of patients with head injury among vehicular accidents: An experience from a tertiary care centre of India

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    Manjul Tripathi


    Full Text Available Background: Pattern of injuries among drivers, pillion riders and co-passengers of two and four-wheeler vehicles need to be separately evaluated and addressed. Materials and Methods: A prospective study was conducted on 1545 patients (1314 males and 231 females between 01 April, 2011 to 31 December, 2011, to evaluate the profile of head injury patients due to road traffic accidents, admitted in Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh. Proper subset of cases and controls with or without helmet, seat belt and history of alcohol intake were compared. Data was analyzed to evaluate the incidence, severity, pattern of head injury and outcome of the patients. Results: Male drivers of two-wheeler vehicular accidents (71.4% were most commonly injured. Among helmeted patients, only 4.8% sustained severe head injuries compared to 23.7% of un-helmeted patients. Only full coverage helmets were effective in preventing head injury. Among helmeted patients with a proper chinstrap, 2.6% suffered critical injuries compared to 14% of non-strapped ones. In 142 patients, helmet was at position after the crash and only 0.7% of these sustained severe head injuries. Drunk driving was noticed among 19% and 6% of two- and four-wheeler vehicular occupants, respectively. Only 7.5% of the four-wheel vehicular occupants were wearing seat belt at the time of accident. Conclusions: Injury profile of two- and four-wheeler vehicular accident victims is entirely different. A ready supply of affordable helmets of appropriate quality and strict legislation for safety constraints is the need of the hour for road safety.

  9. [Cerebral salt wasting syndrome secondary to head injury: a case report]. (United States)

    Kawajiri, K; Matsuoka, Y; Kan, M


    A case of cerebral salt wasting syndrome secondary to head injury is reported here. A 4-year-old boy was admitted to our hospital with head injury. Neurological examination revealed no abnormal findings other than consciousness disturbance. Plain skull X-ray demonstrated a linear fracture of the bilateral parietal bones, and CT scan demonstrated subarachnoid hemorrhage of the tentorium of the cerebellum. He gradually improved, but on the 6th day deterioration of consciousness developed. At that time CT scan demonstrated no abnormal findings. Biochemical analysis showed hyponatremia (116mEq/L) with increased natriuresis. Although a high dose of NaCl was supplied, serum sodium levels did not normalize. So we suspected that SIADH might be causing the hyponatremia, and water restriction was started. He lost 1 kg in body weight over 3 days, but serum sodium levels remained low (118mEq/L) with increased natriuresis. We found that the hyponatremia was caused by cerebral salt wasting syndrome, so we treated the patient with fludrocortisone acetate. Consciousness disturbance improved two days after the medication with fludrocortisone acetate, and serum sodium levels became normal (137mEq/L) on the 27th day. The administration of fludrocortisone acetate was able to be stopped two months after admission, and then the patient was discharged without any neurological deficits. We discussed in detail the diagnosis and the treatment of cerebral salt wasting syndrome.

  10. Experimental study of blast-induced traumatic brain injury using a physical head model. (United States)

    Zhang, Jiangyue; Pintar, Frank A; Yoganandan, Narayan; Gennarelli, Thomas A; Son, Steven F


    This study was conducted to quantify intracranial biomechanical responses and external blast overpressures using physical head model to understand the biomechanics of blast traumatic brain injury and to provide experimental data for computer simulation of blast-induced brain trauma. Ellipsoidal-shaped physical head models, made from 3-mm polycarbonate shell filled with Sylgard 527 silicon gel, were used. Six blast tests were conducted in frontal, side, and 45 degrees oblique orientations. External blast overpressures and internal pressures were quantified with ballistic pressure sensors. Blast overpressures, ranging from 129.5 kPa to 769.3 kPa, were generated using a rigid cannon and 1.3 to 3.0 grams of pentaerythritol tetranitrate (PETN) plastic sheet explosive (explosive yield of 13.24 kJ and TNT equivalent mass of 2.87 grams for 3 grams of material). The PETN plastic sheet explosive consisted of 63% PETN powder, 29% plasticizer, and 8% nitrocellulose with a density of 1.48 g/cm3 and detonation velocity of 6.8 km/s. Propagation and reflection of the shockwave was captured using a shadowgraph technique. Shockwave speeds ranging from 423.3 m/s to 680.3 m/s were recorded. The model demonstrated a two-stage response: a pressure dominant (overpressure) stage followed by kinematic dominant (blast wind) stage. Positive pressures in the brain simulant ranged from 75.1 kPa to 1095 kPa, and negative pressures ranged from -43.6 kPa to -646.0 kPa. High- and normal-speed videos did not reveal observable deformations in the brain simulant from the neutral density markers embedded in the midsagittal plane of the head model. Amplitudes of the internal positive and negative pressures were found to linearly correlate with external overpressure. Results from the current study suggested a pressure-dominant brain injury mechanism instead of strain injury mechanism under the blast severity of the current study. These quantitative results also served as the validation and calibration


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    Sudhir Singh


    Full Text Available A clinic pathological study of paediatric head injury was conducted in patients admitted in Gandhi medical college Bhopal during a period of 23 months from June 2011 to M ay 2013. This was done to assess various epidemiological parameters that influence that causation to trauma as well as the consequent morbidity and mortality in the paediatric age group. The study also included analysis of the paediatric age group head injury in relation to the age, sex, mode and type of injury. We also estimated differences in the incidence of recorded traumatic head injury by geographic area. Computerized tomography was done to diagnose the degree of the severity. Patients were classified by Glasgow coma scale and Scandinavian neurotrauma committee classification. It was found that 6 - 9 years of aged male patient with history of fall from height followed by RTA was the most common group. Closed injuries are more common and mostly associated with the orthopedic injuries. Chest infection is most common complication. Prognosis of open injury is better than closed

  12. Topical diagnostics of traumatic condylar injuries and alloplastic reconstruction of temporomandibular joint heads. (United States)

    Gvenetadze, Z; Danelia, T; Nemsadze, G; Gvenetadze, G


    Condylar fractures have an important place in facial traumatic injuries. Classification of condylar fractures according to clinical-anatomic picture is common in clinical practice. According to this classification there are: 1) fractures of mandibular joint head, aka intraarticular fractures, 2) condylar neck fractures or high extra articular fractures, 3) condylar base fractures. Radiographic imaging plays important role in diagnosing condylar fractures along with knowledge of clinical symptoms. We used computer tomography imaging in our clinical practice. Three-dimensional imaging of computer tomography gives exact information about location of condylar fractures, impact of fractured fragments, displacement of condylar head from articular fossa. This method is mostly important for the cases which are hard to diagnose (fractures of mandibular joint head, aka intraarticular fractures). For this group of patients surgical treatment is necessary with the method of arthroplasty. We have observed 5 patients with bilateral, fragmented, high condylar fractures. In all cases the surgery was performed on both sides with bone cement and titanium mini-plates. Long-term effects of the treatment included observation from 6 months to 2 years. In all cases anatomic and functional results were good. Shape of the mandible is restored, opening of mouth 3-3.5 cm, absence of malocclusion.

  13. Head and neck injury patterns in fatal falls: epidemiologic and biomechanical considerations. (United States)

    Freeman, Michael D; Eriksson, Anders; Leith, Wendy


    Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. In the present study, we accessed data regarding head and neck fractures resulting from fatal falls from a Swedish autopsy database for the years 1992-2010, for the purposes of examining the relationships between skull and cervical spine fracture distribution and the circumstances of the fatal fall. Out of 102,310 medico-legal autopsies performed there were 1008 cases of falls associated with skull or cervical spine fractures. The circumstances of the falls were grouped in 3 statistically homogenous categories; falls occurring at ground level, falls from a height of cervical injuries (C0-C1 dislocation, C1 and C2 fractures), and lower cervical fractures. Logistic regression modeling revealed increased odds of skull base and lower cervical fracture in the middle and upper fall severity groups, relative to ground level falls (lower cervical cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base cervical spine fracture in falls from a height are consistent with prior observations that the risk of such injuries is related to the degree of victim inversion at impact. The finding that C0-C1 dislocations are most common in falls from more than 3 m is unique, an indication that the injuries likely result from high energy shear forces rather than pure tension, as previously thought.

  14. Neuroimaging for non-accidental head injury in childhood: A proposed protocol

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    Jaspan, T.; Griffiths, P.D.; McConachie, N.S.; Punt, J.A.G


    Non-accidental head injury (NAHI) is a major cause of neurological disability and death during infancy. Radiological imaging plays a crucial role in evaluating craniospinal injury, both for guiding medical management and the forensic aspects of abusive trauma. The damage sustained is varied, complex and may be accompanied by an evolving pattern of brain injury secondary to a cascade of metabolic and physiological derangements. Regrettably, many cases are poorly or incompletely evaluated leading to diagnostic errors and difficulties in executing subsequent child care or criminal proceedings. It is evident, from cases referred to the authors, that imaging protocols for NAHI are lacking (or only loosely adhered to, if present) in many centres throughout the U.K. Future research in this field will also be hampered if there is a lack of consistent and reliable radiological data. There is no nationally agreed protocol for imaging NAHI. We propose such a protocol, based upon a wide experience in the medical management of child abuse and extensive involvement in the medicolegal aspects of NAHI. Jaspan, T., et al. (2003). Clinical Radiology58, 44--53.

  15. Dislocation of the fibular head in an unusual sports injury: a case report

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    Ahmad Riaz


    Full Text Available Abstract Introduction One of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding. Case presentation A 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint. Conclusion An exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

  16. Vestibular and stabilometric findings in whiplash injury and minor head trauma. (United States)

    Nacci, A; Ferrazzi, M; Berrettini, S; Panicucci, E; Matteucci, J; Bruschini, L; Ursino, F; Fattori, B


    Vertigo and postural instability following whiplash and/or minor head injuries is very frequent. According to some authors, post-whiplash vertigo cannot be caused by real injury to vestibular structures; other authors maintain that vestibular damage is possible even in the case of isolated whiplash, with vascular or post-traumatic involvement. Furthermore, many of the balance disorders reported after trauma can be justified by post-traumatic modification to the cervical proprioceptive input, with consequent damage to the vestibular spinal reflex. The aim of this study was to evaluate the vestibular condition and postural status in a group of patients (Group A, n = 90) affected with balance disorders following whiplash, and in a second group (Group B, n = 20) with balance disorders after minor head injury associated with whiplash. Both groups were submitted to videonystagmography (VNG) and stabilometric investigation (open eyes - O E, closed eyes - CE, closed eyes with head retroflexed - CER) within 15 days of their injuries and repeated within 10 days after conclusion of cervical physiotherapy treatment. The VNG tests revealed vestibulopathy in 19% of cases in Group A (11% peripheral, 5% central, 3% in an undefined site) and in 60% of subjects in Group B (50% peripheral, 10% central). At the follow-up examination, all cases of non-compensated labyrinth deficit showed signs of compensation, while there were two cases (2%) in Group A and one case (5%) in Group B of PPV. As far as the altered posturographic recordings are concerned, while there was no specific pattern in the two groups, they were clearly pathologic, especially during CER. Both in OE and in CE there was an increase in the surface values and in those pertaining to shifting of the gravity centre on the sagittal plane, which was even more evident during CER. In Group A, the pre-post-physiotherapy comparison of CER results showed that there was a statistically significant improvement in the majority of the

  17. A mouse model of weight-drop closed head injury:emphasis on cognitive and neurological deifciency

    Institute of Scientific and Technical Information of China (English)

    Igor Khalin; Nor Laili Azua Jamari; Nadiawati Bt Abdul Razak; Zubaidah Bt Hasain; Mohd Asri bin Mohd Nor; Mohd Hakimi bin Ahmad Zainudin; Ainsah Bt Omar; Renad Alyautdin


    Traumatic brain injury (TBI) is a leading cause of death and disability in individuals worldwide. Produc-ing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modiifcations concerning cognitive deifciency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.

  18. A seven-year study on head injuries in infants, Iran the changing pattern

    Institute of Scientific and Technical Information of China (English)

    Esmaeil Fakharian; Mahdi Mohammadzadeh; Samin Behdad; Atoosa Babamohammadi; Azadeh Sadat Mirzadeh; Javad Mohammadzadeh


    Objective:Head injury (HI) is the leading cause of mortality and life-long disability in infants.Infants have different anatomical and pathophysiological brain structures from other age groups.The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan,Iran from 2004 to 2010,and to identify the causes of His in this age group.Methods:In this retrospective study,all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study.Demographic,etiologic,and injury data were collected and a descriptive analysis was performed.Results:Infants comprised 20.8% of all children (under 15 years old) with His and 65.1% of the injuries occurred in the home.Falls were the most common cause of injury (63.4%).In hospital mortality was 6.6 per 100 000 infants.A decreasing trend was seen in home events,but His caused by traffic accidents were increasing during the study period.The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010.Conclusion:Although home events and falling are the main causes of infant HIs and need attention,our study showed an increase of HIs caused by road traffic accidents,especially by car accidents,thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed.

  19. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin;


    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury ...

  20. Can low serum levels of S100B predict normal CT findings after minor head injury in adults?: an evidence-based review and meta-analysis

    DEFF Research Database (Denmark)

    Undén, Johan; Romner, Bertil


    To determine whether low levels of S100B in serum can predict normal computed tomography (CT) findings after minor head injury (MHI) in adults.......To determine whether low levels of S100B in serum can predict normal computed tomography (CT) findings after minor head injury (MHI) in adults....

  1. Imaging of penetrating injuries of the head and neck:current practice at a level I trauma center in the United States. (United States)

    Saito, Naoko; Hito, Rania; Burke, Peter A; Sakai, Osamu


    Penetrating neck injuries are commonly related to stab wounds and gunshot wounds in the United States. The injuries are classified by penetration site in terms of the three anatomical zones of the neck. Based on this zonal classification system, penetrating injuries to the head and neck have traditionally been evaluated by conventional angiography and/or surgical exploration. In recent years, multidetector-row computed tomography (CT) angiography has significantly improved detectability of vascular injuries and extravascular injuries in the setting of penetrating injuries. CT angiography is a fast and minimally invasive imaging modality to evaluate penetrating injuries of the head and neck for stable patients. The spectrum of penetrating neck injuries includes vascular injury (extravasation, pseudoaneurysm, dissection, occlusion, and arteriovenous fistula), aerodigestive injury (esophageal and tracheal injuries), salivary gland injury, neurologic injury (spinal canal and cerebral injuries), and osseous injury, all of which can be evaluated using CT angiography. Familiarity with the complications and imaging characteristics of penetrating injuries of the head and neck is essential for accurate diagnosis and optimal treatment.

  2. [Treatment of head injury coma with prolonged pentobarbital anaesthesia (author's transl)]. (United States)

    Artru, F; Guerin, J M; Latarjet, J; Deleuze, R


    Forty-five patients in deep coma resulting from head injury were treated with pentobarbital in doses adjusted to maintain serum barbiturate levels between 15 and 25 mg/l and short burst suppression phases on EEG. Brain death occurred in 20%. The overall mortality rate was 60%, no death being attributable to treatment; 24% of the patients were able to resume active life. Patients with non-reactive pupils during the early phase of coma were compared with patients of similar ages and neurological symptoms non treated with pentobarbital. In treated patients the incidence of brain death was reduced by 50% and the mortality rate by 25% (p less than 0.05), without increase in deaths from intercurrent complications and in severe sequelae among survivors.

  3. Prospective survey on neurosurgical intensive care for patients with severe head injury

    Institute of Scientific and Technical Information of China (English)


    Objective: To prospectively compare the clinical outcome ofintensive care therapy (ICT) with that of conventional care therapy (CCT) in severe head injured patients.Methods: Patients with severe head injury were assigned randomly into Group ICT and Group CCT, 100 patients in each group. Patients in Group ICT accepted intensive care therapy in neurosurgical intensive care (NIC) unit for the first 2 weeks after admission, while patients in Group CCT accepted conventional care therapy in ordinary ward. The outcomes were evaluated 3 months after injury.Results: There was a significant increase in good recovery (54%) (χ2=4.43, P<0.05) and significant decrease of death (25%) (χ2=4.50, P<0.05) in Group ICT compared to 39% and 39% in Group CCT respectively. The differences were also confirmed statistically in the following aspects: the patients under 50 years with good recovery pronounced a number increase (χ2=7.54, P<0.01), while the mortality in the same range of age was decreased in Group ICT (χ2=5.28, P<0.05). The mortality was reduced significantly in patients with GCS for 6-8 on admission (χ2=8.47, P<0.01) and in patients with the level of brain stem injured bellow mesencephalon (χ2=4.15, P<0.05). ICT would improve the outcome in patients undergoing conservative therapy only (χ2=13.13, P<0.01).Conclusions: NIC plays an important role in assessing the neurological state, guiding management, evaluating curative effect and estimating the outcome.

  4. Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    J Y Chinda


    Full Text Available Background: Paediatric head injury (HI is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. Patients and Methods: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. Results: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7% were boys and 15 (33.3% were girls. Three (6.7% children were less than 1 year of age, 21 (46.7% were between 1 years and 6 years while 16 (35.6% and 5 (11.0% were aged 7-11 years and 12-15 years respectively. Thirty six (80.0% of the children were pedestrians, 6 (13.4% fell from a height, while 2 (4.4% and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7% had mild HI, while 53.3% had moderate to severe category. Forty one (91.1% of children were managed as in-patients, mostly (95.1% by conservative non-operative management, while 4 (8.9% were treated on the out-patient basis. The mortality rate was 17.8%. Conclusion: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

  5. The usefulness of diffusion tensor imaging in detection of diffuse axonal injury in a patient with head trauma

    Institute of Scientific and Technical Information of China (English)

    Hyeok Gyu Kwon; Sung Ho Jang


    Diffuse axonal injury is the predominant mechanism of injuries in patients with traumatic brain injury. Neither conventional brain computed tomography nor magnetic resonance imaging has shown sufficient sensitivity in the diagnosis of diffuse axonal injury. In the current study, we attempted to demonstrate the usefulness of diffusion tensor imaging in the detection of lesion sites of diffuse axonal injury in a patient with head trauma who had been misdiagnosed as having a stroke. A 44-year-old man fell from a height of about 2 m. Brain magnetic resonance imaging (32 months after onset) showed leukomalactic lesions in the isthmus of the corpus callosum and the left temporal lobe. He presented with mild quadriparesis, intentional tremor of both hands, and trunkal ataxia. From diffusion tensor imaging results of 33 months after traumatic brain injury onset, we found diffuse axonal injury in the right corticospinal tract (centrum semiovale, pons), both fornices (columns and crus), and both inferior cerebellar peduncles (cerebellar portions). We think that diffusion tensor imaging could be a useful tool in the detection of lesion sites of diffuse axonal injuryin patients with head trauma.

  6. Head injury resulting from scooter accidents in Rome: Differences before and after implementing a universal helmet law

    NARCIS (Netherlands)

    G. La Torre (Giuseppe); E.F. van Beeck (Ed); G. Bertazzoni (Giuliano); W. Ricciardi


    textabstractObjectives: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. Methods: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital 'Umber

  7. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward. (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A


    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  8. Construct Validity of WAIS-R Factors: Neuropsychological Test Correlates in Adults Referred for Evaluation of Possible Head Injury. (United States)

    Sherman, Elisabeth M. S.; And Others


    A 3-factor solution of the Wechsler Adult Intelligence Scale--Revised (WAIS-R) in 260 adults with suspected head injury suggested relatively good construct validity for the factors, based on correlations with neuropsychological tests. Findings are discussed in terms of the multidimensional nature of neuropsychological tests and WAIS-R factors.…

  9. Indices of slowness of information processing in head injury patients : Tests for selective attention related to ERP latencies

    NARCIS (Netherlands)

    Spikman, Jacoba M.; Naalt, van der Joukje; Weerden , van Tiemen; Zomeren , van Adriaan H.


    We explored the relation between neuropsychological (attention tests involving time constraints) and neurophysiological (N2 and P3 event-related potential (ERP) latencies) indices of slowness of information processing after closed head injury (CHI). A group of 44 CHI patients performed worse than he

  10. Indices of slowness of information processing in head injury patients: Tests for selective attention related to ERP latencies

    NARCIS (Netherlands)

    van der Naalt, Joukje; Spikman, Jacoba; van Weerden, Tiemen; van Zomeren, Adriaan


    We explored the relation between neuropsychological (attention tests involving time constraints) and neurophysiological (N2 and P3 event-related potential (ERP) latencies) indices of slowness of information processing after closed head injury (CHI). A group of 44 CHI patients performed worse than he

  11. Computed tomography and magnetic resonance imaging in mild to moderate head injury : Early and late imaging related to outcome

    NARCIS (Netherlands)

    van der Naalt, J; Hew, JM; van Zomeren, AH; Sluiter, WJ; Minderhoud, JM


    Serial magnetic resonance imaging (MRI) and computed tomographic (CT) studies were performed in mild to moderate head injury to evaluate whether early and late imaging have additional value in predicting outcome in this category of patients. During 1-year follow-up of a series of 67 patients, a CT s

  12. The contribution of alcohol to fatal traumatic head injuries in the forensic setting.

    LENUS (Irish Health Repository)

    Cryan, J


    Excessive drinking increases the risk of dying unnaturally. In the Republic of Ireland such deaths are referred to the State Pathologist. Blood alcohol concentration (BAC) is routinely measured. We created a database of cases presenting to the State Pathologist over a nine year period (2000-2008 inclusive) to evaluate the relationship between alcohol and fatal traumatic brain injuries (FTBI). Of a total of 1778 cases, 332 (275 Male [M]; 57 Female [F]) died of head injuries. Fatalities were highest in males aged 36-50 (N = 97) and 26-35 (N = 73). Assaults (N = 147), falls (N = 95), road traffic accidents (RTA) (N = 50) and suicide (N = 15) were the commonest modes of presentation. A positive blood alcohol concentration (BAC) was found in 36% of assaults, 41% of falls and 40% of suicides. In the RTA group BAC was positive in 59% of pedestrians, 33% of drivers and 14% of passengers. Alcohol clearly plays a significant role in FTBI in the forensic setting.

  13. Translational Research in Enteral and Parenteral Nutrition Support for Patients with Severe Head Injury

    Directory of Open Access Journals (Sweden)

    Fa-liang LIN


    Full Text Available Abstract Objective: To explore the key points of the translational research in enteral and pareenteral nutrition support for patients with severe head injury (SHI, and to analyze the influence of different nutritional support routes on the prognosis of SHI patients. Methods: Totally 141 patients with severe craniocerebral injury were selected as study subjects, 47 cases for each group, and were given early enteral nutrition (EEN, delayed enteral nutrition (DEN, and parenteral nutrition (PN, respectively. The effect of different nutritional support routes on SHI patients was observed. Results: After 14 d of treatment, Glasgow coma scale (GCS scores of 3 groups were higher than treatment before (P<0.01, and with statistical differences among groups (P<0.05, or P<0.01. The levels of serum albumin, total serum protein and hemoglobin were higher in EEN group than the other groups (P<0.01. The level of serum albumin was lower in PN group than in DEN group (P<0.05. There were statistical differences in the incidence of complications among three groups (χ2=9.2487, P=0.0098. Conclusion: EEN support is more conductive to the improvement of the nutrition status, reduction of the incidence of complications, and promotion of the prognosis of SHI patients than DEN and PN.

  14. Repeated Closed Head Injury in Mice Results in Sustained Motor and Memory Deficits and Chronic Cellular Changes.

    Directory of Open Access Journals (Sweden)

    Amanda N Bolton Hall

    Full Text Available Millions of mild traumatic brain injuries (TBIs occur every year in the United States, with many people subject to multiple head injuries that can lead to chronic behavioral dysfunction. We previously reported that mild TBI induced using closed head injuries (CHI repeated at 24h intervals produced more acute neuron death and glial reactivity than a single CHI, and increasing the length of time between injuries to 48h reduced the cumulative acute effects of repeated CHI. To determine whether repeated CHI is associated with behavioral dysfunction or persistent cellular damage, mice receiving either five CHI at 24h intervals, five CHI at 48h intervals, or five sham injuries at 24h intervals were evaluated across a 10 week period after injury. Animals with repeated CHI exhibited motor coordination and memory deficits, but not gait abnormalities when compared to sham animals. At 10wks post-injury, no notable neuron loss or glial reactivity was observed in the cortex, hippocampus, or corpus callosum. Argyrophilic axons were found in the pyramidal tract of some injured animals, but neither silver stain accumulation nor inflammatory responses in the injury groups were statistically different from the sham group in this region. However, argyrophilic axons, microgliosis and astrogliosis were significantly increased within the optic tract of injured animals. Repeated mild CHI also resulted in microgliosis and a loss of neurofilament protein 200 in the optic nerve. Lengthening the inter-injury interval from 24h to 48h did not effectively reduce these behavioral or cellular responses. These results suggest that repeated mild CHI results in persistent behavioral dysfunction and chronic pathological changes within the visual system, neither of which was significantly attenuated by lengthening the inter-injury interval from 24h to 48h.

  15. Caregivers' voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood. (United States)

    Wharewera-Mika, Julie; Cooper, Erana; Kool, Bridget; Pereira, Susana; Kelly, Patrick


    Head injury is a leading cause of mortality and acquired neurological impairment in children. Head-injured children may have neurobehavioural deficits that persist for years following injury. Head injury can result in significant and persistent caregiver burden, including mental health issues, family stress and disorganisation, and unmet social and healthcare service needs. Few studies have examined the healthcare and social service needs of children and their families following head injury sustained at an early age. This qualitative study aims to describe the experiences of caregivers of children who sustained a serious head injury (particularly non-accidental head injury) before the age of 2 years. Caregivers were interviewed up to 15 years following the initial injury. Semi-structured interviews with 21 caregivers of 15 children (aged 3-15 years at the time of interview) were completed. Thematic analysis of interview data generated three key themes: impact, support and information. The study's findings reveal the broad impact of serious childhood head injury on caregivers, specifically the significant distress and burden brought about through lack of information, challenges in accessing support and inconsistent care. Recommendations for developing a quality 'model of care' and improving ease of access to supports for caregivers are provided.

  16. Lipopolysaccharide preconditioning prevents acceleration of kindling epileptogenesis induced by traumatic brain injury. (United States)

    Eslami, Mansoureh; Sayyah, Mohammad; Soleimani, Mansoureh; Alizadeh, Leila; Hadjighassem, Mahmoudreza


    10-20% of symptomatic epilepsies are post-traumatic. We examined effect of LPS preconditioning on epileptogenesis after controlled cortical impact (CCI). LPS (0.01, 0.1 and 0.5 mg/kg) was injected i.p. to rats 5 days before induction of CCI to parieto-temporal cortex. Kindling started 24h after CCI by i.p. injection of 30 mg/kg of pentylenetetrazole every other day until manifestation of 3 consecutive generalized seizures. CCI injury accelerated the rate of kindled seizures acquisition. LPS (0.1 and 0.5 mg/kg) prevented the acceleration of kindling. LPS preconditioning significantly decreased IL-1β and TNF-α over-expression and the number of damaged neurons in the hippocampus of traumatic rats.

  17. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis

    DEFF Research Database (Denmark)

    Bourhis, J.; Overgaard, Jens; Audry, H.


    -specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction. FINDINGS: 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer...

  18. Early insulin resistance in severe trauma without head injury as outcome predictor? A prospective, monocentric pilot study

    Directory of Open Access Journals (Sweden)

    Bonizzoli Manuela


    Full Text Available Abstract Background Hyperglycemia following major trauma is a well know phenomenon related to stress-induced systemic reaction. Reports on glucose level management in patients with head trauma have been published, but the development of insulin resistance in trauma patients without head injury has not been extensively studied. The aim of this study was therefore to investigate the prognostic role of acute insulin-resistance, assessed by the HOMA model, in patients with severe trauma without head injury. Methods All patients consecutively admitted to the Intensive Care Unit (ICU of a tertiary referral center (Careggi Teaching Hospital, Florence, IT for major trauma without head injury (Jan-Dec 2010 were enrolled. Patients with a previous diagnosis of diabetes mellitus requiring insulin therapy or metabolism alteration were excluded from the analysis. Patients were divided into “insulin resistant” and “non-insulin resistant” based on the Homeostasis Model Assessment index (HOMA IR. Results are expressed as medians. Results Out of 175 trauma patients admitted to the ICU during the study period, a total of 54 patients without head trauma were considered for the study, 37 of whom met the inclusion criteria. In total, 23 patients (62.2% resulted insulin resistant, whereas 14 patients (37.8% were non-insulin resistant. Groups were comparable in demographic, clinical/laboratory characteristics, and severity of injury. Insulin resistant patients had a significantly higher BMI (P=0.0416, C-reactive protein (P=0.0265, and leukocytes count (0.0301, compared to non-insulin resistant patients. Also ICU length of stay was longer in insulin resistant patients (P=0.0381. Conclusions Our data suggest that admission insulin resistance might be used as an early outcome predictor.

  19. Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)


    To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

  20. An accelerator-based epithermal neutron beam design for BNCT and dosimetric evaluation using a voxel head phantom. (United States)

    Lee, Deok-jae; Han, Chi Young; Park, Sung Ho; Kim, Jong Kyung


    The beam shaping assembly design has been investigated in order to improve the epithermal neutron beam for accelerator-based boron neutron capture therapy in intensity and quality, and dosimetric evaluation for the beams has been performed using both mathematical and voxel head phantoms with MCNP runs. The neutron source was assumed to be produced from a conventional 2.5 MeV proton accelerator with a thick (7)Li target. The results indicate that it is possible to enhance epithermal neutron flux remarkably as well as to embody a good spectrum shaping to epithermal neutrons only with the proper combination of moderator and reflector. It is also found that a larger number of thermal neutrons can reach deeply into the brain and, therefore, can reduce considerably the treatment time for brain tumours. Consequently, the epithermal neutron beams designed in this study can treat more effectively deep-seated brain tumours.

  1. Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Landon A. Jones


    Full Text Available Introduction: Traumatic brain injury (TBI is a significant health concern. While 70-90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP clinical recommendations regarding indications for a non-contrast head computed tomography (CT in patients with mild TBI. Methods: We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old and presence or absence of visible trauma above the clavicles. A single important question was asked: “Would you perform a non-contrast head CT on this patient?” Results: Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61, decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles. Conclusion: Respondents poorly differentiated the “older” patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem.

  2. Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study (United States)

    Marín-Caballos, Antonio J; Murillo-Cabezas, Francisco; Cayuela-Domínguez, Aurelio; Domínguez-Roldán, Jose M; Rincón-Ferrari, M Dolores; Valencia-Anguita, Julio; Flores-Cordero, Juan M; Muñoz-Sánchez, M Angeles


    Introduction Higher and lower cerebral perfusion pressure (CPP) thresholds have been proposed to improve brain tissue oxygen pressure (PtiO2) and outcome. We study the distribution of hypoxic PtiO2 samples at different CPP thresholds, using prospective multimodality monitoring in patients with severe traumatic brain injury. Methods This is a prospective observational study of 22 severely head injured patients admitted to a neurosurgical critical care unit from whom multimodality data was collected during standard management directed at improving intracranial pressure, CPP and PtiO2. Local PtiO2 was continuously measured in uninjured areas and snapshot samples were collected hourly and analyzed in relation to simultaneous CPP. Other variables that influence tissue oxygen availability, mainly arterial oxygen saturation, end tidal carbon dioxide, body temperature and effective hemoglobin, were also monitored to keep them stable in order to avoid non-ischemic hypoxia. Results Our main results indicate that half of PtiO2 samples were at risk of hypoxia (defined by a PtiO2 equal to or less than 15 mmHg) when CPP was below 60 mmHg, and that this percentage decreased to 25% and 10% when CPP was between 60 and 70 mmHg and above 70 mmHg, respectively (p < 0.01). Conclusion Our study indicates that the risk of brain tissue hypoxia in severely head injured patients could be really high when CPP is below the normally recommended threshold of 60 mmHg, is still elevated when CPP is slightly over it, but decreases at CPP values above it. PMID:16356218

  3. Underbody Blast Models of TBI Caused by Hyper-Acceleration and Secondary Head Impact (United States)


    2006. 21Nahum, A. M., and J. Melvin. Accidental injury: biome- chanics and prevention. Berlin: Springer, 2002. 22Nilsson, B., U. Ponten, and G. Voigt...despite findings of white matter axonal injury and cerebrovascular damage.21 In this study we used Y maze and Elevated Plus maze tests for hippocampus...Expression of neurosynaptic proteins In addition to cerebrovascular damage, inflammation, and neuronal death, significant disruption to

  4. Comparison of two methods for assessing leakage radiation dose around the head of the medical linear accelerators

    Institute of Scientific and Technical Information of China (English)

    Ehab M Attalla


    Objective:The aim of this study was to measure the leakage by two methods with ion chamber and ready packs film, and to investigate the feasibility and the advantages of using two dosimetry methods for assessing leakage radiation around the head of the linear accelerators. Methods:Measurements were performed using a 30 cm3 ion chamber;the gantry at 0°, the X-ray head at 0°, the field size at between the central axis and a plane surface at a FSD of 100 as a reference, a series of concentric circles having radi of 50, 75, and 100 cm with their common centre at the reference point. The absorbed dose was measured at the reference point, and this would be used as the reference dose. With the diaphragm closed, the measurements were taken along the circumference of the three circles and at 45° intervals. Results:Leakage radiations while the treatment head was in the vertical position varied between 0.016%–0.04%. With the head lying horizontal y, leak-age radiation was the same order magnitude and varied between 0.02%–0.07%. In the second method, the verification was accomplished by closing the col imator jaws and covering the head of the treatment unit with the ready pack films. The films were marked to permit the determination of their positions on the machine after exposed and processed. With the diaphragm closed, and the ready packs films around the linear accelerator the beam turned on for 2500 cGy (2500 MU). The optical den-sity of these films was measured and compared with this of the reference dose. Leakage radiation varied according to the film positions and the magnitude of leakage was between 0.005%–0.075%. Conclusion:The dif erences between the values of the leakage radiation levels observed at dif erent measurement points do not only reflect dif erences in the ef ective shielding thickness of the head wal , but are also related to dif erences in the distances between the target and the measurement points. The experimental errors involved in dosimetric

  5. Head, Face, and Neck Injuries During Operation Iraqi Freedom II: Results From the US Navy and Marine Corps Combat Trauma Registry (United States)


    injuries at Navy–Marine Corps military medical treatment facilities (MTFs). Examples of Navy–Marine Corps MTFs include battalion aids stations (ie...incident details, injuries , treatment , and outcomes is collected by the patient’s medical provider(s) in the form of a clinical record. Clinical...and mouth; and neck injuries included trauma to cervical area and cervical spine. Head, Face, and Neck Injuries During OIF-II 7 Descriptive

  6. Study the efficacy of neuroprotective drugs on brain physiological properties during focal head injury using optical spectroscopy data analysis (United States)

    Abookasis, David; Shochat, Ariel


    We present a comparative evaluation of five different neuroprotective drugs in the early phase following focal traumatic brain injury (TBI) in mouse intact head. The effectiveness of these drugs in terms of changes in brain tissue morphology and hemodynamic properties was experimentally evaluated through analysis of the optical absorption coefficient and spectral reduced scattering parameters in the range of 650-1000 nm. Anesthetized male mice (n=50 and n=10 control) were subjected to weight drop model mimics real life focal head trauma. Monitoring the effect of injury and neuroprotective drugs was obtained by using a diffuse reflectance spectroscopy system utilizing independent source-detector separation and location. Result indicates that administration of minocycline improve hemodynamic and reduced the level of tissue injury at an early phase post-injury while hypertonic saline treatment decrease brain water content. These findings highlight the heterogeneity between neuroprotective drugs and the ongoing controversy among researchers regarding which drug therapy is preferred for treatment of TBI. On the other hand, our results show the capability of optical spectroscopy technique to noninvasively study brain function following injury and drug therapy.

  7. Applying DTI white matter orientations to finite element head models to examine diffuse TBI under high rotational accelerations.

    LENUS (Irish Health Repository)

    Colgan, Niall C


    The in-vivo mechanical response of neural tissue during impact loading of the head is simulated using geometrically accurate finite element (FE) head models. However, current FE models do not account for the anisotropic elastic material behaviour of brain tissue. In soft biological tissue, there is a correlation between internal microscopic structure and macroscopic mechanical properties. Therefore, constitutive equations are important for the numerical analysis of the soft biological tissues. By exploiting diffusion tensor techniques the anisotropic orientation of neural tissue is incorporated into a non-linear viscoelastic material model for brain tissue and implemented in an explicit FE analysis. The viscoelastic material parameters are derived from published data and the viscoelastic model is used to describe the mechanical response of brain tissue. The model is formulated in terms of a large strain viscoelastic framework and considers non-linear viscous deformations in combination with non-linear elastic behaviour. The constitutive model was applied in the University College Dublin brain trauma model (UCDBTM) (i.e. three-dimensional finite element head model) to predict the mechanical response of the intra-cranial contents due to rotational injury.

  8. Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing

    Directory of Open Access Journals (Sweden)

    Sunanda Sharma


    Full Text Available Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response.The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.

  9. Continuous Hyperfractionated Accelerated Radiation Therapy In Head And Neck Cancers- A Pilot Study

    Directory of Open Access Journals (Sweden)

    Thejaswini B


    Conclusion:CHART achieves good locoregional response in stages III and IV of head and neck cancer. The acute mucosal reactions were within acceptable limits. The compliance to the treatment was good. [Natl J Med Res 2014; 4(3.000: 218-221

  10. Accelerated reendothelialization, increased neovascularization and erythrocyte extravasation after arterial injury in BAMBI-/- mice.

    Directory of Open Access Journals (Sweden)

    Nicolas Guillot

    Full Text Available BACKGROUND: Intimal injury rapidly activates TGFβ and enhances vascular repair by the growth of endothelial (EC and vascular smooth muscle cells (VSMC. The response to the TGFβ family of growth factors can be modified by BAMBI (BMP, Activin, Membrane Bound Inhibitor acting as a non-signaling, competitive antagonist of TGFβ type I receptors such as ALK 1 and 5. In vivo the effect of BAMBI will depend on its cell-specific expression and of that of the ALK type receptors. We recently reported EC restricted BAMBI expression and genetic elimination of BAMBI resulting in an in vitro and in vivo phenotype characterized by endothelial activation and proliferation involving alternative pathway activation by TGFβ through ALK 1. METHODOLOGY/PRINCIPAL FINDINGS: To test the hypothesis that BAMBI modulates arterial response to injury via its effects on endothelial repair and arterial wall neovascularization we used a model of femoral arterial denudation injury in wild type (WT and BAMBI(-/- mice. Arterial response was evaluated at 2 and 4 weeks after luminal endothelial denudation of femoral arteries. The BAMBI(-/- genotype mice showed accelerated luminal endothelial repair at 2 weeks and a highly unusual increase in arterial wall neovascularization compared to WT mice. The exuberant intimal and medial neovessel formation with BAMBI(-/- genotype was also associated with significant red blood cell extravasation. The bleeding into the neointima at 2 weeks transiently increased it's area in the BAMBI(-/-genotype despite the faster luminal endothelial repair in this group. Vascular smooth muscle cells were decreased at 2 weeks in BAMBI(-/- mice, but comparable to wild type at 4 weeks. CONCLUSIONS/SIGNIFICANCE: The absence of BAMBI results in a highly unusual surge in arterial wall neovascularization that surprisingly mimiks features of intra-plaque hemorrhage of advanced atheroma in a mechanical injury model. This suggests important effects of BAMBI on

  11. Repeat cranial tomography in patients with mild head injury and stable neurological examination - a perspective from a developing country

    Institute of Scientific and Technical Information of China (English)

    Sadaf Nasir; Manzar Hussain


    Objective: To determine the frequency of altered findings on repeat cranial tomography (CT) in patients with mild head injury along with stable neurological examination at tertiary care hospital.Methods: Cross-sectional study was done in the Department of Radiology, Liaquat National Hospital, Karachi from January 2008 to September 2010. All patients with mild head injury in terms of Glasgow Coma Scale (GCS) who underwent repeat scan without clinical or neurological deterioration in the emergency department of a tertiary care centre were included. The collected data were accordingly entered and analyzed by the principal investigator using Statistical Package for Social Sciences (SPSS) version 16.0.Results: In all 275 patients, only 17 (6%) of the patients were found worseing on repeat CT, 120 (43.63%)scans improved, 138 (50.18%) unchanged and 17 (6.18%)worsened. None of these patients showed signs of clinical deterioration.Conclusion: Our results suggest that for patients with mild head injury and stable neurological examination, only 6% of them show deterioration on repeat CT, especially when patients' GCS is below 13.


    Gong, Jie; Liu, Hong; Wu, Jing; Qi, Hong; Wu, Zhou-Yang; Shu, Hua-Qing; Li, Hong-Bin; Chen, Lin; Wang, Ya-Xin; Li, Bo; Tang, Min; Ji, Yu-Dong; Yuan, Shi-Ying; Yao, Shang-Long; Shang, You


    Acute lung injury (ALI) is characterized by lung inflammation and diffuse infiltration of neutrophils. Neutrophil apoptosis is recognized as an important control point in the resolution of inflammation. Maresin 1 (MaR1) is a new docosahexaenoic acid-derived proresolving agent that promotes the resolution of inflammation. However, its function in neutrophil apoptosis is unknown. In this study, isolated human neutrophils were incubated with MaR1, the pan-caspase inhibitor z-VAD-fmk, and lipopolysaccharide (LPS) to determine the mechanism of neutrophil apoptosis. Acute lung injury was induced by intratracheal instillation of LPS. In addition, mice were treated with MaR1 intravenously at the peak of inflammation and administered z-VAD-fmk intraperitoneally. We found that culture of isolated human neutrophils with LPS dramatically delayed neutrophil apoptosis through the phosphorylation of AKT, ERK, and p38 to upregulate the expression of the antiapoptotic proteins Mcl-1 and Bcl-2, which was blocked by pretreatment with MaR1 in vitro. In mice, MaR1 accelerated the resolution of inflammation in LPS-induced ALI through attenuation of neutrophil accumulation, pathohistological changes, and pulmonary edema. Maresin 1 promoted resolution of inflammation by accelerating caspase-dependent neutrophil apoptosis. Moreover, MaR1 also reduced the LPS-induced production of proinflammatory cytokines and upregulated the production of the anti-inflammatory cytokine interleukin-10. In contrast, treatment with z-VAD-fmk inhibited the proapoptotic action of MaR1 and attenuated the protective effects of MaR1 in LPS-induced ALI. Taken together, MaR1 promotes the resolution of LPS-induced ALI by overcoming LPS-mediated suppression of neutrophil apoptosis.

  13. Head Impact Laboratory (HIL) (United States)

    Federal Laboratory Consortium — The HIL uses testing devices to evaluate vehicle interior energy attenuating (EA) technologies for mitigating head injuries resulting from head impacts during mine/...

  14. Minor head injury in anticoagulated patients: a 6-year retrospective analysis in an emergency department

    Directory of Open Access Journals (Sweden)

    Alessandro Riccardi


    Full Text Available The appropriate management of minor head injury (MHI in patients receiving oral anticoagulant (OAC is unclear. In this retrospective study, we focused on elderly patients (>65 years treated with OAC, presented to our emergency department with MHI between 2004 and 2010. Three hundred and six patients with MHI were taking OAC: we documented 7.19% hemorrhages at the first computed tomography (C; 18.19% deaths; 50.1% spontaneous reabsorptions; 22.73% deteriorations of intracranial bleeding without surgical intervention (for clinical comorbidity, and 4.55% neurosurgical interventions. We documented a second positive CT scan in 2 patients (1.51% who had no symptoms and remained asymptomatic during observation. In both cases, intracranial bleeding resolved spontaneously. The mean international normalized ratio (INR value was 2.26, higher in the group of patients with bleeding (2.74 than in the group without bleeding (2.19. We found a significant increased risk in patients with posttraumatic loss of consciousness [odds ratio (OR 28.3], diffuse headache (OR 14.79, vomiting (OR 14.2 and neurological signs (OR 5.27. We did not reach significance in patients with post-traumatic amnesia. Our data confirm the need for a CT scan of any patients on OAC with MHI. None of our patients developed any symptoms or signs during observation, and only 2 patients developed an intracranial hemorrhage in the second CT scan with a favorable evolution. Our data need to be confirmed with an observational study, but we suggest that the second CT could be reserved for patients developing symptoms and signs during observation. We also underline the role of the INR in the stratification of risk.

  15. Deficiency of complement receptors CR2/CR1 in Cr2⁻/⁻ mice reduces the extent of secondary brain damage after closed head injury. (United States)

    Neher, Miriam D; Rich, Megan C; Keene, Chesleigh N; Weckbach, Sebastian; Bolden, Ashley L; Losacco, Justin T; Patane, Jenée; Flierl, Michael A; Kulik, Liudmila; Holers, V Michael; Stahel, Philip F


    Complement activation at the C3 convertase level has been associated with acute neuroinflammation and secondary brain injury after severe head trauma. The present study was designed to test the hypothesis that Cr2-/- mice, which lack the receptors CR2/CD21 and CR1/CD35 for complement C3-derived activation fragments, are protected from adverse sequelae of experimental closed head injury. Adult wild-type mice and Cr2-/- mice on a C57BL/6 genetic background were subjected to focal closed head injury using a standardized weight-drop device. Head-injured Cr2-/- mice showed significantly improved neurological outcomes for up to 72 hours after trauma and a significantly decreased post-injury mortality when compared to wild-type mice. In addition, the Cr2-/- genotype was associated with a decreased extent of neuronal cell death at seven days post-injury. Western blot analysis revealed that complement C3 levels were reduced in the injured brain hemispheres of Cr2-/- mice, whereas plasma C3 levels remained unchanged, compared to wild-type mice. Finally, head-injured Cr2-/- had an attenuated extent of post-injury C3 tissue deposition, decreased astrocytosis and microglial activation, and attenuated immunoglobulin M deposition in injured brains compared to wild-type mice. Targeting of these receptors for complement C3 fragments (CR2/CR1) may represent a promising future approach for therapeutic immunomodulation after traumatic brain injury.

  16. Biomechanism of impact resistance in the woodpecker's head and its application. (United States)

    Wang, LiZhen; Lu, Shan; Liu, XiaoYu; Niu, XuFeng; Wang, Chao; Ni, YiKun; Zhao, MeiYa; Feng, ChengLong; Zhang, Ming; Fan, YuBo


    The woodpecker does not suffer head/eye impact injuries while drumming on a tree trunk with high acceleration (more than 1000×g) and high frequency. The mechanism that protects the woodpecker's head has aroused the interest of ornithologists, biologists and scientists in the areas of mechanical engineering, material science and electronics engineering. This article reviews the literature on the biomechanisms and materials responsible for protecting the woodpecker from head impact injury and their applications in engineering and human protection.

  17. A Preliminary Investigation of Traumatically Induced Axonal Injury in a Three-Dimensional (3-D) Finite Element Model (FEM) of the Human Head During Blast-Loading (United States)


    SUBJECT TERMS diffuse axonal injury (DAI), traumatic brain injury (TBI), blast TBI (bTBI), computational biomechanics of brain tissue, finite...resulting biomechanical response and injury (11). Therefore, once validated, simulations like this would need to be reanalyzed with typical head-borne...protective systems that might alter the inertial response. 13 Although active muscles have an effect on the response of the cervical spine in

  18. Closed head injury causes hyperexcitability in rat hippocampal CA1 but not in CA3 pyramidal cells. (United States)

    Griesemer, Désirée; Mautes, Angelika M


    Traumatic brain injury frequently elicits epileptic seizures hours or days after the impact. The mechanisms on cellular level are poorly understood. Because posttraumatic epilepsy appears in many cases as a temporal-lobe epilepsy which originated the hippocampus, we studied trauma-induced hyperexcitability on the cellular level in this brain area. We used the model of closed head injury to analyse the electrophysiological changes in CA1 and CA3 pyramidal cells and in interneurones of the CA1 field, which is extremely sensitive to ischemia. We found that morphologically closed head injury (CHI) led to a gradual progressive, cell type specific time course in neuronal degeneration. To analyse electrophysiological impairment we measured resting membrane potential, recorded spontaneous action potentials and induced action potentials by current pulses at different times after CHI. We found a dramatic increase in the frequency of spontaneous action potentials of CA1 but not of CA3 pyramidal cells after CHI. This hyperexcitability was maximal at 2 h (4.5-fold higher than sham), was also observed at 24 h after CHI and disappeared after 3 days. We found that CA1 interneurones responded by a much weaker increase of AP frequency after CHI. We conclude that the strong hyperexcitability after CHI is cell-type specific and transient. The understanding of the complex neuronal interactions probably offers a promising possibility for pharmacological intervention to prevent posttraumatic epilepsy.

  19. Head kinematics during shaking associated with abusive head trauma. (United States)

    Lintern, T O; Puhulwelle Gamage, N T; Bloomfield, F H; Kelly, P; Finch, M C; Taberner, A J; Nash, M P; Nielsen, P M F


    Abusive head trauma (AHT) is a potentially fatal result of child abuse but the mechanisms of injury are controversial. To address the hypothesis that shaking alone is sufficient to elicit the injuries observed, effective computational and experimental models are necessary. This paper investigates the use of a coupled rigid-body computational modelling framework to reproduce in vivo shaking kinematics in AHT. A sagittal plane OpenSim computational model of a lamb was developed and used to interpret biomechanical data from in vivo shaking experiments. The acceleration of the head during shaking was used to provide in vivo validation of the associated computational model. Results of this study demonstrated that peak accelerations occurred when the head impacted the torso and produced acceleration magnitudes exceeding 200ms(-)(2). The computational model demonstrated good agreement with the experimental measurements and was shown to be able to reproduce the high accelerations that occur during impact. The biomechanical results obtained with the computational model demonstrate the utility of using a coupled rigid-body modelling framework to describe infant head kinematics in AHT.

  20. Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

    LENUS (Irish Health Repository)

    Ghori, Kamran A


    BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8\\/15 patients (53%) in the midazolam group and 7\\/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg\\/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg\\/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg\\/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg\\/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

  1. Current controversies in the interpretation of non-accidental head injury

    Energy Technology Data Exchange (ETDEWEB)

    Jaspan, Tim [Imaging Centre, University Hospital, Nottingham (United Kingdom)


    The field of non-accidental injury (NAI) has been the subject of a number of theories and hypotheses of variable merit. Concerning injuries that occur within the intracranial compartment, much research has been undertaken to investigate the cause of SDH and parenchymal brain injury. Much, however, remains contentious, particularly regarding the medicolegal aspects of suspected child abuse. Issues that present the greatest challenges will be addressed. (orig.)

  2. The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: a rejoinder. (United States)

    Rissel, Chris


    This paper challenges the conclusion of a recent paper by Walter et al. (Accident Analysis and Prevention 2011, doi:10.1016/j.aap.2011.05.029) reporting that despite numerous data limitations repealing the helmet legislation in Australia could not be justified. This conclusion is not warranted because of the limited time period used in their analysis and the lack of data beyond a few years before the introduction of legislation, the failure to adequately account for the effect of the phasing in of the legislation, the effect of the marked reduction in child cyclists, and the non-comparability of the pedestrian and cycling injuries and related lack of consideration of the severity of head injuries. The extent to which helmet legislation deters people from cycling is discussed.

  3. Oxidative injury to blood vessels and glia of the pre-laminar optic nerve head in human glaucoma. (United States)

    Feilchenfeld, Zac; Yücel, Yeni H; Gupta, Neeru


    Glaucoma is a leading cause of irreversible world blindness. Oxidative damage and vascular injury have been implicated in the pathogenesis of this disease. The purpose of this study was to determine in human primary open angle glaucoma whether oxidative injury occurs in pre-laminar optic nerve blood vessels and glial cells. Following IRB approval, sections from post-mortem primary open angle glaucoma eyes (n=5) with mean age of 77 +/- 9 yrs (+/-SD) were compared to normal control eyes (n=4) with mean age 70 +/- 9 yrs (Eye Bank of Canada). Immunostaining with nitrotyrosine, a footprint for peroxynitrite-mediated injury, was performed and sections were double-labeled with markers for vascular endothelial cells, perivascular smooth muscle cells, and astrocytes with CD34, smooth muscle actin (SMA), and glial fibrillary acidic protein (GFAP), respectively. Immunostaining was captured in a masked fashion using confocal microscopy, and defined regions of interest for blood vessels and glial tissue. Intensity measurements of supra-threshold area in pixels as percent of the total number of pixels were calculated using ImageJ (NIH) and compared using two-tailed Mann-Whitney nonparametric tests between glaucoma and control groups. Colocalization coefficients with cell-specific markers were determined and compared with random coefficients of correlation. Increased nitrotyrosine immunoreactivity was observed in pre-laminar optic nerve head blood vessels of primary open angle glaucoma eyes compared to controls and this difference was statistically significant (1.35 +/- 1.11% [+/-SD] vs. 0.01 +/- 0.01%, P=0.016). NT-immunoreactivity was also increased in the glial tissue surrounding the pre-laminar optic nerve head in the glaucoma group and compared to controls, and this difference was statistically significant (18.37 +/-12.80% vs. 0.08 +/- 0.04%, P=0.016). Colocalization studies demonstrated nitrotyrosine staining in vascular endothelial and smooth muscle cells, in addition to

  4. Closed head experimental traumatic brain injury increases size and bone volume of callus in mice with concomitant tibial fracture (United States)

    Brady, Rhys D; Grills, Brian L; Church, Jarrod E; Walsh, Nicole C; McDonald, Aaron C; Agoston, Denes V; Sun, Mujun; O’Brien, Terence J; Shultz, Sandy R; McDonald, Stuart J


    Concomitant traumatic brain injury (TBI) and long bone fracture are commonly observed in multitrauma and polytrauma. Despite clinical observations of enhanced bone healing in patients with TBI, the relationship between TBI and fracture healing remains poorly understood, with clinical data limited by the presence of several confounding variables. Here we developed a novel trauma model featuring closed-skull weight-drop TBI and concomitant tibial fracture in order to investigate the effect of TBI on fracture healing. Male mice were assigned into Fracture + Sham TBI (FX) or Fracture + TBI (MULTI) groups and sacrificed at 21 and 35 days post-injury for analysis of healing fractures by micro computed tomography (μCT) and histomorphometry. μCT analysis revealed calluses from MULTI mice had a greater bone and total tissue volume, and displayed higher mean polar moment of inertia when compared to calluses from FX mice at 21 days post-injury. Histomorphometric results demonstrated an increased amount of trabecular bone in MULTI calluses at 21 days post-injury. These findings indicate that closed head TBI results in calluses that are larger in size and have an increased bone volume, which is consistent with the notion that TBI induces the formation of a more robust callus. PMID:27682431

  5. Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

    Directory of Open Access Journals (Sweden)

    Priyambada Binita


    Full Text Available Abstract Background An important factor contributing to the high mortality in patients with severe head trauma is cerebral hypoxia. The mechanical ventilation helps both by reduction in the intracranial pressure and hypoxia. Ventilatory support is also required in these patients because of patient's inability to protect the airway, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Prolonged endotracheal intubation is however associated with trauma to the larynx, trachea, and patient discomfort in addition to requirement of sedatives. Tracheostomy has been found to play an integral role in the airway management of such patients, but its timing remains subject to considerable practice variation. In a developing country like India where the intensive care facilities are scarce and rarely available, these critical patients have to be managed in high dependency cubicles in the ward, often with inadequately trained nursing staff and equipment to monitor them. An early tracheostomy in the selected group of patients based on Glasgow Coma Score(GCS may prove to be life saving.Against this background a prospective study was contemplated to assess the role of early tracheostomy in patients with isolated closed head injury. Methods The series consisted of a cohort of 50 patients admitted to the surgical emergency with isolated closed head injury, that were not considered for surgery by the neuro-surgeon or shifted to ICU, but had GCS score of less than 8 and SAPS II score of more than 50. First 50 case records from January 2001 that fulfilled the criteria constituted the control group. The patients were managed as per ATLS protocol and intubated if required at any time before decision to perform tracheostomy was taken. These patients were serially assessed for GCS (worst score of the day as calculated by senior surgical resident and SAPS scores till day 15 to chart any changes in their status of head injuries and predictive

  6. Head Start and Unintended Injury: The Use of the Family Map Interview to Document Risk (United States)

    Whiteside-Mansell, Leanne; Johnson, Danya; Aitken, Mary M.; Bokony, Patti A.; Conners-Burrow, Nicola; McKelvey, Lorraine


    Much is known about how to provide safe environments for preschool children (3-5 years-of-age); however, many preschool children still experience preventable injuries--particularly children living in poverty. This study examined the use of an assessment tool used to identify children at risk for unintended injury in two large, federally funded…

  7. Central Pain Mechanisms and Novel Therapeutic Strategies in a Model of Closed Head Injury (United States)


    AD_________________ Award Number: W81XWH-14-1-0594 TITLE: Central Pain Mechanisms and Novel Therapeutic Strategies in a Model of Closed Head...30Sep2014-29Sep2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Central Pain Mechanisms and Novel Therapeutic Strategies in a Model of Closed Head...was to determine the pattern of inflammation-induced sensitization of the central trigeminal pain neurons, and if sensitization is detectable by

  8. Dynamic biomechanics of the human head in lateral impacts. (United States)

    Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A


    The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced with brain simulant (Sylgard 527). Three tri-axial accelerometers were instrumented at the anterior, posterior, and vertex of the specimen, and a pyramid nine accelerometer package (pNAP) was used at the contra-lateral site. Biomechanical responses were computed by transforming accelerations measured at each location to the head CG. The results indicated significant "hoop effect" from skull deformation. Translational head CG accelerations were accurately measured by transforming the pNAP, the vertex accelerations, or the average of anterior/posterior acceleration to the CG. The material stiffness and structural rigidity of the padding changed the biomechanical responses of the head with stiffer padding resulting in higher head accelerations. At the skull fracture, HIC values were more than 2-3x higher than the frontal skull fracture threshold (HIC=1000), emphasizing the differences between frontal and lateral impact. Rotational head accelerations up to 42.1 krad/s(2) were observed before skull fracture, indicating possible severe brain injury without skull fracture in lateral head impact. These data will help to establish injury criteria and threshold in lateral impacts for improved automotive protection and help clinicians understand the biomechanics of lateral head impact from improved diagnosis.

  9. Prospective randomized trial to compare accelerated (six fractions a week radiotherapy against concurrent chemoradiotherapy (using conventional fractionation in locally advanced head and neck cancers

    Directory of Open Access Journals (Sweden)

    Manoj Gupta


    Full Text Available Background: Concurrent chemoradiation (CCRT is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week against CCRT in locally advanced head and neck cancer. Materials and Methods: We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks. Control group (67 patients received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks along with intravenous cisplatin 30 mg/m 2 weekly. Tumor control, survival, acute and late toxicities were assessed. Results: Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1% in the accelerated radiotherapy arm and 47 patients (70.1% in the CCRT arm were disease free (P = 0.402. Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. Conclusion: We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.

  10. Pilot study of the effects of mixed light touch manual therapies on active duty soldiers with chronic post-traumatic stress disorder and injury to the head. (United States)

    Davis, Lauren; Hanson, Brenda; Gilliam, Sara


    This pilot study was designed to examine the effects of mixed Light Touch Manual Therapies (LTMT) on headache, anxiety and other symptoms suffered by active duty United States service members experiencing chronic Post-Traumatic Stress Disorder (PTSD). Ten service members diagnosed with PTSD and having a self-reported injury to the head acquired at least two years prior, were provided with two hour-long sessions of mixed LTMT given a week apart. Data to assess the immediate and durable effects were gathered before and after the LTMT sessions. Results indicate that headache, anxiety, and pain interference were significantly reduced during the course of the pilot study. This suggests that mixed LTMT may be helpful in reducing some of the symptoms of PTSD and injury to the head. Further studies will be needed to determine if LTMT is an effective non-pharmacological treatment for headache, anxiety or other problems associated with PTSD or injury to the head.

  11. Recovery of speed of information processing in closed-head-injury patients

    NARCIS (Netherlands)

    Zwaagstra, R.; Schmidt, I; Vanier, M


    After severe traumatic brain injury, patients almost invariably demonstrate a slowing of reaction time, reflecting a slowing of central information processing. Methodological problems associated with the traditional method for the analysis of longitudinal data (MANOVA) severely complicate studies on

  12. Child abuse. Non-accidental head injury; Kindesmisshandlung. Nicht akzidentelle Kopfverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Klee, Dirk; Schaper, Joerg [Universitaetsklinik Duesseldorf (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie


    Knowledge of the radiological appearances that are the result of child abuse is an integral part of prevention of further, potentially life-threatening, injury. Radiologists must have un understanding of typical injury patterns of the skeletal system, visceral and intra-cranial structures, which should ideally be ordered chronologically. Necessary radiological investigations follow guidelines with specific criteria that are pointed out in this review. In equivocal cases of abuse, the opinion of a second (paediatric) radiologist should be sought. (orig.)

  13. Analytical modelling of soccer heading

    Indian Academy of Sciences (India)

    Zahari Taha; Mohd Hasnun Arif Hassan; Iskandar Hasanuddin


    Heading occur frequently in soccer games and studies have shown that repetitive heading of the soccer ball could result in degeneration of brain cells and lead to mild traumatic brain injury. This study proposes a two degree-of-freedom linear mathematical model to study the impact of the soccer ball on the brain. The model consists of a mass–spring–damper system, in which the skull, the brain and the soccer ball are modelled as a mass and the neck modelled as a spring–damper system. The proposed model was compared with previous dynamic model for soccer ball-to-head impact. Moreover, it was also validated against drop ball experiment on an instrumented dummy skull and also compared with head acceleration data from previous studies. Comparison shows that our proposed model is capable of describing both the skull and brain accelerations qualitatively and quantitatively. This study shows that a simple linear mathematical model can be useful in giving a preliminary insight on the kinematics of human skull and brain during a ball-to-head impact. The model can be used to investigate the important parameters during soccer heading that affect the brain displacement and acceleration, thus providing better understanding of the mechanics behind it.

  14. Decay accelerating factor (CD55 protects neuronal cells from chemical hypoxia-induced injury

    Directory of Open Access Journals (Sweden)

    Tsokos George C


    Full Text Available Abstract Background Activated complement system is known to mediate neuroinflammation and neurodegeneration following exposure to hypoxic-ischemic insults. Therefore, inhibition of the complement activation cascade may represent a potential therapeutic strategy for the management of ischemic brain injury. Decay-accelerating factor (DAF, also known as CD55 inhibits complement activation by suppressing the function of C3/C5 convertases, thereby limiting local generation or deposition of C3a/C5a and membrane attack complex (MAC or C5b-9 production. The present study investigates the ability of DAF to protect primary cultured neuronal cells subjected to sodium cyanide (NaCN-induced hypoxia from degeneration and apoptosis. Methods Cultured primary cortical neurons from embryonic Sprague-Dawley rats were assigned one of four groups: control, DAF treatment alone, hypoxic, or hypoxic treated with DAF. Hypoxic cultures were exposed to NaCN for 1 hour, rinsed, followed by 24 hour exposure to 200 ng/ml of recombinant human DAF in normal medium. Human DAF was used in the present study and it has been shown to effectively regulate complement activation in rats. Neuronal cell function, morphology and viability were investigated by measuring plateau depolarization potential, counting the number dendritic spines, and observing TUNEL and MTT assays. Complement C3, C3a, C3a receptor (R production, C3a-C3aR interaction and MAC formation were assessed along with the generation of activated caspase-9, activated caspase-3, and activated Src. Results When compared to controls, hypoxic cells had fewer dendritic spines, reduced plateau depolarization accompanied by increased apoptotic activity and accumulation of MAC, as well as up-regulation of C3, C3a and C3aR, enhancement of C3a-C3aR engagement, and elevated caspase and Src activity. Treatment of hypoxic cells with 200 ng/ml of recombinant human DAF resulted in attenuation of neuronal apoptosis and exerted

  15. Tendon mineralization is accelerated bilaterally and creep of contralateral tendons is increased after unilateral needle injury of murine achilles tendons. (United States)

    O'Brien, Etienne John Ogilvy; Shrive, Nigel G; Rosvold, Joshua M; Thornton, Gail M; Frank, Cyril B; Hart, David A


    Heterotopic mineralization may result in tendon weakness, but effects on other biomechanical responses have not been reported. We used a needle injury, which accelerates spontaneous mineralization of murine Achilles tendons, to test two hypotheses: that injured tendons would demonstrate altered biomechanical responses; and that unilateral injury would accelerate mineralization bilaterally. Mice underwent left hind (LH) injury (I; n = 11) and were euthanized after 20 weeks along with non-injured controls (C; n = 9). All hind limbs were examined by micro computed tomography followed by biomechanical testing (I = 7 and C = 6). No differences were found in the biomechanical responses of injured tendons compared with controls. However, the right hind (RH) tendons contralateral to the LH injury exhibited greater static creep strain and total creep strain compared with those LH tendons (p ≤ 0.045) and RH tendons from controls (p ≤ 0.043). RH limb lesions of injured mice were three times larger compared with controls (p = 0.030). Therefore, despite extensive mineralization, changes to the responses we measured were limited or absent 20 weeks postinjury. These results also suggest that bilateral occurrence should be considered where tendon mineralization is identified clinically. This experimental system may be useful to study the mechanisms of bilateral new bone formation in tendinopathy and other conditions.

  16. Diaphragmatic rupture causing repeated vomiting in a combined abdominal and head injury patient: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Symeonidis Dimitrios


    Full Text Available Abstract Background Diaphragmatic rupture after blunt abdominal injury is a rare trauma condition. Delayed diagnosis is not uncommon especially in the emergency room setting. Associated injuries often shift diagnosis and treatment priorities towards other more life-threatening conditions. Case presentation We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms. Conclusions The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.

  17. A Targeted Inhibitor of the Alternative Complement Pathway Accelerates Recovery From Smoke-Induced Ocular Injury (United States)

    Woodell, Alex; Jones, Bryan W.; Williamson, Tucker; Schnabolk, Gloriane; Tomlinson, Stephen; Atkinson, Carl; Rohrer, Bärbel


    Purpose Morphologic and genetic evidence exists that an overactive complement system driven by the complement alternative pathway (AP) is involved in pathogenesis of age-related macular degeneration (AMD). Smoking is the only modifiable risk factor for AMD. As we have shown that smoke-related ocular pathology can be prevented in mice that lack an essential activator of AP, we ask here whether this pathology can be reversed by increasing inhibition in AP. Methods Mice were exposed to either cigarette smoke (CS) or filtered air (6 hours/day, 5 days/week, 6 months). Smoke-exposed animals were then treated with the AP inhibitor (CR2-fH) or vehicle control (PBS) for the following 3 months. Spatial frequency and contrast sensitivity were assessed by optokinetic response paradigms at 6 and 9 months; additional readouts included assessment of retinal morphology by electron microscopy (EM) and gene expression analysis by quantitative RT-PCR. Results The CS mice treated with CR2-fH showed significant improvement in contrast threshold compared to PBS-treated mice, whereas spatial frequency was unaffected by CS or pharmacologic intervention. Treatment with CR2-fH in CS animals reversed thinning of the retina observed in PBS-treated mice as analyzed by spectral-domain optical coherence tomography, and reversed most morphologic changes in RPE and Bruch's membrane seen in CS animals by EM. Conclusions Taken together, these findings suggest that AP inhibitors not only prevent, but have the potential to accelerate the clearance of complement-mediated ocular injury. Improving our understanding of the regulation of the AP is paramount to developing novel treatment approaches for AMD. PMID:27064393

  18. Study of the effects of mild hypothermia on cerebral PO2, PCO2 and pH and body temperature in patients with acute severe head injury

    Institute of Scientific and Technical Information of China (English)

    JIA Jun; LIN Yuan-quan; LIU Wen-feng; ZHONG Tian-an; ZHANG Jun; YE Yu; XU Yi-qun


    Objective: To study the effects of mild hypothermia on cerebral oxygen partial pressure, carbon dioxide partial pressure, pH and body temperature (PbrO2, PbrCO2, pHbr and BT) in patients with acute severe head injury.Methods: Thirty-eight patients with acute severe head injury were treated with mild hypothermia, meantime PbrO2, PbrCO2, pHbr and BT were monitored in order to study the changes of PbrO2, PbrCO2, pHbr and BT.Results: In patients with acute head injury, mild hypothermia obviously increased PbrO2, decreased PbrCO2 and CO2 accumulation and acidosis in brain tissue. BT was 1℃-1.5℃ higher than rectal temperature(RT) after injury. The BT and RT were decreased when the patients were treated with mild hypothermia, but at the same time the difference between BT and RT was increased.Conclusions: In patients with acute severe head injury the direct monitoring of PbrO2, PbrCO2, pHbr and BT was safe and reliable, and is helpful in estimating prognosis and mild hypothermia therapy.

  19. Development of an ultrasmall C-band linear accelerator guide for a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head. (United States)

    Kamino, Yuichiro; Miura, Sadao; Kokubo, Masaki; Yamashita, Ichiro; Hirai, Etsuro; Hiraoka, Masahiro; Ishikawa, Junzo


    We are developing a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head. It is capable of pursuing irradiation and delivering irradiation precisely with the help of an agile moving x-ray head on the gimbals. Requirements for the accelerator guide were established, system design was developed, and detailed design was conducted. An accelerator guide was manufactured and basic beam performance and leakage radiation from the accelerator guide were evaluated at a low pulse repetition rate. The accelerator guide including the electron gun is 38 cm long and weighs about 10 kg. The length of the accelerating structure is 24.4 cm. The accelerating structure is a standing wave type and is composed of the axial-coupled injector section and the side-coupled acceleration cavity section. The injector section is composed of one prebuncher cavity, one buncher cavity, one side-coupled half cavity, and two axial coupling cavities. The acceleration cavity section is composed of eight side-coupled nose reentrant cavities and eight coupling cavities. The electron gun is a diode-type gun with a cerium hexaboride (CeB6) direct heating cathode. The accelerator guide can be operated without any magnetic focusing device. Output beam current was 75 mA with a transmission efficiency of 58%, and the average energy was 5.24 MeV. Beam energy was distributed from 4.95 to 5.6 MeV. The beam profile, measured 88 mm from the beam output hole on the axis of the accelerator guide, was 0.7 mm X 0.9 mm full width at half maximum (FWHM) width. The beam loading line was 5.925 (MeV)-Ib (mA) X 0.00808 (MeV/mA), where Ib is output beam current. The maximum radiation leakage of the accelerator guide at 100 cm from the axis of the accelerator guide was calculated as 0.33 cGy/min at the rated x-ray output of 500 cGy/min from the measured value. This leakage requires no radiation shielding for the accelerator guide itself per IEC 60601-2-1.

  20. A Literature Review of Musculoskeletal Injuries to the Human Neck and the Effects of Head-Supported Mass Worn by Soldier (United States)


    Sturzenegger, M., DiStefano, G., Radanov, B.P., and Schnidrig, A. (1994) Presenting Symptoms and Signs After Whiplash Injury: The Influence of whiplash -type injury studies (Table 1). At the time it was the most sophisticated head- neck model available. This model uses a series of rigid...set to respond actively after a certain time of 40 to 100 ms into the simulation. Overall, the simulations show that active muscle behavior can have a

  1. Partial Kluver-Bucy syndrome as a delayed manifestation of head injury

    Directory of Open Access Journals (Sweden)

    P S Bhat


    Full Text Available After traumatic brain injury (TBI, the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Kluver-Bucy syndrome (KBS is a rare neurobehavioral condition, first described in 1937 as an experimental neurobehavioral syndrome in monkeys with bitemporal brain lesions. The syndrome in man was subsequently observed to be transient or permanent in a variety of neurodegenerative disorders and after traumatic, nontraumatic and infectious brain injury. However, partial KBS may occur in the absence of the classic bilateral temporal lesion, though rare. Pharmacological treatment of post-TBI neuropsychiatric sequelae consists of symptomatic, functional and hypothetical approaches. Specific pharmacological treatment consists of antipsychotics, anti-kindling anticonvulsants or a combination thereof. A case of partial KBS presenting as delayed manifestation of traumatic brain injury that improved with carbamazapine and antipsychotics is presented.

  2. Head injury management algorithm as described in Hippocrates' "peri ton en cephali traumaton". (United States)

    Dimopoulos, Vassilios G; Machinis, Theofilos G; Fountas, Kostas N; Robinson, Joe S


    HIPPOCRATIC WORKS LEND themselves still today to the modern physician for further analysis of his approach to the diagnosis and treatment of various pathological conditions. We present an attempt to systematize his methodology regarding the management of head trauma and present it in the format of a modern-era algorithm.

  3. El trauma cráneo encefálico como causa de muerte violenta en Costa Rica en el año 2004 Head injury as a cause of violent death in Costa Rica in 2004

    Directory of Open Access Journals (Sweden)

    Maikel Vargas Sanabria


    Full Text Available Es bien sabido que el trauma cráneo encefálico es un importante contribuyente dentro de las causas de muertes traumáticas, sin embargo en Costa Rica no existen estadísticas actualizadas al respecto. En este trabajo se analizaron las muertes provocadas por este tipo de trauma en el año 2004 para determinar sus características demográficas, ubicación temporal y geográfica, etiología médico legal y las lesiones específicas que provocaron la muerte. Se concluyó, después del análisis de los datos obtenidos, que la mayoría de muertes son prevenibles (accidentes de tránsito, heridas por proyectil de arma de fuego, que las lesiones más frecuentes son las producidas por traumatismos sin objeto animado (non missile injuries, que las lesiones anotadas como causa ulterior de muerte son predominantemente la contusión y laceración cerebral, pero que existe un subdiagnóstico de lesiones letales como el daño axonal difuso, por dificultades técnicas. No obstante el resto del perfil epidemiológico de las víctimas (masculino, de edad laboralmente productiva y habitante de ciudad coinciden con la bibliografía más reciente revisada.It’s a well-known fact the importance of head injury as causes of death on violent deaths around the world; however in Costa Rica there’re not current statistics about this phenomenon. In this paper we analyzed this kind of violent deaths in 2004 for to define its demographic, geographic and chronological characteristics. Also, for analyzing its medico-legal etiology and its specific lethal injury. The conclusions of this paper were: in most cases lethal injury was subject to prevention, because they were caused by traffic accidents or gunshots. The non missile injury, the head experiments a suddenly acceleration, it was the main mechanism involved in lethal injuries. Principal injuries notated as main cause of death in the final autopsy report were brain contusion and lacerations, however there were a sub

  4. Direct hits to the head during amateur boxing is associated with a rise in serum biomarkers for brain injury. (United States)

    Graham, M R; Myers, T; Evans, P; Davies, B; Cooper, S M; Bhattacharya, K; Grace, F M; Baker, J S


    Boxing exposes participants to the physiological response to high intensity exercise and also to direct body and brain trauma. Amateur boxing is increasing and females have also been included in the Olympics. The aim of this study is to assess the stress response and possible brain injury incurred during a match by measuring serum biomarkers associated with stress and cellular brain injury before and after combat. Sixteen male amateur boxers were studied retrospectively. The study population was divided into two groups: (a) a group that received predominantly punches to the head (PTH) and (b) a group that received predominantly punches to the body (PTB). Blood samples were taken before and five minutes after each contest. They were analysed for S-100B, neuron-specific enolase (NSE), creatine kinase (CK) and cortisol. The PTH group received direct contacts to the head (not blocked, parried or avoided) and to the body (n=8, age: 17.6 ± 5.3, years; height: 1.68 ± 0.13, meters; mass: 65.4 ± 20.3, kg). The PTB group received punches to the body including blocked and parried punches, but received no direct punches to the head, (n=8, mean ± SD, age: 19.1 ± 3.2 years; height: 1.70 ± 0.75, meters; mass: 68.5 ± 15 kg). Significant increases (P<0.05) were observed between pre- and post-combat serum concentrations in serum concentrations in PTH of S-100B (0.35 ± 0.61 vs. 0.54 ± 0.73, μg.L-1) NSE (19.7 ± 14 vs.31.1 ± 26.6, and cortisol (373 ± 202 vs. 756 ± 93, nmol.L-1). Significant increases (P<0.05) of creatine kinase were recorded in both groups. This study demonstrates significant elevations in neurochemical biomarkers in boxers who received direct blows to the head. However, further work is required to quantify this volumetric brain damage and long term clinical sequelae.

  5. Arthroscopic evaluation and treatment of biceps brachii long head tendon injuries: A survey of the MOON shoulder group

    Directory of Open Access Journals (Sweden)

    Timothy Miller


    Full Text Available Context: Injuries to the biceps brachii long head tendon commonly occur in conjunction with tears in the rotator cuff and glenoid labrum. Consensus on treatment of varying levels of severity is undetermined. Settings and Design: We surveyed members of the Multicenter Orthopedic Outcomes Network (MOON Shoulder Group, to determine a consensus on arthroscopic grading and treatment. Aims: We hypothesized that the Lafosse classification system would show a high level of inter- and intraobserver agreement regarding grading/treatment. Materials and Methods: Arthroscopic videos of 30 patients determined to have biceps brachii long head tendon injuries were viewed by 13 surgeons. The surgeons graded the severity of the injury macrostructure based on the Lafosse classification system and chose from a list of treatment options. Four months later the same surgeons viewed the same videos and repeated the survey. Statistical Analysis Used: Analysis with weighted and non-weighted Kappa values was performed to determine intra- and interobserver reliability for severity grading and to determine the preferred treatments for each level of severity. Results: Intraobserver reliability testing for the Lafosse system showed substantial agreement after two rounds (81.28%, K=0.7006. Interobserver testing demonstrated substantial agreement for Grade 0 (K=0.7152, fair agreement for Grade 1 (K=0.3803, and moderate agreement for Grade 2 (K=0.5156. Combined responses recommended no surgical treatment for 95.4% of the lesions classified as grade 0 (62/65. No surgical treatment was recommended for Grade 1 lesions in 24.1% of the cases (35/145, debridement in 38.6% (56/145, and tenotomy or tenodesis in 37.2% (54/145. Evaluators preferred tenotomy or tenodesis for 98.3% of the Grade 2 lesions (177/180. Conclusions: Analysis of the Lafosse system indicated substantial intraobserver reliability for all grades. As Grades 1 and 2 showed only fair and moderate agreement, a need for a

  6. The impact of compulsory helmet legislation on cyclist head injuries in New South Wales, Australia: a response. (United States)

    Walter, Scott R; Olivier, Jake; Churches, Tim; Grzebieta, Raphael


    This article responds to criticisms made in a rejoinder (Accident Analysis and Prevention 2012, 45: 107-109) questioning the validity of a study on the impact of mandatory helmet legislation (MHL) for cyclists in New South Wales, Australia. We systematically address the criticisms through clarification of our methods, extension of the original analysis and discussion of new evidence on the population-level effects of MHL. Extensions of our analysis confirm the original conclusions that MHL had a beneficial effect on head injury rates over and above background trends and changes in cycling participation. The ongoing debate around MHL draws attention away from important ways in which both safety and participation can be improved through investment in well-connected cycling infrastructure, fostering consideration between road users, and adequate legal protection for vulnerable road users. These are the essential elements for providing a cycling environment that encourages participation, with all its health, economic and environmental benefits, while maximising safety.

  7. Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection

    Directory of Open Access Journals (Sweden)

    Ehud Atoun


    Full Text Available Background: Shoulder pain in general and acromioclavicular joint (ACJ pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA. The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. Materials and Methods: Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years. All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI. Arthroscopic ACJ excision arthroplasty was performed in all patients. Results: At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. Conclusion: Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.

  8. Appropriate Treatment of Head Injuries by Surgeons During the Civil War (United States)


    surgeon’s evaluation it was discovered that the suture line at the top of his head was extremely wide, indicating a fracture and depression along the suture...the bodies of both superior maxillaries , both lachrymal bones, the body of the ethmoid, with the turbinated bones, the left great wing of the sphenoid...and forming the top and sides of the cranium Periosteum. A dense fibrous membrane covering the surface of bones Second intention. Wound site is not

  9. Interaction of Blast and Head Impact in the Generation of Brain Injuries (United States)


    supported during the acceleration phase in order to eliminate the neck flexion /extension prior to impact. The NDTs were implanted into two (1999). Relationship Between Localized Spine Deformation and Cervical Vertebral Motions for Low Speed Rear Impacts Using Human Volunteers. In: Ir

  10. Chronic angiotensin (1-7) injection accelerates STZ-induced diabetic renal injury

    Institute of Scientific and Technical Information of China (English)

    Ying SHAO; Ming HE; Li ZHOU; Tai YAO; Yu HUANG; Li-min LU


    ameliorate STZ-induced diabetic rat renal injury; on the contrary, it accelerated the progressive diabetic nephropathies.

  11. Mental fatigue after very severe closed head injury: Sustained performance, mental effort, and distress at two levels of workload in a driving simulator

    NARCIS (Netherlands)

    Riese, H.; Hoedemaeker, M.; Brouwer, W.H.; Mulder, L.J.M.; Cremer, R.; Veldman, J.B.P.


    In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three

  12. Porcine head response to blast

    Directory of Open Access Journals (Sweden)

    Jay eShridharani


    Full Text Available Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposed porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110-740 kPa peak incident overpressure with scaled durations from 1.3-6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. The bulk head acceleration and the pressure at the surface of the head and in the cranial cavity were measured. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within thirty seconds and the remaining two recovered within 8 minutes following bagging and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80-685 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300-2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385-3845 G’s and were well correlated with peak incident overpressure (R2=0.90. One standard deviation corridors for the surface pressure, intracranial pressure, and head acceleration are presented to provide experimental data for

  13. A population-based study of survival and discharge status for survivors after head injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Teasdale, T W


    -Meier survival functions were calculated for these two categories. Hospital records for a random sample of 389 survivors in 1997 after cranial fracture, acute brain lesion or chronical subdural haematoma, which occurred in 1982, 1987 and 1992 in patients aged 15 years or more at injury, were reviewed. Survivors...... the decreasing incidence with time, the point prevalence of survivors in 1997 after brain lesions occurring in 1982, 1987 or 1992 was nearly the same, averaging 8.4 per 100 000 of the population above age 14. Half of them were severe, as defined by initial Glasgow Coma Score ... and cerebral lesion was described quantitatively through Kaplan-Meier survival distributions. Besides, patterns of severity, neurophysical and mental sequelae among survivors 5, 10 and 15 years post-injury were described. It was shown by examples how the study has been useful already for the planning...

  14. Vestibular Balance Deficits Following Head Injury: Recommendations Concerning Evaluation and Rehabilitation in the Military Setting (United States)


    rather than abstract/symbolic) interfaces, such as the spatially- referenced waist circumference vibrotactile belt employed by Dr. Atkins, Dr. Mortimer...resulting in prolonged inability to return-to-duty and increasing the risk of further injury (e.g., due to falling or vehicle accidents) ( an aviation orientation cueing system supplying vibrotactile feedback (through the clothing) to the circumference of the torso came to be

  15. Citicoline protects brain against closed head injury in rats through suppressing oxidative stress and calpain over-activation. (United States)

    Qian, Ke; Gu, Yi; Zhao, Yumei; Li, Zhenzong; Sun, Ming


    Citicoline, a natural compound that functions as an intermediate in the biosynthesis of cell membrane phospholipids, is essential for membrane integrity and repair. It has been reported to protect brain against trauma. This study was designed to investigate the protective effects of citicoline on closed head injury (CHI) in rats. Citicoline (250 mg/kg i.v. 30 min and 4 h after CHI) lessened body weight loss, and improved neurological functions significantly at 7 days after CHI. It markedly lowered brain edema and blood-brain barrier permeability, enhanced the activities of superoxide dismutase and the levels of glutathione, reduced the levels of malondialdehyde and lactic acid. Moreover, citicoline suppressed the activities of calpain, and enhanced the levels of calpastatin, myelin basic protein and αII-spectrin in traumatic tissue 24 h after CHI. Also, it attenuated the axonal and myelin sheath damage in corpus callosum and the neuronal cell death in hippocampal CA1 and CA3 subfields 7 days after CHI. These data demonstrate the protection of citicoline against white matter and grey matter damage due to CHI through suppressing oxidative stress and calpain over-activation, providing additional support to the application of citicoline for the treatment of traumatic brain injury.

  16. Dual-wavelength laser speckle imaging for monitoring brain metabolic and hemodynamic response to closed head traumatic brain injury in mice (United States)

    Kofman, Itamar; Abookasis, David


    The measurement of dynamic changes in brain hemodynamic and metabolism events following head trauma could be valuable for injury prognosis and for planning of optimal medical treatment. Specifically, variations in blood flow and oxygenation levels serve as important biomarkers of numerous pathophysiological processes. We employed the dual-wavelength laser speckle imaging (DW-LSI) technique for simultaneous monitoring of changes in brain hemodynamics and cerebral blood flow (CBF) at early stages of head trauma in a mouse model of intact head injury (n=10). For induction of head injury, we used a weight-drop device involving a metal mass (˜50 g) striking the mouse's head in a regulated manner from a height of ˜90 cm. In comparison to baseline measurements, noticeable dynamic variations were revealed immediately and up to 1 h postinjury, which indicate the severity of brain damage and highlight the ability of the DW-LSI arrangement to track brain pathophysiology induced by injury. To validate the monitoring of CBF by DW-LSI, measurements with laser Doppler flowmetry (LDF) were also performed (n=5), which confirmed reduction in CBF following injury. A secondary focus of the study was to investigate the effectiveness of hypertonic saline as a neuroprotective agent, inhibiting the development of complications after brain injury in a subgroup of injured mice (n=5), further demonstrating the ability of DW-LSI to monitor the effects upon brain dynamics of drug treatment. Overall, our findings further support the use of DW-LSI as a noninvasive, cost-effective tool to assess changes in hemodynamics under a variety of pathological conditions, suggesting its potential contribution to the biomedical field. To the best of our knowledge, this work is the first to make use of the DW-LSI modality in a small animal model to (1) investigate brain function during the critical first hour of closed head injury trauma, (2) correlate between injury parameters of LDF measurements, and (3

  17. Head Injury as a Risk Factor for Dementia and Alzheimer’s Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies (United States)

    Li, Yanjun; Li, Yongming; Li, Xiaotao; Zhang, Shuang; Zhao, Jincheng; Zhu, Xiaofeng; Tian, Guozhong


    Background Head injury is reported to be associated with increased risks of dementia and Alzheimer’s disease (AD) in many but not all the epidemiological studies. We conducted a systematic review and meta-analysis to estimate the relative effect of head injury on dementia and AD risks. Methods Relevant cohort and case-control studies published between Jan 1, 1990, and Mar 31, 2015 were searched in PubMed, Web of Science, Scopus, and ScienceDirect. We used the random-effect model in this meta-analysis to take into account heterogeneity among studies. Results Data from 32 studies, representing 2,013,197 individuals, 13,866 dementia events and 8,166 AD events, were included in the analysis. Overall, the pooled relative risk (RR) estimates showed that head injury significantly increased the risks of any dementia (RR = 1.63, 95% CI 1.34–1.99) and AD (RR = 1.51, 95% CI 1.26–1.80), with no evidence of publication bias. However, when considering the status of unconsciousness, head injury with loss of consciousness did not show significant association with dementia (RR = 0.92, 95% CI 0.67–1.27) and AD (RR = 1.49, 95% CI 0.91–2.43). Additionally, this positive association did not reach statistical significance in female participants. Conclusions The findings from this meta-analysis indicate that head injury is associated with increased risks of dementia and AD. PMID:28068405

  18. March 2008 - ITER Organization Director-General K.Ikeda and Deputy Director-General N. Holtkamp, visiting the ATLAS cavern with Spokesperson P. Jenni, Accelerators Technology Department Head P. Lebrun and LHC Mangnets Group Leader L. Rossi.

    CERN Multimedia

    Claudia Marcelloni


    March 2008 - ITER Organization Director-General K.Ikeda and Deputy Director-General N. Holtkamp, visiting the ATLAS cavern with Spokesperson P. Jenni, Accelerators Technology Department Head P. Lebrun and LHC Mangnets Group Leader L. Rossi.

  19. Head injuries in the 18th century: the management of the damaged brain. (United States)

    Ganz, Jeremy C


    The 18th century was the time when trauma neurosurgery began to develop into the modern discipline. Before this, the management had, for the most part, changed little from the days of Hippocrates, Celsus, and Galen. Attention was directed to skull injuries, and the brain was treated as the seat of the rational soul but without other function. Symptoms after trauma were attributed to injuries to the bone and meninges. Following the lead of the Royal Academy of Surgery in Paris, it was accepted from the 1730s that the brain was the seat of symptoms after cranial trauma. During the 18th century, at least 12 surgeons published articles on cranial injury, 6 describing significant clinical series on this topic. They were Henri-François Le Dran (1685-1770) of Paris, Percival Pott (1714-1788) of London, James Hill (1703-1776) from Dumfries, Sylvester O'Halloran (1728-1807) of Limerick (Ireland), William Dease (1750-1798) of Dublin, and John Abernethy (1764-1831) of London. This article analyzes these series. Each individual made a different contribution. It is suggested that the relatively lesser-known James Hill in Scotland demonstrated the greatest understanding of the management of brain trauma and achieved the best results. A product of the Scottish Enlightenment, he adapted his management to his own experience and was not tied to the accepted authorities of his day, but he improved the management of each case following his experience with previous patients. He deserves to be remembered.

  20. Critical appraisal of neuroprotection trials in head injury: what have we learned? (United States)

    Tolias, Christos M; Bullock, M Ross


    To date, despite very encouraging preclinical results, almost all phase II/III clinical neuroprotection trials in traumatic brain injury (TBI) have failed to show any consistent improvement in outcome for TBI patients. To understand the reasons behind such developments we need to review and evaluate the evolution of trial design as a result of our changing understanding of the pathophysiology of brain cell death and progress of translational research from the laboratory bench to the bedside. This paper attempts to critically appraise these neuroprotection trials, rationalize the paucity of effectiveness, review any recent developments in the field, and try to draw some conclusions on how to move forward.

  1. Effect of mild hypothermia on partial pressure of oxygen in brain tissue and brain temperature in patients with severe head injury

    Institute of Scientific and Technical Information of China (English)

    张赛; 只达石; 林欣; 尚彦国; 牛玉德


    Objective: To study the changes of partial pressure of oxygen in brain tissue (PbtO2) and brain temperature (BT) in patients in acute phase of severe head injury, and to study the effect of mild hypothermia on PbtO2 and BT.   Methods: The PbtO2 and the BT of 18 patients with severe head injury were monitored, and the patients were treated with mild hypothermia within 20 hours after injury. The rectal temperature (RT) of the patients was kept on 31.5-34.9℃ for 1-7 days (57.7 hours±28.4 hours averagely), simultaneously, the indexes of PbtO2 and BT were monitored for 1-5 days (with an average of 54.8 hours±27.0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated at 6 months after injury.   Results: Within 24 hours after severe head injury, the PbtO2 was significantly lower (9.6 mm Hg±6.8 mm Hg, 1 mm Hg=0.133 kPa) than the normal value (16-40 mm Hg). After treatment of mild hypothermia, the mean PbtO2 increased to 28.7 mm Hg±8.8 mm Hg during the first 24 hours, and the PbtO2 was still maintained within the range of normal value at 3 days after injury. The BT was higher than the RT in the patients in acute phase of severe head injury, and the difference between the BT and the RT significantly increased after treatment of mild hypothermia. Hyperventilation (the partial pressure of carbon dioxide in artery (PaCO2)≈25 mm Hg) decreased the high intracranial pressure (ICP) and significantly decreased the PbtO2.   Conclusions: This study demonstrates that PptO2 and BT monitoring is a safe, reliable and sensitive diagnostic method to follow cerebral oxygenation. It might become an important tool in our treatment regime for patients in the acute phase of severe head injury requiring hypothermia and hyperventilation.

  2. Abusive Head Trauma (Shaken Baby Syndrome) (United States)

    ... Your 1- to 2-Year-Old Abusive Head Trauma (Shaken Baby Syndrome) KidsHealth > For Parents > Abusive Head ... babies tend to cry the most. How These Injuries Happen Abusive head trauma results from injuries caused ...

  3. Embedded-structure template for electronic records affects patient note quality and management for emergency head injury patients: An observational pre and post comparison quality improvement study. (United States)

    Sonoo, Tomohiro; Iwai, Satoshi; Inokuchi, Ryota; Gunshin, Masataka; Kitsuta, Yoichi; Nakajima, Susumu


    Along with article-based checklists, structured template recording systems have been reported as useful to create more accurate clinical recording, but their contributions to the improvement of the quality of patient care have been controversial. An emergency department (ED) must manage many patients in a short time. Therefore, such a template might be especially useful, but few ED-based studies have examined such systems.A structured template produced according to widely used head injury guidelines was used by ED residents for head injury patients. The study was conducted by comparing each 6-month period before and after launching the system. The quality of the patient notes and factors recorded in the patient notes to support the head computed tomography (CT) performance were evaluated by medical students blinded to patient information.The subject patients were 188 and 177 in respective periods. The numbers of patient notes categorized as "CT indication cannot be determined" were significantly lower in the postintervention term (18% → 9.0%), which represents the patient note quality improvement. No difference was found in the rates of CT performance or CT skip without clearly recorded CT indication in the patient notes.The structured template functioned as a checklist to support residents in writing more appropriately recorded patient notes in the ED head injury patients. Such a template customized to each clinical condition can facilitate standardized patient management and can improve patient safety in the ED.

  4. A single administration of the peptide NAP induces long-term protective changes against the consequences of head injury: gene Atlas array analysis. (United States)

    Romano, Jacob; Beni-Adani, Liana; Nissenbaum, Orlev Levy; Brenneman, Douglas E; Shohami, Esther; Gozes, Illana


    The femtomolar-acting eight-amino-acid peptide (NAP), derived from activity-dependent neuroprotective protein (ADNP), provides long-term protection against the deleterious effects of closed head injury (CHI) in mice. Fifteen minutes after injury, mice were divided into two groups, control and NAP-treated and a single subcutaneous injection of NAP or vehicle was administered. A third group served as sham-treated (not subjected to head trauma). Each mouse was assessed for its clinical function, using neurological severity score, at various time intervals following CHI, up to 30-45 d. Total cerebral cortex RNA was prepared from the site of injury of CHI mice, and from parallel regions in peptide-treated and sham brains. RNA was then reversed transcribed to yield radioactive cDNA preparations that were hybridized to Atlas array membranes containing 1200 cDNAs spots. Comparison of sham-treated individual mice showed differential expression levels of at least 15 mRNA species. Furthermore, results indicated that one of the genes that did not change among individuals but specifically increased after CHI and decreased after NAP treatment was the cell surface glycoprotein Mac-1 (CD11B antigen). Thus, Mac-1 is suggested as a marker for the long-term outcome of head injury and as a potential target for NAP protective actions.

  5. Pre-hospital and initial management of head injury patients: An update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury


    Full Text Available Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013, which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  6. A Prediction of Response of the Head and Neck of the U.S. Adult Military Population to Dynamic Impact Acceleration from Selected Dynamic Test Subjects. (United States)


    concussion in whiplash . However, Hodgson (13), Gurdjian (12) and others contend that other factors such as resultant intracranial pressure gradients of head-neck hyperextension. This disagreement among researchers as to the mecha- nisms of injury in hdad impact and whiplash is also seen in...results were obtained after some 62 42 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ > _ _ _ _ _ fi 4 ae I4 *0 &AeJ s- C9. d -- q a 3 1 8 £ 3 36 3’ U) L) 4’ U- 4-) i d

  7. 17β-Estradiol Promotes Schwann Cell Proliferation and Differentiation, Accelerating Early Remyelination in a Mouse Peripheral Nerve Injury Model

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    Yan Chen


    Full Text Available Estrogen induces oligodendrocyte remyelination in response to demyelination in the central nervous system. Our objective was to determine the effects of 17β-estradiol (E2 on Schwann cell function and peripheral nerve remyelination after injury. Adult male C57BL/6J mice were used to prepare the sciatic nerve transection injury model and were randomly categorized into control and E2 groups. To study myelination in vitro, dorsal root ganglion (DRG explant culture was prepared using 13.5-day-old mouse embryos. Primary Schwann cells were isolated from the sciatic nerves of 1- to 3-day-old Sprague–Dawley rats. Immunostaining for myelin basic protein (MBP expression and toluidine blue staining for myelin sheaths demonstrated that E2 treatment accelerates early remyelination in the “nerve bridge” region between the proximal and distal stumps of the transection injury site in the mouse sciatic nerve. The 5-bromo-2′-deoxyuridine incorporation assay revealed that E2 promotes Schwann cell proliferation in the bridge region and in the primary culture, which is blocked using AKT inhibitor MK2206. The in vitro myelination in the DRG explant culture determined showed that the MBP expression in the E2-treated group is higher than that in the control group. These results show that E2 promotes Schwann cell proliferation and myelination depending on AKT activation.

  8. Clinical evaluation of accelerated hyperfractionated irradiation for locally advanced head and neck cancer with concomitant use of daily low-dose Carboplatin (CBDCA)

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Kazuo; Sekiya, Yuichi; Araki, Hitoshi [Chiba Cancer Center (Japan)


    From May 1994 to May 1996, 39 patients with locally advanced head and neck cancer were treated with accelerated hyperfractionated irradiation (1.6 Gy, twice daily, 10 times a week, with minimum interval of 6 hours between fractions and the total tumor dose to 70.4 Gy) and concomitant use of daily low-dose Carboplatin (30 mg/body). The average age was 64.2 years (38-85). The median follow-up period was 16.4 months with a range of 2-36 months. Complete response rate was 66.7%. The organ preservation rates were almost acceptable in advanced cases. The major acute toxicity was stomatitis, but no therapeutic interruption was observed. Grade 4 laryngeal late sequelae was observed in 2 cases. We think this method is effective for locally advanced head and neck cancer but total dose should be reduced to 67.2 Gy for laryngeal and hypopharyngeal cancer. (author)

  9. Influence of basal cisterns, midline shift and pathology on outcome in head injury. (United States)

    Athiappan, S; Muthukumar, N; Srinivasan, U S


    The relationship of outcome to the basal cisterns, midline shift and pathology as seen on initial CT scan was assessed in 107 moderate and severe head injured patients. The mortality rates were 82 cases (76%) and 29 cases (27%) among those with obliterated and normal basal cisterns, and 74 cases (69%) and 42 cases (39%) when the midline shift was present and absent, respectively. The state of the cisterns and midline shift was correlated with the type of intracranial pathology and Glasgow Coma Scale (GCS) scores. The state of the cisterns and midline shift was more important for those with single contusions and intra-cerebral haematoma (ICH) than for those with multiple lesions, extradural haematoma, subdural haematoma, diffuse cerebral oedema and normal CT scan. The state of the above two parameters when correlated with GCS score, showed that they were important for those with higher GCS scores. This indicates that the status of the cisterns and midline shift is correlated with the type of pathology and GCS score rather than these parameters taken alone in prediction.

  10. Dural sinus obstruction following head injury: a diagnostic and clinical study. (United States)

    Benifla, Mony; Yoel, Uri; Melamed, Israel; Merkin, Vladimir; Cohen, Avi; Shelef, Ilan


    OBJECTIVE The aim of this study is to describe the clinical characteristics of patients with skull fracture adjacent to a dural venous sinus (DVS) and evaluate the role of CT venography (CTV) in the diagnosis of the effect of this fracture on the involved DVS. METHODS The study comprised patients with vault or skull base fracture adjacent to a DVS who were admitted to 1 medical center during a 2-year period. The medical records were reviewed for the clinical and radiographic characteristics. All patients had undergone CTV to evaluate potential DVS pathology. The clinical and radiological findings of the patients with DVS pathology were compared with those of the patients with normal DVS. The groups were compared using the chi-square and t-tests for categorical and continuous data, respectively. The potential risk for poor outcome among the patients with DVS pathology was also investigated. RESULTS Of 434 patients with skull fractures, 41 (9.4%) had fractures adjacent to a DVS. DVS pathology was detected in 51% of patients (21 of 41 patients). For 9 (43%) patients, obstruction was extraluminal without thrombosis, and 12 (57%) patients had dural sinus thrombosis (DST). In patients with a positive-CTV scan, the severity of injury according to the Glasgow Coma Scale score at presentation was correlated with the presence of DST (p = 0.007). The sensitivity of noncontrast CT (NCCT) for DVS involvement was 38% among the patients with positive-CTV scans. For patients with DVS pathology, poor outcome was correlated with DST (intraluminal), rather than extraluminal obstruction without thrombosis (p = 0.02), and superior sagittal sinus (SSS) involvement (p = 0.05). CONCLUSIONS NCCT is not sensitive enough to detect DVS obstruction in patients with skull fracture adjacent to a DVS, and CTV should be performed in order to rule it out. A correlation was found between the severity of injury and the presence of DST, rather than extraluminal obstruction. The authors' findings

  11. Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

    Institute of Scientific and Technical Information of China (English)

    Xi-Ping CHEN; Lu-Yang TAO; Andrew CN CHEN


    Objective To evaluate the usefulness of quantitative electroencephalogram (QEEG), flash visual evoked potential (F-VEP) and auditory brainstem responses (ABR) as indicators of general neurological status. Methods Comparison was conducted on healthy controls (N=30) and patients with brain concussion (N=60) within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram (EEG) and evoked potential (EEG-EP) testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded.Results Between patients and normal controls, the results indicated: (1) Highly significance (P < 0.01) in average power of α1 and power ratios of θ/α1, θ/α2, α1/α2 of EEG recording; (2) N70-P100 amplitude of F-VEP in significant difference at early brain concussion; and (3) apparent prolongation of Ⅰ~Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury (MTBI). Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of

  12. Phase-plane analysis of gaze stabilization to high acceleration head thrusts: a continuum across normal subjects and patients with loss of vestibular function. (United States)

    Peng, Grace C Y; Zee, David S; Minor, Lloyd B


    We investigated the vestibulo-ocular reflex (VOR) during high-acceleration, yaw-axis, head rotations in 12 normals and 15 patients with vestibular loss [7 unilateral vestibular deficient (UVD) and 8 bilateral vestibular deficient (BVD)]. We analyzed gaze stabilization within a 200-ms window after head rotation began, using phase planes, which allowed simultaneous analysis of gaze velocity and gaze position. These "gaze planes" revealed critical dynamic information not easily gleaned from traditional gain measurements. We found linear relationships between peak gaze-velocity and peak gaze-position error when normalized to peak head speed and position, respectively. Values fell on a continuum, increasing from normals, to normals tested with very high acceleration (VHA = 10,000-20,000 degrees/s2), to UVD patients during rotations toward the intact side, to UVD patients during rotations toward the lesioned side, to BVD patients. We classified compensatory gaze corrections as gaze-position corrections (GPCs) or gaze-velocity error corrections (GVCs). We defined patients as better-compensated when the value of their end gaze position was low relative to peak gaze position. In the gaze plane this criterion corresponded to relatively stereotyped patterns over many rotations, and appearance of high velocity (100-400 degrees/s) GPCs in the gaze plane ending quadrant (150-200 ms after head movement onset). In less-compensated patients, and normals at VHA, more GVCs were generated, and GPCs were generated only after gaze-velocity error was minimized. These findings suggest that challenges to compensatory vestibular function can be from vestibular deficiency or novel stimuli not previously experienced. Similar patterns of challenge and compensation were observed in both patients with vestibular loss and normal subjects.

  13. Traumatic brain injury-induced sleep disorders

    Directory of Open Access Journals (Sweden)

    Viola-Saltzman M


    Full Text Available Mari Viola-Saltzman, Camelia Musleh Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA Abstract: Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%–70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. Keywords: traumatic brain injury, insomnia, hypersomnia, sleep apnea, periodic limb movement disorder, fatigue

  14. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... special x-ray equipment to help assess head injuries, severe headaches, dizziness, and other symptoms of aneurysm, ... cancer. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ...

  15. Decay-accelerating Factor Limits Hemorrhage-instigated Tissue Injury and Improves Resuscitation Clinical Parameters (United States)


    hemorrhage followed by Hextend resuscitation in pigs . (A) Representative liver histologic images. (B) Hepatic injury scores. (C) Representative kidney...J Inflamm 1998;48:13. [31] Garratty G. Blood group antigens as tumor markers, parasitic /bacterial/viral receptors, and their association with

  16. Subdural Effusions with Hydrocephalus after Severe Head Injury: Successful Treatment with Ventriculoperitoneal Shunt Placement: Report of 3 Adult Cases

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    N. Tzerakis


    Full Text Available Background. Subdural collections of cerebrospinal fluid (CSF with associated hydrocephalus have been described by several different and sometimes inaccurate terms. It has been proposed that a subdural effusion with hydrocephalus (SDEH can be treated effectively with a ventriculoperitoneal shunt (V-P shunt. In this study, we present our experience treating patients with SDEH without directly treating the subdural collection. Methods. We treated three patients with subdural effusions and hydrocephalus as a result of a head injury. All the patients were treated with a V-P shunt despite the fact that there was an extra-axial CSF collection with midline shift. Results. In all of the patients, the subdural effusions subsided and the ventricular dilatation improved in the postoperative period. The final clinical outcome remains difficult to predict and depends not only on the successful CSF diversion but also on the primary and secondary brain insult. Conclusion. Subdural effusions with hydrocephalus can be safely and effectively treated with V-P shunting, without directly treating the subdural effusion which subsides along with the treatment of hydrocephalus. However, it is extremely important to make an accurate diagnosis of an SDEH and differentiate this condition from other subdural collections which require different management.

  17. Knotting of a nasogastric feeding tube in a child with head injury: A case report and review of literature. (United States)

    Ismail, Nasiru J; Bot, Gyang Markus; Hassan, Ismail; Shilong, Danaan J; Obande, Joseph O; Aliu, Salamat Ahuoiza; Dung, Ezekiel D; Shehu, Bello B


    Nasogastric intubation is one of the most common routine nonoperative procedures available for the hospital care of patients. The insertion and removal of this tube is associated with many complications. The complications include trauma, nasal septal abscess and inadvertent entry into the cranial cavity and trachea, ulceration, bleeding from varices and perforation. Knotting of the nasogastric tube is one of the very rare complications of nasogastric intubation particularly in children. To the best of our knowledge there are very few reported cases in children. The technique used in the patient was the application of a steady tug which allows the lower oesophageal sphincter to open, therefore enabling the removal of the nasogastric tube. The possible predispositions to knotting of a nasogastric tube include small bore tubes, excess tube length and gastric surgery. We postulate that reduced gastric tone is another possible predisposing factor with head injury being the most likely reason in the index patient. We also challenge the fact that the small sized stomach is a risk factor for knotting of a feeding tube if the functional status and tone are normal, because of the rarity in children.

  18. An examination of the impact of participation in a conversation group for individuals with a closed head injury. (United States)

    Goldblum, G; Mulder, M; von Gruenewaldt, A


    This study describes the impact of participation in a conversational group for individuals with chronic closed head injury in the Department of Communication Pathology at the University of Pretoria over the period 1995-2000. The information was obtained through a combination of clinical observations by the writers; the examination of data from Pragmatic measures; and a Quality of Life Scale that was compiled and administered (to both the subjects and their significant others) examining the perceived effects of group therapy over time. The results showed that despite the plateauing of pragmatic competence over time, the impact of group therapy appeared to reveal itself in perceived improvements in social-communicative competence and quality of life by the subjects. Recommendation and suggestions were made for the refinement of the QOL Scale to more reliably measure the subjective perceptions of group members regarding the perceived value of group therapy. In addition to addressing future implications to move the conversation group forward, the results of the current study lead the authors to advocate the establishment of conversation groups for individuals with CHI who are suitable candidates.

  19. Perivascular adipose tissue-secreted angiopoietin-like protein 2 (Angptl2) accelerates neointimal hyperplasia after endovascular injury. (United States)

    Tian, Zhe; Miyata, Keishi; Tazume, Hirokazu; Sakaguchi, Hisashi; Kadomatsu, Tsuyoshi; Horio, Eiji; Takahashi, Otowa; Komohara, Yoshihiro; Araki, Kimi; Hirata, Yoichiro; Tabata, Minoru; Takanashi, Shuichiro; Takeya, Motohiro; Hao, Hiroyuki; Shimabukuro, Michio; Sata, Masataka; Kawasuji, Michio; Oike, Yuichi


    Much attention is currently focused on the role of perivascular adipose tissue in development of cardiovascular disease (CVD). Some researchers view it as promoting CVD through secretion of cytokines and growth factors called adipokines, while recent reports reveal that perivascular adipose tissue can exert a protective effect on CVD development. Furthermore, adiponectin, an anti-inflammatory adipokine, reportedly suppresses neointimal hyperplasia after endovascular injury, whereas such vascular remodeling is enhanced by pro-inflammatory adipokines secreted by perivascular adipose, such as tumor necrosis factor-α (TNF-α). These findings suggest that extent of vascular remodeling, a pathological process associated with CVD development, depends on the balance between pro- and anti-inflammatory adipokines secreted from perivascular adipose tissue. We previously demonstrated that angiopoietin-like protein 2 (Angptl2), a pro-inflammatory factor secreted by adipose tissue, promotes adipose tissue inflammation and subsequent systemic insulin resistance in obesity. Here, we examined whether Angptl2 secreted by perivascular adipose tissue contributes to vascular remodeling after endovascular injury in studies of transgenic mice expressing Angptl2 in adipose tissue (aP2-Angptl2 transgenic mice) and Angptl2 knockout mice (Angptl2(-/-) mice). To assess the role of Angptl2 secreted by perivascular adipose tissue on vascular remodeling after endovascular injury, we performed adipose tissue transplantation experiments using these mice. Wild-type mice with perivascular adipose tissue derived from aP2-Angptl2 mice exhibited accelerated neointimal hyperplasia after endovascular injury compared to wild-type mice transplanted with wild-type tissue. Conversely, vascular inflammation and neointimal hyperplasia after endovascular injury were significantly attenuated in wild-type mice transplanted with Angptl2(-/-) mouse-derived perivascular adipose tissue compared to wild-type mice

  20. Clinical decision rules for the application of computed tomography in children with minor head injury%儿童轻型头部外伤 CT 检查临床决策规则及应用现状

    Institute of Scientific and Technical Information of China (English)

    张靖; 丁华新


    Pediatric head injury is the leading cause of death and disability,about 40% to 60% of kids of head injury get a CT,and the majority are those with minor head injury,about 10% of these CT scans are positive.Clinical decision rules for pediatric head injury exist to identify children at risk of traumatic brain injury.Those of the highest quality are children's head injury algorithm for the prediction of important clinical events(CHALICE),Pediatric Emergency Care Applied Research Network(PECARN)and the Canadian as-sessment of tomography for childhood head injury(CATCH)clinical decision rules.This review aimed to systematically introduce primary clinical decision rules for children with minor head injury and compare them for diagnostic accuracy in detecting intracranial injury and injury requiring neurosurgery.%脑外伤是儿童主要创伤性疾病和致死、致残原因,儿童头部外伤大约40%~60%进行了头部 CT 检查,其中不到10%发生外伤性脑损伤。为减少儿童不必要的头部 CT 检查,国外研究主要有预测儿童头部损伤重要临床事件、儿科急救治疗应用研究网络和加拿大儿童头部外伤 X 线检查评估等临床决策规则,指导临床医生决策儿童轻型头部外伤后 CT 的应用,现就目前临床应用的主要临床决策规则进行综述。

  1. An Introductory Characterization of a Combat-Casualty-Care Relevant Swine Model of Closed Head Injury Resulting from Exposure to Explosive Blast (United States)


    Richard Bauman, Geoffrey Ling, Lawrence Tong, Adolph Januszkiewicz , Denes Agoston, Nihal Delanerolle, Young Kim, Dave Ritzel, Randy Bell, James Ecklund...of Closed Head Injury Resulting from Exposure to Explosive Blast* Richard A. Bauman,1 Geoffrey Ling,2 Lawrence Tong,3 Adolph Januszkiewicz ,4 Denes...inflammation, and neuronal death cascades. J. Neurotrauma 26, 901-911. Ananiadou, O., Bibou, K ., Drossos, G., Bai, M., Haj-Yahia, S., Charchardi, A., and

  2. A Modified Hybrid III 6-Year-Old Dummy Head Model for Lateral Impact Assessment

    Directory of Open Access Journals (Sweden)

    I. A. Rafukka


    Full Text Available Hybrid III six-year-old (6YO child dummy head model was developed and validated for frontal impact assessment according to the specifications contained in Code of Federal Regulations, Title 49, Part 572.122, Subpart N by Livermore Software Technology Corporation (LSTC. This work is aimed at improving biofidelity of the head for frontal impact and also extending its application to lateral impact assessment by modifying the head skin viscoelastic properties and validating the head response using the scaled nine-year-old (9YO child cadaver head response recently published in the literature. The modified head model was validated for two drop heights for frontal, right, and left parietal impact locations. Peak resultant acceleration of the modified head model appeared to have good correlation with scaled 9YO child cadaver head response for frontal impact on dropping from 302 mm height and fair correlation with 12.3% difference for 151 mm drop height. Right parietal peak resultant acceleration values correlate well with scaled 9YO head experimental data for 153 mm drop height, while fair correlation with 16.4% difference was noticed for 302 mm drop height. Left parietal, however, shows low biofidelity for the two drop heights as the difference in head acceleration response was within 30%. The modified head model could therefore be used to estimate injuries in vehicle crash for head parietal impact locations which cannot be measured by the current hybrid III dummy head model.

  3. Evaluation of a laboratory model of human head impact biomechanics. (United States)

    Hernandez, Fidel; Shull, Peter B; Camarillo, David B


    This work describes methodology for evaluating laboratory models of head impact biomechanics. Using this methodology, we investigated: how closely does twin-wire drop testing model head rotation in American football impacts? Head rotation is believed to cause mild traumatic brain injury (mTBI) but helmet safety standards only model head translations believed to cause severe TBI. It is unknown whether laboratory head impact models in safety standards, like twin-wire drop testing, reproduce six degree-of-freedom (6DOF) head impact biomechanics that may cause mTBI. We compared 6DOF measurements of 421 American football head impacts to twin-wire drop tests at impact sites and velocities weighted to represent typical field exposure. The highest rotational velocities produced by drop testing were the 74th percentile of non-injury field impacts. For a given translational acceleration level, drop testing underestimated field rotational acceleration by 46% and rotational velocity by 72%. Primary rotational acceleration frequencies were much larger in drop tests (~100 Hz) than field impacts (~10 Hz). Drop testing was physically unable to produce acceleration directions common in field impacts. Initial conditions of a single field impact were highly resolved in stereo high-speed video and reconstructed in a drop test. Reconstruction results reflected aggregate trends of lower amplitude rotational velocity and higher frequency rotational acceleration in drop testing, apparently due to twin-wire constraints and the absence of a neck. These results suggest twin-wire drop testing is limited in modeling head rotation during impact, and motivate continued evaluation of head impact models to ensure helmets are tested under conditions that may cause mTBI.

  4. Comparison of mortality following hospitalisation for isolated head injury in England and Wales, and Victoria, Australia.

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    Belinda J Gabbe

    Full Text Available BACKGROUND: Traumatic brain injury (TBI remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes. METHODS: Isolated TBI admissions (>15 years, July 2005-June 2006 were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3 admissions were provided by the Trauma Audit and Research Network (TARN and Victorian State Trauma Registry (VSTR for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions. FINDINGS: Mortality was 12% (749/6256 in England/Wales and 9% (91/1048 in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5, and for cases <65 years (OR 2.36, 95% CI: 1.51, 3.69. For severe TBI, mortality was 23% (133/575 for TARN and 20% (68/346 for VSTR, with 72% of TARN and 86% of VSTR cases managed at a neurosurgical centre. The adjusted mortality odds for severe TBI cases in TARN were higher compared to the VSTR (OR 1.45, 95% CI: 0.96, 2.19, but particularly for cases <65 years (OR 2.04, 95% CI: 1.07, 3.90. Neurosurgical centre management modified the effect overall (OR 1.12, 95% CI: 0.73, 1.74 and for cases <65 years (OR 1.53, 95% CI: 0.77, 3.03. CONCLUSION: The risk-adjusted odds of mortality for all isolated TBI admissions, and severe TBI cases, were higher in England/Wales when compared to Victoria. The lower percentage of cases managed at neurosurgical centres in England and Wales was an explanatory factor, supporting the changes made to the NICE

  5. Human Recombinant Decay-Accelerating Factor (DAF) Increases Survival and Limits Tissue Injury After Hemorrhagic Shock (United States)


    For lung injury scoring as described previously (Carraway, et al., 2003), four parameters ( alveolar fibrin edema, alveolar hemorrhage, septal...thickening and intra- alveolar inflammatory cells) were scored on each slide for 1) severity (0: absent; 1, 2 and 3 for more severe changes) and 2) extent...groups at 120 min (Table 1). Significantly reduced bicarbonate levels and base deficit were observed in the H + DAF25μg + Hextend® group at the

  6. Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks). An alternative in the treatment of locally advanced head and neck cancer

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    Kubes, Jiri; Vondracek, Vladimir; Pala, Miloslav [Prague Univ., Prag (Czech Republic). Inst. of Radiation Oncology; Cvek, Jakub; Feltl, David [Faculty Hospital Ostrava (Czech Republic). Dept. of Oncology


    To present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer. A total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%. The median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13-45 days). The mean radiotherapy dose was 68.4 Gy (16-74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity {>=} grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%). Accelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.

  7. Blast-Induced Acceleration in a Shock Tube: Distinguishing Primary and Tertiary Blast Injury (United States)


    Annual, Year 2 3. DATES COVERED 4. TITLE AND SUBTITLE Blast-Induced Acceleration in a Shock Tube : Distinguishing Primary and Tertiary 5a...Using a highly characterized shock tube simulation of blast, rats will be exposed to BOP with varied peak amplitudes and impulse in association...understanding of the relation of the former to the latter. As the use of shock tubes has greatly expanded in recent years for biomedical research

  8. An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast. (United States)

    Bauman, Richard A; Ling, Geoffrey; Tong, Lawrence; Januszkiewicz, Adolph; Agoston, Dennis; Delanerolle, Nihal; Kim, Young; Ritzel, Dave; Bell, Randy; Ecklund, James; Armonda, Rocco; Bandak, Faris; Parks, Steven


    Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs).

  9. Understanding Edward Muybridge: historical review of behavioral alterations after a 19th-century head injury and their multifactorial influence on human life and culture. (United States)

    Manjila, Sunil; Singh, Gagandeep; Alkhachroum, Ayham M; Ramos-Estebanez, Ciro


    Edward Muybridge was an Anglo-American photographer, well known for his pioneering contributions in photography and his invention of the "zoopraxiscope," a forerunner of motion pictures. However, this 19th-century genius, with two original patents in photographic technology, made outstanding contributions in art and neurology alike, the latter being seldom acknowledged. A head injury that he sustained changed his behavior and artistic expression. The shift of his interests from animal motion photography to human locomotion and gait remains a pivotal milestone in our understanding of patterns in biomechanics and clinical neurology, while his own behavioral patterns, owing to an injury to the orbitofrontal cortex, remain a mystery even for cognitive neurologists. The behavioral changes he exhibited and the legal conundrum that followed, including a murder of which he was acquitted, all depict the complexities of his personality and impact of frontal lobe injuries. This article highlights the life journey of Muybridge, drawing parallels with Phineas Gage, whose penetrating head injury has been studied widely. The wide sojourn of Muybridge also illustrates the strong connections that he maintained with Stanford and Pennsylvania universities, which were later considered pinnacles of higher education on the two coasts of the United States.

  10. Computation of the head-related transfer function via the fast multipole accelerated boundary element method and its spherical harmonic representation. (United States)

    Gumerov, Nail A; O'Donovan, Adam E; Duraiswami, Ramani; Zotkin, Dmitry N


    The head-related transfer function (HRTF) is computed using the fast multipole accelerated boundary element method. For efficiency, the HRTF is computed using the reciprocity principle by placing a source at the ear and computing its field. Analysis is presented to modify the boundary value problem accordingly. To compute the HRTF corresponding to different ranges via a single computation, a compact and accurate representation of the HRTF, termed the spherical spectrum, is developed. Computations are reduced to a two stage process, the computation of the spherical spectrum and a subsequent evaluation of the HRTF. This representation allows easy interpolation and range extrapolation of HRTFs. HRTF computations are performed for the range of audible frequencies up to 20 kHz for several models including a sphere, human head models [the Neumann KU-100 ("Fritz") and the Knowles KEMAR ("Kemar") manikins], and head-and-torso model (the Kemar manikin). Comparisons between the different cases are provided. Comparisons with the computational data of other authors and available experimental data are conducted and show satisfactory agreement for the frequencies for which reliable experimental data are available. Results show that, given a good mesh, it is feasible to compute the HRTF over the full audible range on a regular personal computer.

  11. Acute Ozone (O3) Exposure Accelerates Diet-Induced Pulmonary Injury and Metabolic Alterations in a Rat Model of Type II Diabetes (United States)

    Abstract for Society of Toxicology, March 22-25, 2015, San Diego, CAAcute Ozone (O3) Exposure Accelerates Diet-Induced Pulmonary Injury and Metabolic Alterations in a Rat Model of Type II DiabetesS.J. Snow1,3, D. Miller2, V. Bass2, M. Schladweiler3, A. Ledbetter3, J. Richards3, C...

  12. Biofidelic neck influences head kinematics of parietal and occipital impacts following short falls in infants. (United States)

    Sullivan, Sarah; Coats, Brittany; Margulies, Susan S


    Falls are a major cause of traumatic head injury in children. Understanding head kinematics during low height falls is essential for evaluating injury risk and designing mitigating strategies. Typically, these measurements are made with commercial anthropomorphic infant surrogates, but these surrogates are designed based on adult biomechanical data. In this study, we improve upon the state-of-the-art anthropomorphic testing devices by incorporating new infant cadaver neck bending and tensile data. We then measure head kinematics following head-first falls onto 4 impact surfaces from 3 fall heights with occipital and parietal head impact locations. The biofidelic skull compliance and neck properties of the improved infant surrogate significantly influenced the measured kinematic loads, decreasing the measured impact force and peak angular accelerations, lowering the expected injury risk. Occipital and parietal impacts exhibited distinct kinematic responses in primary head rotation direction and the magnitude of the rotational velocities and accelerations, with larger angular velocities as the head rebounded after occipital impacts. Further evaluations of injury risk due to short falls should take into account the impact surface and head impact location, in addition to the fall height.

  13. To compare the effects of multiple sessions of Hyperbaric Oxygen Therapy in neurological improvement in head injury patients: A prospective randomized trial

    Directory of Open Access Journals (Sweden)

    Amlendu Yadav


    Full Text Available Introduction: Hyperbaric oxygen therapy (HBOT is used to improve functional outcome following brain injuries. Different number of sessions of HBOT have been reported but the frequency of HBOT sessions in head injured patients has not been standardized. We planned this prospective randomized study with an aim to compare the neurological effects of 10, 20 and 30 sessions of HBOT in the head injured patients. Materials and Methods: After review board approval, this study was conducted in 60 head injury patients with Glasgow Coma Scale (GCS score ≤ 9. All patients were resuscitated, stabilized and received neurological care according to institutional protocol. Patients were randomly allotted to-Group H10 (n-20-which received 10 sittings of HBOT, Group H20 (n-20-which received 20 sittings of HBOT, Group H30 (n-30-which received 30 sittings of HBOT. GCS score was recorded after every 10 sittings and at 30 days from initiation of HBOT. Improvement Global rating and Glasgow outcome scale (GOS were recorded after 30 days. Results: The maximum improvement in GCS scores was seen in group H30. The difference in the average improvement global rating scale was significant between group H10 and group H20, between group H10 and group H30 but was comparable between groups H20 and H30. The GOS was better after 30 sessions as compared to 10 sessions. Patients of all groups showed improvement in spasticity but group H30 showed a maximum improvement. Conclusion: A minimum of 30 HBOT sessions should be considered in head injury patients to show improvement with HBOT. Progressive improvement in GCS scores, GOS, spasticity, mood swings was better seen with increased number of HBOT sessions.

  14. A transient finite element study reveals the importance of the bycicle helmet material properties on head protection during an impact


    Asiminei, Aida Georgeta; Van der Perre, Georges; Verpoest, Ignace; Goffin, Jan


    This paper is focused on understanding the mechanism that gives the bicycle helmet the role of protecting the head during an impact. The finite element method is used here as a first step in the helmet optimisation and improvement process. The relation between different helmet mechanical parameters and the risk of head injury during the impact is described using MSC Marc Mentat finite element software. The reduction in resulting head linear acceleration by more than 80% and in resulting stres...

  15. Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study.

    Directory of Open Access Journals (Sweden)

    A Khan

    Full Text Available Traumatic brain injury (TBI is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs. We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability.We analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430 distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico. Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR from Poisson regressions were used to identify associated risk factors.The standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29-1.82, younger (PR: 0.95, 95% CI: 0.92-0.99, with lower education (PR 0.91, 95% CI: 0.86-0.96, and having fewer assets (PR 0.92, 95% CI: 0.88-0.96, was associated with a higher prevalence of TBI when pooling estimates across sites.Our analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.

  16. A head impact detection system using SVM classification and proximity sensing in an instrumented mouthguard. (United States)

    Wu, Lyndia C; Zarnescu, Livia; Nangia, Vaibhav; Cam, Bruce; Camarillo, David B


    Injury from blunt head impacts causes acute neurological deficits and may lead to chronic neurodegeneration. A head impact detection device can serve both as a research tool for studying head injury mechanisms and a clinical tool for real-time trauma screening. The simplest approach is an acceleration thresholding algorithm, which may falsely detect high-acceleration spurious events such as manual manipulation of the device. We designed a head impact detection system that distinguishes head impacts from nonimpacts through two subsystems. First, we use infrared proximity sensing to determine if the mouthguard is worn on the teeth to filter out all off-teeth events. Second, on-teeth, nonimpact events are rejected using a support vector machine classifier trained on frequency domain features of linear acceleration and rotational velocity. The remaining events are classified as head impacts. In a controlled laboratory evaluation, the present system performed substantially better than a 10-g acceleration threshold in head impact detection (98% sensitivity, 99.99% specificity, 99% accuracy, and 99.98% precision, compared to 92% sensitivity, 58% specificity, 65% accuracy, and 37% precision). Once adapted for field deployment by training and validation with field data, this system has the potential to effectively detect head trauma in sports, military service, and other high-risk activities.

  17. Mild hypothermia to decrease serum glucose and improve prognosis in patients with severe head injury%亚低温治疗对重型颅脑损伤血糖降低改善预后功能的影响

    Institute of Scientific and Technical Information of China (English)


    @@ Background: It is a common phenomenon that serum glucose would increase after head injury due to stress response,in general,the more severe the injury was,the higher the serum glucose was.Research had shown that hyperglycemia after head injury would aggravate extent of brain tissue secondary damage,and the higher of the serum glucose was,the worse the prognosis was.Therefore,control hyperglycemia after head injury as soon as possible was very important to improve prognosis.The utility of mild hypothermia has been confirmed,therapeutic mild hypothermia is widely used for the treatment of severe head injury.

  18. Accelerated neointima formation after vascular injury in mice with stromelysin-3 (MMP-11) gene inactivation. (United States)

    Lijnen, H R; Van Hoef, B; Vanlinthout, I; Verstreken, M; Rio, M C; Collen, D


    The hypothesis that stromelysin-3 (MMP-11), a unique member of the matrix metalloproteinase (MMP) family, plays a role in neointima formation was tested with the use of a vascular injury model in wild-type (MMP-11(+/+)) and MMP-11-deficient (MMP-11(-/-)) mice. Neointima formation 2 to 3 weeks after electric injury of the femoral artery was significantly enhanced in MMP-11(-/-) as compared with MMP-11(+/+) mice, in both mice of a pure 129SV genetic background (0.014 versus 0.0010 mm(2) at 2 weeks, P<0.001) and those of a 50/50 mixed 129SV/BL6 background (0.030 versus 0.013 mm(2) at 3 weeks, P<0.05). The medial areas were comparable, resulting in intima/media ratios that were significantly increased in MMP-11(-/-) as compared with MMP-11(+/+) arteries, in mice of both the 129SV (1. 0 versus 0.18, P<0.001) and mixed (1.5 versus 0.70, P<0.05) backgrounds. Nuclear cell counts in cross-sectional areas of the intima of the injured region were higher in arteries from MMP-11(-/-) mice than in those from MMP-11(+/+) mice (210 versus 48, P<0.001, in pure 129SV mice and 290 versus 150, P<0.01, in mice of the mixed genetic background). Immunocytochemical analysis revealed that alpha-actin-positive and CD45-positive cells were more abundant in intimal sections of MMP-11(-/-) mice. Degradation of the internal elastic lamina was more extensive in arteries of MMP-11(-/-) mice than in those of MMP-11(+/+) mice (39% versus 6.8% at 3 weeks, P<0. 005). The mechanisms by which MMP-11 could impair elastin degradation and cellular migration in this model remain, however, unknown.

  19. Current and future concepts in helmet and sports injury prevention. (United States)

    Hoshizaki, T Blaine; Post, Andrew; Oeur, R Anna; Brien, Susan E


    Since the introduction of head protection, a decrease in sports-related traumatic brain injuries has been reported. The incidence of concussive injury, however, has remained the same or on the rise. These trends suggest that current helmets and helmet standards are not effective in protecting against concussive injuries. This article presents a literature review that describes the discrepancy between how helmets are designed and tested and how concussions occur. Most helmet standards typically use a linear drop system and measure criterion such as head Injury criteria, Gadd Severity Index, and peak linear acceleration based on research involving severe traumatic brain injuries. Concussions in sports occur in a number of different ways that can be categorized into collision, falls, punches, and projectiles. Concussive injuries are linked to strains induced by rotational acceleration. Because helmet standards use a linear drop system simulating fall-type injury events, the majority of injury mechanisms are neglected. In response to the need for protection against concussion, helmet manufacturers have begun to innovate and design helmets using other injury criteria such as rotational acceleration and brain tissue distortion measures via finite-element analysis. In addition to these initiatives, research has been conducted to develop impact protocols that more closely reflect how concussions occur in sports. Future research involves a better understanding of how sports-related concussions occur and identifying variables that best describe them. These variables can be used to guide helmet innovation and helmet standards to improve the quality of helmet protection for concussive injury.

  20. Head Injury Prevention Tips (United States)

    ... gear should be worn at all times for: • Baseball and Softball (when batting) • Cycling • Football • Hockey • Horseback ... use playgrounds with hard surface grounds. • Follow all rules and warning signs at water parks, swimming pools, ...

  1. Overview of Head Injuries (United States)

    ... Clear fluid or blood may drain from the nose, ears, or both if a person has a fracture of the base of the skull (see Skull Fracture ). Herniation: The Brain Under Pressure Bleeding or swelling in the brain ...

  2. Repressor and activator protein accelerates hepatic ischemia reperfusion injury by promoting neutrophil inflammatory response. (United States)

    Li, Chang Xian; Lo, Chung Mau; Lian, Qizhou; Ng, Kevin Tak-Pan; Liu, Xiao Bing; Ma, Yuen Yuen; Qi, Xiang; Yeung, Oscar Wai Ho; Tergaonkar, Vinay; Yang, Xin Xiang; Liu, Hui; Liu, Jiang; Shao, Yan; Man, Kwan


    Repressor and activator protein (Rap1) directly regulates nuclear factor-κB (NF-κB) dependent signaling, which contributes to hepatic IRI. We here intended to investigate the effect of Rap1 in hepatic ischemia reperfusion injury (IRI) and to explore the underlying mechanisms. The association of Rap1 expression with hepatic inflammatory response were investigated in both human and rat liver transplantation. The effect of Rap1 in hepatic IRI was studied in Rap1 knockout mice IRI model in vivo and primary cells in vitro. Our results showed that over expression of Rap1 was associated with severe liver graft inflammatory response, especially in living donor liver transplantation. The results were also validated in rat liver transplantation model. In mice hepatic IRI model, the knockout of Rap1 reduced hepatic damage and hepatic inflammatory response. In primary cells, the knockout of Rap1 suppressed neutrophils migration activity and adhesion in response to liver sinusoidal endothelial cells through down-regulating neutrophils F-Actin expression and CXCL2/CXCR2 pathway. In addition, the knockout of Rap1 also decreased production of pro-inflammatory cytokines/chemokines in primary neutrophils and neutrophils-induced hepatocyte damage. In conclusion, Rap1 may induce hepatic IRI through promoting neutrophils inflammatory response. Rap1 may be the potential therapeutic target of attenuating hepatic IRI.

  3. The Postural Control Characteristics of Individuals with and without a History of Ankle Sprain during Single-leg Standing: Relationship between Center of Pressure and Acceleration of the Head and Foot Parameters. (United States)

    Abe, Yota; Sugaya, Tomoaki; Sakamoto, Masaaki


    [Purpose] This study aimed to investigate the postural control characteristics of individuals with and without a history of ankle sprain during single-leg standing by examining the relationship between various parameters of center of pressure (COP) and head and foot acceleration. [Subjects] Twenty subjects with and 23 subjects without a history of ankle sprain (sprain and control groups, respectively) participated. [Methods] Mean and maximum COP velocity and maximum COP range in the anteroposterior and mediolateral components of movement were calculated using a gravicorder. The anteroposterior and mediolateral maximum accelerations of the head and foot, as well as the root mean square (RMS) of each acceleration parameter, were measured using accelerometers. [Results] In the mediolateral component, a significant positive correlation was found between maximum acceleration of the foot and all COP parameters in the sprain group. [Conclusion] Our findings suggest that mediolateral momentary motion of the foot in individuals with a history of ankle sprain has relevance to various parameters of COP.

  4. Investigation of the relationship between facial injuries and traumatic brain injuries using a realistic subject-specific finite element head model. (United States)

    Tse, Kwong Ming; Tan, Long Bin; Lee, Shu Jin; Lim, Siak Piang; Lee, Heow Pueh


    In spite of anatomic proximity of the facial skeleton and cranium, there is lack of information in the literature regarding the relationship between facial and brain injuries. This study aims to correlate brain injuries with facial injuries using finite element method (FEM). Nine common impact scenarios of facial injuries are simulated with their individual stress wave propagation paths in the facial skeleton and the intracranial brain. Fractures of cranio-facial bones and intracranial injuries are evaluated based on the tolerance limits of the biomechanical parameters. General trend of maximum intracranial biomechanical parameters found in nasal bone and zygomaticomaxillary impacts indicates that severity of brain injury is highly associated with the proximity of location of impact to the brain. It is hypothesized that the midface is capable of absorbing considerable energy and protecting the brain from impact. The nasal cartilages dissipate the impact energy in the form of large scale deformation and fracture, with the vomer-ethmoid diverging stress to the "crumpling zone" of air-filled sphenoid and ethmoidal sinuses; in its most natural manner, the face protects the brain. This numerical study hopes to provide surgeons some insight in what possible brain injuries to be expected in various scenarios of facial trauma and to help in better diagnosis of unsuspected brain injury, thereby resulting in decreasing the morbidity and mortality associated with facial trauma.

  5. Routine Repeat Head CT may not be Indicated in Patients on Anticoagulant/Antiplatelet Therapy Following Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    McCammack, Kevin C.


    Full Text Available Introduction: Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP therapy that present after mild traumatic brain injury (TBI are controversial. At our institution, an initial noncontrast head computed tomography (HCT is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH. This study was performed to evaluate the yield and advisability of this approach. Methods: We performed a retrospective review of subjects undergoing evaluation for ICH after mild TBI in patients on ACAP therapy between January of 2012 and April of 2013. We assessed for the frequency of ICH on both the initial noncontrast HCT and on the routine six-hour follow-up HCT. Additionally, chart review was performed to evaluate the clinical implications of ICH, when present, and to interrogate whether pertinent clinical and laboratory data may predict the presence of ICH prior to imaging. We used multivariate generalized linear models to assess whether presenting Glasgow Coma Score (GCS, loss of consciousness (LOC, neurological or physical examination findings, international normalized ratio, prothrombin time, partial thromboplastin time, platelet count, or specific ACAP regimen predicted ICH. Results: 144 patients satisfied inclusion criteria. Ten patients demonstrated initial HCT positive for ICH, with only one demonstrating delayed ICH on the six-hour follow-up HCT. This patient was discharged without any intervention required or functional impairment. Presenting GCS deviation (p<0.001, LOC (p=0.04, neurological examination findings (p<0.001, clopidogrel (p=0.003, aspirin (p=0.03 or combination regimen (p=0.004 use were more commonly seen in patients with ICH. Conclusion: Routine six-hour follow-up HCT is likely not indicated in patients on ACAP therapy, as our study suggests clinically significant delayed ICH does not occur. Additionally, presenting GCS deviation, LOC, neurological examination

  6. Influence of the crash pulse shape on the peak loading and the injury tolerance levels of the neck in in vitro low-speed side-collisions. (United States)

    Kettler, Annette; Fruth, Kai; Claes, Lutz; Wilke, Hans-Joachim


    The aim of the present in vitro study was to investigate the effect of the crash pulse shape on the peak loading and the injury tolerance levels of the human neck. In a custom-made acceleration apparatus 12 human cadaveric cervical spine specimens, equipped with a dummy head, were subjected to a series of incremental side accelerations. While the duration of the acceleration pulse of the sled was kept constant at 120 ms, its shape was varied: Six specimens were loaded with a slowly increasing pulse, i.e. a low loading rate, the other six specimens with a fast increasing pulse, i.e. a high loading rate. The loading of the neck was quantified in terms of the peak linear and angular acceleration of the head, the peak shear force and bending moment of the lower neck and the peak translation between head and sled. The shape of the acceleration curve of the sled only seemed to influence the peak translation between head and sled but none of the other four parameters. The neck injury tolerance level for the angular acceleration of the head and for the bending moment of the lower neck was almost identical for both, the high and the low loading rate. In contrast, the injury tolerance level for the linear acceleration of the head and for the shear force of the lower neck was slightly higher for the low loading rate as compared to the high loading rate. For the translation between head and sled this difference was even statistically significant. Thus, if the shape of the crash pulse is not known, solely the peak bending moment of the lower neck and the peak angular acceleration of the head seem to be suitable predictors for the neck injury risk but not the peak shear force of the lower neck, the peak linear acceleration of the head and the translation between head and thorax.

  7. 颅脑损伤并发低钠血症的补液护理%The fluid infusion nursing on hyponatremia following head injury

    Institute of Scientific and Technical Information of China (English)



    目的 探讨颅脑外伤并发低钠血症患者的观察护理.方法 回顾性分析42例颅脑损伤并发低钠血症病例,通过正确合理补液和口服或鼻饲盐水,动态监测血钠的变化.结果 患者血清钠均小于130 mmol/L,尿钠大于20 mmol/L.经正确的补钠治疗和全面的护理,均在2周左右得到纠正.结论 密切观察患者意识、生命体征,监测血清钠,有助于低钠血症的早期诊断和治疗,强调低钠血症患者的全面护理,可降低病残率和病死率.%Objective To invastigate the observation and fluid infusion nursing of hyponatremia following head injury. Methods To retrospectively analysis 42 cases of head injury complicated with hyponatremia,through correct reasonable fluid infusion and oral adninistration or nasal feeding salt water, continously monitoring blood serum natrium change. Results In these 42 patients, blood serum natrium is less than 130 mmol/l,urine natrium is more than 20 mnol/L just after head injury. Through correct administration of sodium, the patient blood serum natrium changed to nornal. Conclusion Closely observe the patients consciousness, vital signs, monitorring blood serum natrium change, are helpful to diagnose and treat hyponatremia. Emphasize the overall nursing of the patients, can decrease the nortality and morbidity .

  8. Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

    Institute of Scientific and Technical Information of China (English)

    朱岩湘; 姚杰; 卢尚坤; 章更生; 周关仁


    Objective: To study the changes of partial pressure of brain tissue oxygen (PbtO2) and brain temperature in acute phase of severe head injury during mild hypothermia therapy and the clinical significance.Methods: One hundred and sixteen patients with severe head injury were selected and divided into a mild hypothermia group (n=58), and a control group (n=58) according to odd and even numbers of hospitalization. While mild hypothermia therapy was performed PbtO2 and brain temperature were monitored for 1-7 days (mean=86 hours), simultaneously, the intracranial pressure, rectum temperature, cerebral perfusion pressure, PaO2 and PaCO2 were also monitored. The patients were followed up for 6 months and the prognosis was evaluated with GOS (Glasgow outcome scale).Results: The mean value of PbtO2 within 24 hour monitoring in the 116 patients was 13.7 mm Hg±4.94 mm Hg, lower than the normal value (16 mm Hg±40 mm Hg) The time of PbtO2 recovering to the normal value in the mild hypothermia group was shortened by 10±4.15 hours compared with the control group (P<0.05). The survival rate of the mild hypothermia group was 60.43%, higher than that of the control group (46.55%). After the recovery of the brain temperature, PbtO2 increased with the rise of the brain temperature. Conclusions: Mild hypothermia can improve the survival rate of severe head injury. The technique of monitoring PbtO2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy.

  9. A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury

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    Satyen Parida


    Full Text Available Background and Aims: Evidence and utility of the individual steps of the rapid sequence induction and tracheal intubation protocols have been debated, especially in the setting of traumatic brain injury. The purpose of this survey was to determine preferences in the current approach to rapid sequence intubation ( RSI in head injury patients among a population of anaesthesiologists from South India. Methods: A questionnaire was E-mailed to all the members of the Indian Society of Anaesthesiologists′ South Zone Chapter to ascertain their preferences, experience and comfort level with regard to their use of rapid sequence intubation techniques in adult patients with head injury. Participants were requested to indicate their practices for RSI technique for a head-injured patient upon arrival at the Emergency Medical Services department of their hospital. Results: The total response rate was 56.9% (530/932. Of the total respondents, 35% of the clinicians used cricoid pressure routinely, most respondents (68% stated that they pre-oxygenate the patients for about 3 min prior to RSI, thiopentone (61% and propofol (34% were commonly used prior to intubation. Rocuronium was the muscle relaxant of choice for RSI among the majority (44%, compared to succinylcholine (39%. Statistical analyses were performed after the initial entry onto a spreadsheet. Data were summarised descriptively using frequency distribution. Conclusion: In a rapid sequence intubation situation, the practice differed significantly among anaesthesiologists. Owing to disagreements and paucity of evidence-based data regarding the standards of RSI, it is apparent that RSI practice still has considerable variability in clinical practice.

  10. An Independent, Prospective, Head to Head Study of the Reliability and Validity of Neurocognitive Test Batteries for the Assessment of Mild Traumatic Brain Injury (United States)


    exclusions include: presence of Axis I psychiatric disorder , currently on psychotropic or narcotic medication, under the influence of alcohol or drugs in...mTBI). The specific NCAT’s under study include: the Automated Neuropsychiatric Assessment Metric (ANAM), AXON Sports, Defense Automated...mild traumatic brain injury (mTBI). The specific NCAT’s under study include: the Automated Neuropsychiatric Assessment Metric (ANAM), AXON Sports

  11. Ice hockey shoulder pad design and the effect on head response during shoulder-to-head impacts. (United States)

    Richards, Darrin; Ivarsson, B Johan; Scher, Irving; Hoover, Ryan; Rodowicz, Kathleen; Cripton, Peter


    Ice hockey body checks involving direct shoulder-to-head contact frequently result in head injury. In the current study, we examined the effect of shoulder pad style on the likelihood of head injury from a shoulder-to-head check. Shoulder-to-head body checks were simulated by swinging a modified Hybrid-III anthropomorphic test device (ATD) with and without shoulder pads into a stationary Hybrid-III ATD at 21 km/h. Tests were conducted with three different styles of shoulder pads (traditional, integrated and tethered) and without shoulder pads for the purpose of control. Head response kinematics for the stationary ATD were measured. Compared to the case of no shoulder pads, the three different pad styles significantly (p shoulder pads reduced linear head accelerations by an additional 18-21% beyond the other two styles of shoulder pads. The data presented here suggest that shoulder pads can be designed to help protect the head of the struck player in a shoulder-to-head check.

  12. Systemic down-regulation of delta-9 desaturase promotes muscle oxidative metabolism and accelerates muscle function recovery following nerve injury.

    Directory of Open Access Journals (Sweden)

    Ghulam Hussain

    Full Text Available The progressive deterioration of the neuromuscular axis is typically observed in degenerative conditions of the lower motor neurons, such as amyotrophic lateral sclerosis (ALS. Neurodegeneration in this disease is associated with systemic metabolic perturbations, including hypermetabolism and dyslipidemia. Our previous gene profiling studies on ALS muscle revealed down-regulation of delta-9 desaturase, or SCD1, which is the rate-limiting enzyme in the synthesis of monounsaturated fatty acids. Interestingly, knocking out SCD1 gene is known to induce hypermetabolism and stimulate fatty acid beta-oxidation. Here we investigated whether SCD1 deficiency can affect muscle function and its restoration in response to injury. The genetic ablation of SCD1 was not detrimental per se to muscle function. On the contrary, muscles in SCD1 knockout mice shifted toward a more oxidative metabolism, and enhanced the expression of synaptic genes. Repressing SCD1 expression or reducing SCD-dependent enzymatic activity accelerated the recovery of muscle function after inducing sciatic nerve crush. Overall, these findings provide evidence for a new role of SCD1 in modulating the restorative potential of skeletal muscles.


    Energy Technology Data Exchange (ETDEWEB)

    Jonason, C.; Miracle, A.


    The cytoskeletal protein alpha II-spectrin has specifi c neurodegenerative mechanisms that allow the necrotic (injury-induced) and apoptotic (non-injury-induced) pathways of proteolysis to be differentiated in an immunoblot. Consequently, αII-spectrin breakdown products (SBDPs) are potential biomarkers for diagnosing traumatic brain injury (TBI). The purpose of the following investigation, consisting of two studies, was to evaluate the utility of the spectrin biomarker in diagnosing TBI in fi sh that travel through hydroelectric dams in the Columbia and Snake Rivers. The fi rst study used hyperbaric pressure chambers to simulate the pressure changes that affect fi sh during passage through a Federal Columbia River Power System (FCRPS) Kaplan turbine. The second study tested the effect of a removable spillway weir (RSW) on the passage of juvenile chinook (Oncorhynchus tshawytscha). This study was conducted in tandem with a balloon-tag study by the U.S. Army Corps of Engineers. Brain samples from fi sh were collected and analyzed using an immunoblot for SBDPs, and imaging software was used to quantify the protein band density and determine the ratio of cleaved protein to total protein. The biomarker analyses found higher SBDP expression levels in fi sh that were exposed to lower pressure nadirs and fi sh that passed through the RSW at a deep orientation. In general, the incidence of injuries observed after treatment positively correlated with expression levels, suggesting that the biomarker method of analysis is comparable to traditional methods of injury assessment. It was also found that, for some treatments, the 110 kDa spectrin fragment (SBDP 110) correlated more strongly with necrotic head injury incidence and mortality rates than did the total cleaved protein or the 120 kDa fragment. These studies will be informative in future decisions regarding the design of turbines and fi sh passage structures in hydroelectric dams and will hopefully contribute to the

  14. Head Trauma with or without Mild Brain Injury Increases the Risk of Future Traumatic Death: A Controlled Prospective 15-Year Follow-Up Study. (United States)

    Vaaramo, Kalle; Puljula, Jussi; Tetri, Sami; Juvela, Seppo; Hillbom, Matti


    Patients who have recovered from traumatic brain injury (TBI) show an increased risk of premature death. To investigate long-term mortality rates in a population admitted to the hospital for head injury (HI), we conducted a population-based prospective case-control, record-linkage study, All subjects who were living in Northern Ostrobothnia, and who were admitted to Oulu University Hospital in 1999 because of HI (n=737), and 2196 controls matched by age, gender, and residence randomly drawn from the population of Northern Ostrobothnia were included. Death rate and causes of death in HI subjects during 15 years of follow-up was compared with the general population controls. The crude mortality rates were 56.9, 18.6, and 23.8% for subjects having moderate-to-severe traumatic brain injury (TBI), mild TBI, and head injury without TBI, respectively. The corresponding approximate annual mortality rates were 6.7%, 1.4%, and 1.9%. All types of index HI predicted a significant risk of traumatic death in the future. Subjects who had HI without TBI had an increased risk of both death from all causes (hazard ratio 2.00; 95% confidence interval 1.57-2.55) and intentional or unintentional traumatic death (4.01, 2.20-7.30), compared with controls. The main founding was that even HI without TBI carries an increased risk of future traumatic death. The reason for this remains unknown and further studies are needed. To prevent such premature deaths, post-traumatic therapy should include an interview focusing on lifestyle factors.

  15. Dealing with Sports Injuries (United States)

    ... for falling accidents, such as horseback riding and gymnastics. Head injuries include fractures, concussions , contusions (bruises), and ... hockey, or in weightlifting, rowing, golf, figure skating, gymnastics, and dancing. Sex Organ Injuries Injuries to the ...

  16. Traumatic Brain Injury (United States)

    Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the U.S. suffer brain injuries. More than half are bad enough that ...

  17. On the Development of the SIMon Finite Element Head Model. (United States)

    Takhounts, Erik G; Eppinger, Rolf H; Campbell, J Quinn; Tannous, Rabih E; Power, Erik D; Shook, Lauren S


    The SIMon (Simulated Injury Monitor) software package is being developed to advance the interpretation of injury mechanisms based on kinematic and kinetic data measured in the advanced anthropomorphic test dummy (AATD) and applying the measured dummy response to the human mathematical models imbedded in SIMon. The human finite element head model (FEHM) within the SIMon environment is presented in this paper. Three-dimensional head kinematic data in the form of either a nine accelerometer array or three linear CG head accelerations combined with three angular velocities serves as an input to the model. Three injury metrics are calculated: Cumulative strain damage measure (CSDM) - a correlate for diffuse axonal injury (DAI); Dilatational damage measure (DDM) - to estimate the potential for contusions; and Relative motion damage measure (RMDM) - a correlate for acute subdural hematoma (ASDH). During the development, the SIMon FEHM was tuned using cadaveric neutral density targets (NDT) data and further validated against the other available cadaveric NDT data and animal brain injury experiments. The hourglass control methods, integration schemes, mesh density, and contact stiffness penalty coefficient were parametrically altered to investigate their effect on the model's response. A set of numerical and physical parameters was established that allowed a satisfactory prediction of the motion of the brain with respect to the skull, when compared with the NDT data, and a proper separation of injury/no injury cases, when compared with the brain injury data. Critical limits for each brain injury metric were also established. Finally, the SIMon FEHM performance was compared against HIC15 through the use of NHTSA frontal and side impact crash test data. It was found that the injury metrics in the current SIMon model predicted injury in all cases where HIC15 was greater than 700 and several cases from the side impact test data where HIC15 was relatively small. Side impact was

  18. Suicidal single gunshot injury to the head: differences in site of entrance wound and direction of the bullet path between right- and left-handed--an autopsy study. (United States)

    Nikolić, Slobodan; Zivković, Vladimir; Babić, Dragan; Juković, Fehim


    The aim of this study was to determine the differences in the anatomical site of a gunshot entrance wound and the direction of the bullet path between right- and left-handed subjects who committed a suicide by a single gunshot injury to the head. The retrospective autopsy study was performed for a 10-year period, and it included selected cases of single suicidal gunshot head injury, committed by handguns. We considered only contact or near-contact wounds. The sample included 479 deceased, with average age 47.1 ± 19.1 years (range, 12-89 years): 432 males and 47 females, with 317 right-handed, 25 left-handed, and 137 subjects with unknown dominant hand. In our observed sample, most cases involved the right temple as the site of entrance gunshot wound (about 67%), followed by the mouth (16%), forehead (7%), left temple (6%), submental (2%), and parietal region (1%). The left temple, right temple, and forehead were the sites of the gunshot entrance wounds, which were the best predictors of the handedness of the deceased (Spearman ρ = 0.149, P = 0.006). Our study showed that the direction of the bullet intracranial path in cases of suicide was even a more potent predictor of the handedness of the deceased (Spearman ρ = 0.263, P = 0.000; Wald = 149.503, P = 0.000).

  19. Heads Up: Concussion in Youth Sports

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    Full Text Available ... Learn More about the Brain and How it Works Order Free Copies of CDC's “Heads Up” Educational ... Up! Prevent Concussions Prevent Head Injuries Sports Safety Students Play Safe Youth Sports Safety PROMOTIONAL MATERIALS "Heads ...

  20. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... in Spanish [Podcast: 1:27 minutes] Send a Health eCard Heads Up! Prevent Concussions Prevent Head Injuries ... in Spanish [Podcast: 1:27 minutes] Send a Health eCard Heads Up! Prevent Concussions Prevent Head Injuries ...

  1. Split Course Hyperfractionated Accelerated Radio-Chemotherapy (SCHARC for patients with advanced head and neck cancer: Influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Sprague Lisa D


    Full Text Available Abstract Background The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol "SCHARC" and the overall survival of our patients. Methods From 1997 to 2004, 64 patients suffering from advanced head and neck cancer (88 % stage IV, 12 % stage III were assigned to receive the SCHARC protocol. Around half of the patients were diagnosed with oro-hypopharynx carcinoma (52 %, one third with tongue and floor of mouth tumors (29 % and one fifth (19 % suffered from H & N cancer at other sites. The schedule consisted of one therapy block with 30 Gy in 20 fractions over a two week period with concomitant chemotherapy (d 1–5: 20 mg/m2/d DDP + 750–1000 mg/m2/d 5FU (cont. infusion. This therapy block was repeated after a fortnight break up to a cumulative dose of 60 Gy and followed by a boost up to 70 Gy (69–70.5 Gy. All patients assigned to this scheme were included in the survival evaluation. Results Forty patients (63 % received both radiation and chemotherapy according to the protocol. The mean follow up was 2.3 years (829 d and the median follow up was 1.9 years (678 d, respectively. The analysis of survival revealed an estimated 3 year overall survival rate of 57 %. No patient died of complications, 52 patients (80 % had acute grade 2–3 mucositis, and 33 patients (58 % suffered from acute grade 3 skin toxicity. Leucopenia was no major problem (mean nadir 3.4 g/nl, no patient 10.5 g/dl and for patients who completed the protocol. Conclusion The SCHARC protocol was effective in patients diagnosed with advanced head and neck cancer. It led to long-term disease control and survival in about 50 % of the patients with significant but acceptable toxicity. Most patients

  2. Motor, Visual and Emotional Deficits in Mice after Closed-Head Mild Traumatic Brain Injury Are Alleviated by the Novel CB2 Inverse Agonist SMM-189

    Directory of Open Access Journals (Sweden)

    Anton Reiner


    Full Text Available We have developed a focal blast model of closed-head mild traumatic brain injury (TBI in mice. As true for individuals that have experienced mild TBI, mice subjected to 50–60 psi blast show motor, visual and emotional deficits, diffuse axonal injury and microglial activation, but no overt neuron loss. Because microglial activation can worsen brain damage after a concussive event and because microglia can be modulated by their cannabinoid type 2 receptors (CB2, we evaluated the effectiveness of the novel CB2 receptor inverse agonist SMM-189 in altering microglial activation and mitigating deficits after mild TBI. In vitro analysis indicated that SMM-189 converted human microglia from the pro-inflammatory M1 phenotype to the pro-healing M2 phenotype. Studies in mice showed that daily administration of SMM-189 for two weeks beginning shortly after blast greatly reduced the motor, visual, and emotional deficits otherwise evident after 50–60 psi blasts, and prevented brain injury that may contribute to these deficits. Our results suggest that treatment with the CB2 inverse agonist SMM-189 after a mild TBI event can reduce its adverse consequences by beneficially modulating microglial activation. These findings recommend further evaluation of CB2 inverse agonists as a novel therapeutic approach for treating mild TBI.

  3. Motor, visual and emotional deficits in mice after closed-head mild traumatic brain injury are alleviated by the novel CB2 inverse agonist SMM-189. (United States)

    Reiner, Anton; Heldt, Scott A; Presley, Chaela S; Guley, Natalie H; Elberger, Andrea J; Deng, Yunping; D'Surney, Lauren; Rogers, Joshua T; Ferrell, Jessica; Bu, Wei; Del Mar, Nobel; Honig, Marcia G; Gurley, Steven N; Moore, Bob M


    We have developed a focal blast model of closed-head mild traumatic brain injury (TBI) in mice. As true for individuals that have experienced mild TBI, mice subjected to 50-60 psi blast show motor, visual and emotional deficits, diffuse axonal injury and microglial activation, but no overt neuron loss. Because microglial activation can worsen brain damage after a concussive event and because microglia can be modulated by their cannabinoid type 2 receptors (CB2), we evaluated the effectiveness of the novel CB2 receptor inverse agonist SMM-189 in altering microglial activation and mitigating deficits after mild TBI. In vitro analysis indicated that SMM-189 converted human microglia from the pro-inflammatory M1 phenotype to the pro-healing M2 phenotype. Studies in mice showed that daily administration of SMM-189 for two weeks beginning shortly after blast greatly reduced the motor, visual, and emotional deficits otherwise evident after 50-60 psi blasts, and prevented brain injury that may contribute to these deficits. Our results suggest that treatment with the CB2 inverse agonist SMM-189 after a mild TBI event can reduce its adverse consequences by beneficially modulating microglial activation. These findings recommend further evaluation of CB2 inverse agonists as a novel therapeutic approach for treating mild TBI.

  4. Development of Magnetic Resonance Imaging Biomarkers for Traumatic Brain Injury (United States)


    Institutes of Health, 1999), with major causes including motor vehicle crash ( MVC ) accidents, falls, assaults, and sports. TBI has been referred to as “a...Blumbergs et al., 1994), especially in MVC , due to the rota- tional motion or angular acceleration of the head versus neck during vehicle impact, which...acceleration/deceleration injuries (such as MVCs ), diffusion anisotropy typically decreases (Kou et al., 2010; Niogi and Mukherjee, 2010). Theoretically, loss

  5. Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk. (United States)

    Kumar, Ravi; Kumar, Ramesh; Mallory, Grant W; Jacob, Jeffrey T; Daniels, David J; Wetjen, Nicholas M; Foy, Andrew B; O'Neill, Brent R; Clarke, Michelle J


    OBJECT Nonpowder guns, defined as spring- or gas-powered BB or pellet guns, can be dangerous weapons that are often marketed to children. In recent decades, advances in compressed-gas technology have led to a significant increase in the power and muzzle velocity of these weapons. The risk of intracranial injury in children due to nonpowder weapons is poorly documented. METHODS A retrospective review was conducted at 3 institutions studying children 16 years or younger who had intracranial injuries secondary to nonpowder guns. RESULTS The authors reviewed 14 cases of intracranial injury in children from 3 institutions. Eleven (79%) of the 14 children were injured by BB guns, while 3 (21%) were injured by pellet guns. In 10 (71%) children, the injury was accidental. There was 1 recognized assault, but there were no suicide attempts; in the remaining 3 patients, the intention was indeterminate. There were no mortalities among the patients in this series. Ten (71%) of the children required operative intervention, and 6 (43%) were left with permanent neurological injuries, including epilepsy, cognitive deficits, hydrocephalus, diplopia, visual field cut, and blindness. CONCLUSIONS Nonpowder guns are weapons with the ability to penetrate a child's skull and brain. Awareness should be raised among parents, children, and policy makers as to the risk posed by these weapons.

  6. Effect of Die Head Temperature at Compounding Stage on the Degradation of Linear Low Density Polyethylene/Plastic Film Waste Blends after Accelerated Weathering

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    S. M. Al-Salem


    Full Text Available Accelerated weathering test was performed on blends of linear low density polyethylene (LLDPE and plastic film waste constituting the following percentages of polyolefin polymers (wt.%: LLDPE (46%, low density polyethylene (LDPE, 51%, high density polyethylene (HDPE, 1%, and polypropylene (PP, 2%. Compounded blends were evaluated for their mechanical and physical (optical properties. The impact of photodegradation on the formulated blends was studied, and loss of mechanical integrity was apparent with respect to both the exposure duration to weathering and waste content. The effect of processing conditions, namely, the die head temperature (DHT of the blown-film assembly used, was investigated in this work. It was witnessed that surpassing the melting point of the blends constituting polymers did not always result in a synergistic behaviour between polymers. This was suspected to be due to the loss of amorphous region that polyolefin polymers get subjected to with UV exposure under weathering conditions and the effect of the plastic waste constituents. The total change in colour (ΔE did not change with respect to DHT or waste content due to rapid change degradation on the material’s surface. Haze (% and light transmission (% decreased with the increase in waste content which was attributed to lack of miscibility between constituting polymers.

  7. Incorporating Human Body Mass in Standards of Helmet Impact Protection against Traumatic Brain Injury

    CERN Document Server

    Blackman, Eric G


    Impact induced traumatic brain injury (ITBI) describes brain injury from head impact not necessarily accompanied by skull fracture. For sufficiently abrupt head impact decelerations, ITBI results from brain tissue stress incurred as the brain crashes into the inside of the skull wall, displacing the surrounding cerebral spinal fluid (CSF). Proper helmet cushioning can damp the impact force and reduce ITBI. But force is mass times acceleration and commonly used helmet blunt impact standards are based only on acceleration thresholds. Here I show how this implies that present standards overestimate the minimum acceleration onset for ITBI by implicitly assuming that the brain is mechanically decoupled from the body. I quantify how an arbitrary orientation of the body with respect to impact direction increases the effective mass that should be used in calculating the required damping force and injury threshold accelerations. I suggest a practical method to incorporate the body mass and impact angle into ITBI helme...

  8. Computed Tomography (CT) -- Head

    Medline Plus

    Full Text Available ... headaches, dizziness, and other symptoms of aneurysm, bleeding, stroke and brain tumors. It also helps your doctor ... scanning provides more detailed information on head injuries, stroke , brain tumors and other brain diseases than regular ...

  9. Fatores que influenciaram a evolução de 206 pacientes com traumatismo craniencefálico grave Relevant factors in 206 patients with severe head injury

    Directory of Open Access Journals (Sweden)

    Venâncio Pereira Dantas Filho


    Full Text Available A busca de fatores prognósticos para o traumatismo craniencefálico (TCE tem sido alvo de muitos estudos nas últimas décadas. A identificação de indicadores consistentes da evolução destes pacientes tem representado um grande desafio e sua utilidade considerada evidente tanto para orientar o tratamento, quanto para a estimativa do resultado final. Baseados numa casuística de 206 pacientes com TCE grave (8 pontos ou menos pela Escala de Coma de Glasgow - ECG, estudamos a influência de vários fatores sobre a evolução dos pacientes. A gravidade inicial medida pela ECG, a presença de hipertensão intracraniana (níveis acima de 20 mmHg, o tipo de lesão intracraniana e a presença de hipoxia, hipotensão arterial e a associação de hipóxia e hipotensão arterial tiveram influência significativa sobre a evolução dos pacientes. A presença de politraumatismo (pelo menos dois sítios de lesão além do TCE e a idade (acima e abaixo de 40 anos não influenciaram significativamente a evolução dos pacientes desta casuística.The search for head injury prognostic factors has been intense in the last decades. The importance of identification of these factors has been also recognised to treatment orientation and results estimatives. Based on 206 severe head injuried patients series, we analized the influence of factors over the outcome. The initial severity by Glasgow coma scale, the presence of intracranial hypertension (over 20 mmHg, the type of intracranial lesion and the presence of hypoxia, systemic hypotension or both, significantly influenced the results. The presence of multiple traumas (at least two sites of lesion over head injury, as age, did not influence the final results in this series.

  10. Early therapy of cervical vertigo in head injury%颅脑外伤中颈性眩晕的早期治疗研究

    Institute of Scientific and Technical Information of China (English)

    丁轩; 鲍洪; 吴开华; 招建华; 兰蒙


    Objective To discuss early therapy scheme for cervical vertigo in mild and moderate head injury. Methods Eighty-four patients suffering from cervical vertigo in mild or moderate head injury were randomly divided into 2 groups: combined therapy group (n=38) and control group (n=46). In the combined therapy group, patients underwent cervical vertebra traction and stellate ganglion block and early physical therapy for cervix as well as medication; in the control group, simple medication was used. The results were analyzed by nonparametric rank sum test Ridit analysis. Results In the combined therapy group, 29 cases were cured, 8 got better, and 1 remained unchanged, average therapy duration 20 d, while in the control group, 26 were healed, 15 changed better, and 5 did not show a sign of recovery, average therapy duration 30 d. The curative effect was significantly different between the 2 groups, and the combined therapy group was better than the control group (P<0.05). Conclusion The early application of the combined therapy for cervical vertigo in mild and moderate head injury can improve the cure rate and reduce the therapy duration.%目的 探讨轻、中型颅脑外伤中颈性眩晕患者的早期治疗方案.方法 将轻、中型颅脑外伤中颈性眩晕患者84例按随机数字表法分成治疗组(38例)与对照组(46例),治疗组采用颈椎牵引、星状神经节封闭、早期颈部理疗等方法 并结合药物治疗,对照组采用单纯药物治疗,对其疗效进行非参数秩和检验分析.结果 治疗组治愈29例,好转8例,无效1例,平均治疗时间20d;对照组治愈26例,好转15例,无效5例,平均治疗时间30 d;治疗组疗效优于对照组,差异有统计学意义(P<0.05).结论对颅脑外伤中颈性眩晕患者早期采用针对性治疗,其疗效好于单纯药物治疗,且治疗时间缩短.

  11. A Novel Closed-head Model of Mild Traumatic Brain Injury Caused by Primary Overpressure Blast to the Cranium Produces Sustained Emotional Deficits in Mice

    Directory of Open Access Journals (Sweden)

    Scott A Heldt


    Full Text Available Emotional disorders are a common outcome from mild traumatic brain injury (TBI in humans, but their pathophysiological basis is poorly understood. We have developed a mouse model of closed-head blast injury using an air pressure wave delivered to a small area on one side of the cranium, which we have used to create mild TBI. We found that 20-psi blasts in 3-month old C57BL/6 male mice yielded no obvious behavioral or histological evidence of brain injury, while 25-40 psi blasts produced transient anxiety in an open field arena but little histological evidence of brain damage. By contrast, 50-60 psi blasts resulted in anxiety-like behavior in an open field arena that became more evident with time after blast. In additional behavioral tests conducted 2-8 weeks after blast, 50-60 psi mice also demonstrated increased acoustic startle, perseverance of learned fear, and enhanced contextual fear, as well as depression-like behavior and diminished prepulse inhibition. We found no evident cerebral pathology, however, and only scattered axonal degeneration in brain sections from 50-60 psi mice 3-8 weeks after blast. Thus, the TBI caused by single 50-60 psi blasts in mice exhibits the minimal neuronal loss coupled to diffuse axonal injury characteristic of human mild TBI. A reduction in the abundance of a subpopulation of excitatory projection neurons in basolateral amygdala enriched in Thy1 was, however, observed. The reported link of this neuronal population to fear suppression suggests their damage by mild TBI may contribute to the heightened anxiety and fearfulness observed after blast in our mice. Our overpressure air blast model of concussion in mice will enable further studies of the mechanisms underlying the diverse emotional deficits seen after mild TBI.

  12. Gyral high density on CT scan after head injury; [sup 123]I-IMP SPECT and MRI findings in three children

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Takumi; Matsumoto, Kiyoshi (Showa Univ., Tokyo (Japan). School of Medicine); Sakamoto, Tetsuya; Aruga, Tohru


    The authors treated three children who had 'gyral high density' on plain CT scans after head injury with acute subdural hematoma. [sup 123]I-IMP SPECT (IMP) and MRI in the chronic stage were performed. All were males, about one year of age, with acute subdural hematoma. CT scan 48 hours after injury showed diffuse low density in the ipsilateral parenchyma with minimum midline shift, and IMP showed decreased activity in the same area. Plain CT scan 1 to 3 weeks after injury showed remarkably high density along the gyri in part of the same area. This area was markedly enhanced on CT with contrast medium and showed decreased blood flow on IMP. This high density area disappeared within 2 months after injury and the area concerned showed brain atrophy. In the chronic stage (after 6 months), only the high density area along the gyri seen in the CT scan showed MRI evidence of ishemia, but there was no definite evidence of hemorrhage. All three children had hemiplegia at the time of discharge. The gyral high density suggests ischemic brain, but the pathophysiological process might be different from that of so-called hemorrhagic infarction. Presumably, it is due to incomplete autoregulation, the incomplete blood-brain barrier and the sensitivity to stimulation of cerebral blood vessels in the brains of infants. The intensity and range of the gyral high density are considered to be important in estimating the future amount of atrophic change in the insulted brain and the resulting sequelae. (author).

  13. Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves. (United States)

    Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B


    There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves.

  14. Fatal accident distribution by age, gender and head injury, and death probability at accident scene in Mashhad, Iran, 2006-2009. (United States)

    Zangooei Dovom, Hossein; Shafahi, Yousef; Zangooei Dovom, Mehdi


    Several studies have investigated road traffic deaths, but few have compared by road user type. Iran, with an estimated 44 road traffic deaths per 100,000 population in 2002 had higher road traffic deaths than any other country for which reliable estimates can be made. So, the present study was conducted on road death data and identified fatal accident distribution by age, gender and head injury as well as the influences of age and gender on deaths at accident scenes for all road user groups. Data used in this study are on fatal road accidents recorded by forensic medicine experts of the Khorasan Razavi province in Mashhad, the capital of the province, the second largest city and the largest place of pilgrimage, immigration and tourism in Iran. Chi-square test and odds ratio were used to identify the relation of death place with age and gender in 2495 fatal road accidents from 2006 to 2009. The t-test and analysis of variance were employed for continues variable, age, to compare males' and females' mean age for all road user categories. For two genders, all three groups of fatalities (pedestrian, motorcyclist and motor vehicle occupant) had a peak at the ages of 21-30. The youngest were male motorcyclists (mean age = 28). Old pedestrians were included in road deaths very much, too. Male/female overall ratio was 3.41 and the highest male/female ratio was related to motorcyclists (14). The overall ratio of head injury to other organ injuries (torso and underbody) was 2.51 and pedestrians had the largest amount of head injury (38.2%). Regarding death at accident scene, for all road users, gender did not have any significant relation with death at the scene (P-value > 0.1); on the contrary, age had significant relation (P-value accident scenes (male/female ratio at accident sense motorcyclists 41-50 and motor vehicle occupants 31-40 died the most at accident scenes. Identifying the most endangered groups of road accident fatalities, which was conducted in this

  15. Prognosis of the computerized tomography in the severe head injury. Valor pronostico de la tomografia axial computada (TC) en los traumatismos craneoencefalicos severos

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Nieto, J.J.; Lorenzo Dominguez, M.T.; Martin Sanchez, M.J.; Sanchez Gonzalez, E.


    A prospective study is made with sixty five people affected of severe head injury, that is to say, with eight or less points in the Glasgow Coma Scale (GCS), when they get to the hospital. They are studied by computerized tomography at admission, and three and seven days after arrival. In this way, we appraise the type of the lesion, its intensity and the possible prognosis, considering in the last case three features: a) ventricular collapse; b) the mean line structure s shift; and c) effects on perimesencephalic cistern. The findings were parametized and we were able to introduce into the computer program relationships between these findings and the end results. These last ones were appraised through the Glasgow Outcome Scale (GOS). We could show that certain findings in computerized tomography scans have an unavoidable prognosis while as others have a more favorable prognosis. (Author)

  16. Ultrasonic Nakagami-parameter characterization of parotid-gland injury following head-and-neck radiotherapy: A feasibility study of late toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiaofeng; Wu, Ning; Wang, Yuefeng [Radiation Oncology, Emory University, Atlanta, Georgia 30322 (United States); Tridandapani, Srini [Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 (United States); School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332 (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); Beitler, Jonathan J.; Yu, David S.; Curran, Walter J.; Liu, Tian, E-mail: [Radiation Oncology, Emory University, Atlanta, Georgia 30322 and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); Bruner, Deborah W. [Radiation Oncology, Emory University, Atlanta, Georgia 30322 (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); School of Nursing, Emory University, Atlanta, Georgia 30322 (United States)


    Purpose: The study aims to investigate whether Nakagami parameters—estimated from the statistical distribution of the backscattered ultrasound radio-frequency (RF) signals—could provide a means for quantitative characterization of parotid-gland injury resulting from head-and-neck radiotherapy. Methods: A preliminary clinical study was conducted with 12 postradiotherapy patients and 12 healthy volunteers. Each participant underwent one ultrasound study in which ultrasound scans were performed in the longitudinal, i.e., vertical orientation on the bilateral parotids. For the 12 patients, the mean radiation dose to the parotid glands was 37.7 ± 9.5 Gy, and the mean follow-up time was 16.3 ± 4.8 months. All enrolled patients experienced grade 1 or 2 late salivary-gland toxicity (RTOG/EORTC morbidity scale). The normal parotid glands served as the control group. The Nakagami-scaling and Nakagami-shape parameters were computed from the RF data to quantify radiation-induced parotid-gland changes. Results: Significant differences in Nakagami parameters were observed between the normal and postradiotherapy parotid glands. Compared with the control group, the Nakagami-scaling parameter of the postradiotherapy group decreased by 25.8% (p < 0.001), and the Nakagami-shape parameter decreased by 31.3% (p < 0.001). The area under the receiver operating characteristic curve was 0.85 for the Nakagami-scaling parameter and was 0.95 for the Nakagami-shape parameter, which further demonstrated the diagnostic efficiency of the Nakagami parameters. Conclusions: Nakagami parameters could be used to quantitatively measure parotid-gland injury following head-and-neck radiotherapy. Moreover, the clinical feasibility was demonstrated and this study provides meaningful preliminary data for future clinical investigation.

  17. Tormenta simpática paroxística siguiendo a injuria Axonal difusa Paroxysmal sympathetic storm after diffuse axonal head injury

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    Pablo Young


    Full Text Available El término tormenta simpática paroxística se utiliza como sinónimo de alteraciones episódicas de la temperatura corporal, la presión arterial, la frecuencia respiratoria y cardíaca, el tamaño pupilar y el nivel de conciencia, que coinciden con hiperhidrosis, salivación excesiva y postura extensora. Esto siempre en el contexto de una injuria axonal difusa grave que sigue a un traumatismo encéfalo-craneano (TEC grave. Presentamos dos pacientes jóvenes con injuria axonal difusa secundaria a TEC grave, que desarrollan en su evolución cuadros de hipertensión arterial, taquicardia y fiebre, sin evidencia durante los episodios de actividad epileptiforme y habiéndose descartado la causa infecciosa, que responden favorablemente al tratamiento con beta-bloqueantes y morfina. Consideramos que el correcto diagnóstico de esta entidad minimiza la solicitud de estudios innecesarios permitiendo iniciar un tratamiento adecuado.The term paroxysmal sympathetic storms is used to define episodic alterations in body temperature, blood pressure, heart and respiratory rate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during the episodes of epileptiform activity and without any infectious cause with excellent answer to the treatment with beta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application of unnecessary studies allowing an appropriate treatment.

  18. Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. (United States)

    Kaale, Bertel Rune; Krakenes, Jostein; Albrektsen, Grethe; Wester, Knut


    In the present study, we compared magnetic resonance imaging (MRI) findings of soft tissue structures in the upper cervical spine between whiplash-associated disorder (WAD) patients and population-based control persons, and examined whether MRI-verified abnormalities in WAD patients were related to accident-related factors hypothesized to be of importance for severity of injury. A total of 92 whiplash patients and 30 control persons, randomly drawn, were included. Information on the accident-related factors (i.e., head position and impact direction) was obtained by a questionnaire that was answered within 1 week after the accident. The MRI examination was performed 2-9 (mean 6) years after the accident. Focus was on MRI abnormalities of the alar and the transverse ligaments, and the tectorial and posterior atlanto-occipital membranes, graded 0-3. For all neck structures, the whiplash patients had more high-grade lesions (grade 2 or 3) than the control persons (Chi-square test, p Whiplash patients who had been sitting with their head/neck turned to one side at the moment of collision more often had high-grade lesions of the alar and transverse ligaments (p whiplash trauma.

  19. Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years. (United States)

    Büttner, Michael; Schlittler, Fabian Lukas; Michel, Chantal; Exadaktylos, Aris Konstantinos; Iizuka, Tateyuki


    Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye.

  20. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

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    Budach, V.; Boehmer, D.; Badakhshi, H.; Jahn, U.; Stromberger, C. [Campus Virchow Klinikum, Charite Universitaetsmedizin Berlin, Department for Radiooncology, Clinic for Radiooncology, Berlin (Germany); Becker, E.T. [Charite Universitaetsmedizin, Department of Otorhinolaryngology, Berlin (Germany); Wernecke, K.D. [Sostana Statistics GmbH, Charite Universitaetsmedizin Berlin, Berlin (Germany)


    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m{sup 2} on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m{sup 2}). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.) [German] Untersuchung der Akuttoxizitaet und des Langzeitueberlebens einer hyperfraktioniert-akzelerierten simultanen Radiochemotherapie mit Cisplatin/5-Fluorouracil (5-FU) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren. Von 2000 bis 2002 wurden 38 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III (5,3 %) und IV (94,7 %) eingeschlossen. Es erfolgte eine simultane hyperfraktionierte akzelerierte Radiochemotherapie mit 72 Gy in 15 Fraktionen a 2 Gy

  1. Visualisation of the intact dura mater and brain surface in infant autopsies: a minimally destructive technique for the post-mortem assessment of head injury. (United States)

    Cheshire, Emma C; Malcomson, Roger D G; Rutty, Guy N; James, Deryk S


    During the post-mortem examination of babies and young children, it is important to be able to visualise the brain and its coverings, particularly in cases where a head injury is likely to have occurred. In this paper, we present an improved method for removal of the calvarial bones in infant autopsies to enable viewing of the dura mater and brain. In contrast to the standard post-mortem procedure for observing and removing the brain, this novel technique is minimally disruptive, allowing the dura mater to remain undamaged. Specialised paediatric neurosurgical tools were used to remove the skull bones from 23 neonates, infants and young children during post-mortem examination. In 21 of our 23 cases, the calvarial bones were removed successfully with the dura mater remaining intact. In one case, there was a thickening of the dura mater which created a strong adherence of this membrane to the bone. In another case, the dura mater was slightly damaged due to the inexperience of the operator in using the neurosurgical tools. This method of calvarial bone removal reduces the degree of post-mortem artefact and enhances the ability to observe and photographically document autopsy findings, including the artefact-free detection of signs of injury such as epidural or subdural haematoma, and brain swelling. This technique has now become a routine practise in both of our units to remove the skull bones in infant/young children post-mortem examinations.

  2. Intraosseous calcium migration in calcifying tendinitis: a rare cause of single sclerotic injury in the humeral head (2010: 2b). (United States)

    Martin, S; Rapariz, J M


    Intratendinous deposits of hydroxyapatite crystals are very common, particularly in the rotator cuff. In rare cases, the calcium located in the thickness of the supraspinatus tendon can suffer intraosseous migration into the greater tuberosity. We present a case of this rare entity: a 28-year-old patient who attended with pain and functional weakness in the left shoulder. The plain radiograph showed a sclerotic lesion in the greater tuberosity of the humeral head with a radiolucent halo. The MRI showed a lytic lesion containing the calcium inside and associated with an extensive pattern of oedema of the accompanying bone marrow. A plain radiograph taken 6 months before showed a calcifying tendinitis in the thickness of the supraspinatus tendon. A large number of entities can present as single sclerotic lesions of the humeral head. The diagnostic key lies in the existence of the calcifying tendinitis in the earlier study. The treatment of this disease consists of surgical removal of the calcium. The recognition of this entity is important to avoid unnecessary complementary tests and aggressive surgery, given that the surgical treatment is curative and leads to disappearance of the symptoms.

  3. Evaluation of the Effect of Glibenclamide in Patients With Diffuse Axonal Injury Due to Moderate to Severe Head Trauma

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    Full Text Available Background Traumatic brain injury (TBI is a major health problem worldwide. Secondary injuries after TBI, including diffuse axonal injury (DAI often occur, and proper treatments are needed in this regard. It has been shown that glibenclamide could reduce secondary brain damage after experimental TBI and improve outcomes. Objectives We aim to evaluate the role of glibenclamide on the short-term outcome of patients with DAI due to moderate to severe TBI. Patients and Methods In this controlled randomized clinical trial, 40 patients with moderate to severe TBI were assigned to glibenclamide (n = 20 and control (n = 20 groups. Six hours after admission the intervention group received 1.25 mg glibenclamide every 12 hours. The Glasgow coma scale (GCS was administered at admission, in the first 24 and 48 hours, at one week post-trauma and at discharge. The Glasgow outcome scale (GOS was also administered at discharge. All results were evaluated and compared between groups. Results Patients treated with glibenclamide compared to the control group had a significantly better GCS score one week post-trauma (P = 0.003 and at discharge (P = 0.004, as well as a better GOS score at discharge (P = 0.001. The glibenclamide group also had a shorter length of hospital stay compared to the control group (P = 0.03. In the control group, two patients (10% died during the first week post-trauma, but there was no mortality in the glibenclamide group (P = 0.48. Conclusions Treatment with glibenclamide in patients with DAI due to moderate to severe TBI significantly improves short-term outcomes.

  4. Understanding text after severe closed-head injury: assessing inferences and memory operations with a think-aloud procedure. (United States)

    Schmitter-Edgecombe, Maureen; Bales, James W


    A think-aloud method was used to examine the content of information available to working memory during narrative comprehension in a CHI population. Twenty severe CHI participants (>1 year post-injury) and 20 controls talked aloud after they read each sentence of story narratives. Trabasso and Magliano's (1996a) verbal protocol analysis was then used to code for the production of inferential and non-inferential clauses and the memory operations that supported inferential clause production. We found that CHI and control groups produced a comparable number of clauses, that inferences dominated narrative comprehension, and that both groups produced more explanatory inferences than predictive or associative inferences. Despite these qualitative similarities, the CHI group demonstrated poorer comprehension, generated proportionately fewer inferences, relied less on retrieval as a memory source for explanatory inferences, and produced more non-inferential clauses and associative inferences.

  5. Comparative yield of positive brain Computed Tomography after implementing the NICE or SIGN head injury guidelines in two equivalent urban populations

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    Summerfield, R., E-mail: ruth.summerfield@uhns.nhs.u [Medical Imaging, University Hospital of North Staffordshire, City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG (United Kingdom); Macduff, R. [Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF (United Kingdom); Davis, R. [Medical Imaging, University Hospital of North Staffordshire, City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG (United Kingdom); Sambrook, M. [Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF (United Kingdom); Britton, I. [Medical Imaging, University Hospital of North Staffordshire, City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG (United Kingdom)


    Aims: To compare the yield of positive computed tomography (CT) brain examinations after the implementation of the National Institute for Clinical Excellence (NICE) or the Scottish Intercollegiate Guidance Network (SIGN) guidelines, in comparable urban populations in two teaching hospitals in England and Scotland. Materials and methods: Four hundred consecutive patients presenting at each location following a head injury who underwent a CT examination of the head according to the locally implemented guidelines were compared. Similar matched populations were compared for indication and yield. Yield was measured according to (1) positive CT findings of the sequelae of trauma and (2) intervention required with anaesthetic or intensive care unit (ICU) support, or neurosurgery. Results: The mean ages of patients at the English and Scottish centres were 49.9 and 49.2 years, respectively. Sex distribution was 64.1% male and 66.4% male respectively. Comparative yield was 23.8 and 26.5% for positive brain scans, 3 and 2.75% for anaesthetic support, and 3.75 and 2.5% for neurosurgical intervention. Glasgow Coma Score (GCS) <13 (NICE) and GCS {<=}12 and radiological or clinical evidence of skull fracture (SIGN) demonstrated the greatest statistical association with a positive CT examination. Conclusion: In a teaching hospital setting, there is no significant difference in the yield between the NICE and SIGN guidelines. Both meet the SIGN standard of >10% yield of positive scans. The choice of guideline to follow should be at the discretion of the local institution. The indications GCS <13 and clinical or radiological evidence of a skull fracture are highly predictive of intracranial pathology, and their presence should be an absolute indicator for fast-tracking the management of the patient.

  6. Risk Factors Analysis and Prevention of Head Injury Complicated with Stress Ulceration and Bleeding%颅脑损伤后并发应激性溃疡出血的危险因素分析及预防

    Institute of Scientific and Technical Information of China (English)



    目的 分析颅脑损伤后并发应激性溃疡出血的危险因素,为临床实施有效的预防措施提供参考信息.方法 选择2009年2月-2011年6月本院收治的颅脑损伤患者148例,观察患者是否并发应激性溃疡出血并分析发生的危险因素.结果 本组148例颅脑损伤患者中并发应激性溃疡出血29例,其发生与患者的性别、年龄一般资料无关(P>0.05),与患者的损伤程度、体温、血糖、血压相关(P<0.05).结论 颅脑损伤患者的损伤程度严重、发热、高血糖、低血压均为并发应激性溃疡出血的危险因素,临床上针对以上危险因素采取相应的预防措施,可以促进颅脑损伤患者的康复.%Objective To analyze the risk factors of head injury complicated with stress ulceration and bleeding, and to provide the evidence for effective implementation of prevention measures in clinical practice. Methods Totally 148 patients with head injury hospitalized in the Hospital of Tanghai County from February 2009 to June 2011 were enrolled in the study. The development of stress ulceration and bleeding was observed and the risk factors for the occurrence were analyzed. Results Among the 148 cases of head injury, 29 cases complicated with stress ulceration and bleeding, its occurrence was unrelated to the patients' gender, age and general information (P>0.05), but correlated with the patients' degree of injury, body temperature, blood glucose, and blood pressure (P<0.05). Conclusions Severe head injury, fever, high blood sugar, and hypotension are the risk factors of head injury complicated with stress ulceration and bleeding. Adopting the appropriate preventive measures based on the above risk factors in clinical practice can promote the recovery of the patients with traumatic brain injury.

  7. Comparison of build-up dose between Elekta and Varian linear accelerators for high-energy photon beams using radiochromic film and clinical implications for IMRT head and neck treatments. (United States)

    Paelinck, L; De Wagter, C; Van Esch, A; Duthoy, W; Depuydt, T; De Neve, W


    Skin toxicity has been reported for IMRT of head and neck cancer. The purpose of this study was to investigate the dose in the build-up region delivered by a 6 MV treatment plan for which important skin toxicity was observed. We also investigated if the different designs of the treatment head of an Elekta and a Varian linear accelerator, especially the lower position of the Varian multi-leaf collimator, give rise to different build-up doses. For regular square open beams, the build-up dose along the central beam axis is higher for the Varian machine than for the Elekta machine, both for 6 MV and 18 MV. At the Elekta machine at 18 MV, the superficial dose of a diamond shaped 10 x 10 cm2 field is 3.6% lower than the superficial dose of a regular 10 x 10 cm2 field. This effect is not seen at 6 MV. At the Varian machine, the superficial dose of the diamond shaped field is respectively 3.5 and 14.2% higher than the superficial dose of the regular 10 x 10 cm2 field for 6 MV and 18 MV. Despite the differences measured in build-up dose for single beams between the Elekta and the Varian linear accelerator, there were no measurable differences in superficial dose when a typical IMRT dose plan of 6 MV for a head and neck tumour is executed at the two machines.

  8. Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. (United States)

    Toutant, S M; Klauber, M R; Marshall, L F; Toole, B M; Bowers, S A; Seelig, J M; Varnell, J B


    The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p less than 0.001). The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.

  9. Clinical Trials Network / Building Infrastructure to Accelerate Transfer of Basic Research in Spinal Cord Injury (SCI) to Clinical Practice (United States)


    all sites received research ethics board approval and training in study operations by the AOSpine Methods Core. Eligibility criteria Detailed... robotics and exoskeletons)1. 4b (upper extremity function)2. 3d (physical therapy)3. Descriptor 1 2a (Traumatic Injury) Descriptor 2 4h (Other-ASIA Motor

  10. Avaliação da gravidade do traumatismo crânio-encefálico por índices anatômicos e fisiológicos Evaluation of head injury severity reported by physiologic and anatomic indexes

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    Maria de Fátima Paiva Imai


    Full Text Available Este estudo analisou prospectivamente a gravidade do Traumatismo Crânio-Encefálico (TCE a partir de índices anatômicos e fisiológicos em pacientes internados em Unidade de Terapia Intensiva. Teve por objetivo caracterizar a população quanto a idade, sexo, tempo de permanência na UTI e causa externa. Caracterizar a gravidade das lesões pela Abbreviated Injury Scale (AIS, do trauma pelo Injury Severity Score (ISS e do TCE pela Escala de Coma de Glasgow (ECGl, além de verificar a possível associação entre os índices. Os resultados apontam a predominância de adultos jovens e do sexo masculino com causa externa mais freqüente em acidentes de trânsito de veículo a motor e média de permanência na UTI de 6,28 dias. Quanto a gravidade das lesões constatou-se que os pacientes apresentaram lesões graves, que não ameaçam a vida (AIS3 e lesões graves, que ameaçam a vida (AIS4 e que a região corpórea mais atingida foi a cabeça e pescoço. Em relação a gravidade do trauma constatou-se que a maioria dos pacientes obteve ISS 3 16. Pela gravidade do TCE, a maioria dos pacientes apresentou TCE grave ou ECGl de 3 a 8. Através da associação entre os índices analisados por grupos de gravidade constatou-se que há associação estatisticamente significativa entre a ECGl-1 e a AIS da região cabeça, ou seja ECGl 3 a 8 e AIS- cabeça 4 e 5 e ECGl 9 a 12 e AIS- cabeça 2 e 3. Não houve associação estatisticamente significativa entre a ECGl-1 e o ISS, TCE isolado ou TCE associado a outras lesões e o ISS ou a ECGl.The purpose of this study was the analysis of head injury severity based on physiologic and anatomic indexes, shown by hospitalized patients from the Intensive Care Unit. The study was characterized according to patients' age, gender, external cause and remaining time at the Intensive Care Unit, and it was verified that from the total of admitted patients the most of them were young adult males with a remaining time

  11. Multiscale Analysis of Head Impacts in Contact Sports (United States)

    Guttag, Mark; Sett, Subham; Franck, Jennifer; McNamara, Kyle; Bar-Kochba, Eyal; Crisco, Joseph; Blume, Janet; Franck, Christian


    Traumatic brain injury (TBI) is one of the world's major causes of death and disability. To aid companies in designing safer and improved protective gear and to aid the medical community in producing improved quantitative TBI diagnosis and assessment tools, a multiscale finite element model of the human brain, head and neck is being developed. Recorded impact data from football and hockey helmets instrumented with accelerometers are compared to simulated impact data in the laboratory. Using data from these carefully constructed laboratory experiments, we can quantify impact location, magnitude, and linear and angular accelerations of the head. The resultant forces and accelerations are applied to a fully meshed head-form created from MRI data by Simpleware. With appropriate material properties for each region of the head-form, the Abaqus finite element model can determine the stresses, strains, and deformations in the brain. Simultaneously, an in-vitro cellular TBI criterion is being developed to be incorporated into Abaqus models for the brain. The cell-based injury criterion functions the same way that damage criteria for metals and other materials are used to predict failure in structural materials.

  12. 汶川地震致颅脑损伤流行病学和临床特点荟萃分析%Meta- analysis of epidemiology and clinical charateristics of head injuries in the Wenchuan earthquake

    Institute of Scientific and Technical Information of China (English)

    罗晟; 何永生; 陈隆益; 黄光富


    Objective To estimate the epidemiology and clinical characteristics of patients with head injuries in Wenchuan Earthquake. Methods A comprehensive study of clinical data and literature meta - analysis evaluation of the 2008 - 2011 published articles on the traumatic brain injuries caused by the Wenchuan earthquake were carried out. Results Totally 68 retrieved documents met the essential requirements.According to the literature inclusion criteria,there were 18 papers were enrolled into the standard meta- analysis.They were sampled from all 3 involved provinces as Sichuan,Shanxi and Gansu.And this covered the 26 earthquake hit and severe hit regions.As the cumulative statistical showed that the earthquake injured 32 415 people,in which 5 559 people had head injuries ( 17.1% ).The Male:female ratio was 1.53:1.The mild earthquake caused head injuries accounted for 69.4%,moderate 21.0%,and severe 9.6%.The open head injuries accounted for 17.7% and combined injuries accounted for 54.7%.The mortality rate of earthquake caused head injury mortality rate was 0.16%.Conclusions Head injuries caused by the Wenchuan earthquake have some characteristics such as the high incidence,the complicated injury mechanism,combined injuries,nulti - injuries,rapid clinical changes and so on.And to improve the emergency response to victims of disaster in different stages’ hospitals would play greatly important role in increasing the rescue survival and reducing the disability and death rate.%目的 总结汶川地震致颅脑损伤( ERHI)患者的流行病学特征及临床特点.方法 对2008年至2011年公开发表的汶川地震致颅脑创伤相关研究文献进行荟萃分析和再评价.结果 共检索文献68篇,根据录入标准18篇论文进入荟萃分析,样本涉及四川、陕西、甘肃3省,涵盖地震极重灾区和重灾区26个,统计地震伤员32 415人,其中颅脑损伤5 559人(占17.1%).男:女=1.53:1.其中轻型ERHI占69.4%,中型21.0

  13. What Is the Incidence of Intracranial Bleeding in Patients with Mild Traumatic Brain Injury? A Retrospective Study in 3088 Canadian CT Head Rule Patients

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    C. E. Albers


    Full Text Available Objective. Only limited data exists in terms of the incidence of intracranial bleeding (ICB in patients with mild traumatic brain injury (MTBI. Methods. We retrospectively identified 3088 patients (mean age 41 range (7–99 years presenting with isolated MTBI and GCS 14-15 at our Emergency Department who had undergone cranial CT (CCT between 2002 and 2011. Indication for CCT was according to the “Canadian CT head rules.” Patients with ICB were either submitted for neurosurgical treatment or kept under surveillance for at least 24 hours. Pearson’s correlation coefficient was used to correlate the incidence of ICB with age, gender, or intake of coumarins, platelet aggregation inhibitors, or heparins. Results. 149 patients (4.8% had ICB on CCT. No patient with ICB died or deteriorated neurologically. The incidence of ICB increased with age and intake of anticoagulants without clinically relevant correlation (R=0.11; P<0.001; R=-0.06; P<0.001. Conclusion. Our data show an incidence of 4.8% for ICB after MTBI. However, neurological deterioration after MTBI seems to be rare, and the need for neurosurgical intervention is only required in selected cases. The general need for CCT in patients after MTBI is therefore questionable, and clinical surveillance may be sufficient when CCT is not available.

  14. Is the spatial distribution of brain lesions associated with closed-head injury in children predictive of subsequent development of posttraumatic stress disorder? (United States)

    Herskovits, Edward H.; Gerring, Joan P.; Davatzikos, Christos; Bryan, R. Nick


    PURPOSE: To determine whether there is an association between the spatial distributions of lesions detected at magnetic resonance (MR) imaging of the brain in children, adolescents, and young adults after closed-head injury (CHI) and development of the reexperiencing symptoms of posttraumatic stress disorder (PTSD). MATERIALS AND METHODS: Data obtained in 94 subjects without a history of PTSD as determined by parental interview were analyzed. MR images were obtained 3 months after CHI. Lesions were manually delineated and registered to the Talairach coordinate system. Mann-Whitney analysis of lesion distribution and PTSD status at 1 year (again, as determined by parental interview) was performed, consisting of an analysis of lesion distribution versus the major symptoms of PTSD: reexperiencing, hyperarousal, and avoidance. RESULTS: Of the 94 subjects, 41 met the PTSD reexperiencing criterion and nine met all three PTSD criteria. Subjects who met the reexperiencing criterion had fewer lesions in limbic system structures (eg, the cingulum) on the right than did subjects who did not meet this criterion (Mann-Whitney, P =.003). CONCLUSION: Lesions induced by CHI in the limbic system on the right may inhibit subsequent manifestation of PTSD reexperiencing symptoms in children, adolescents, and young adults. Copyright RSNA, 2002.

  15. Injuries to children riding BMX bikes.



    One hundred children presented over 40 days with BMX bike injuries, 40 of which had been sustained while trying to perform stunts. Injuries in this series were compared with previously reported injuries from accidents on ordinary bicycles. BMX bike injuries differed little from ordinary bike injuries except in the greater proportion of injuries due to stunts and the smaller incidence of head injuries.

  16. Características dos pacientes com trauma cranioencefálico na cidade do Salvador, Bahia, Brasil Characteristics of patients with head injury at Salvador City (Bahia - Brazil

    Directory of Open Access Journals (Sweden)

    José Roberto Tude Melo


    Full Text Available OBJETIVO: Descrever as características de pacientes com traumatismo cranioencefálico (TCE na cidade do Salvador, assim como determinar as faixas etárias mais acometidas e definir as taxas de morbidade e letalidade. MÉTODO: Revisão retrospectiva de 555 prontuários de vítimas de TCE internadas no Hospital Geral do Estado da Bahia (HGE no ano de 2001, com posterior preenchimento de questionário. RESULTADOS: Foram verificados 82,9% de vítimas do sexo masculino e 17,1% do sexo feminino com principal faixa etária entre 21 e 30 anos. A principal causa de TCE foi acidente com meios de transporte (40,7%, seguido das agressões com ou sem armas (25,4% e quedas (24%. Foi evidenciada taxa de morbidade de 24,9% e letalidade de 22,9%. CONCLUSÃO: Os mais envolvidos no TCE foram adultos jovens do sexo masculino, tendo como principal causa os acidentes com meios de transporte, com taxas elevadas de morbidade e letalidade.OBJECTIVE: To describe the characteristics from people with head injury at Salvador city, as well, to point out the most frequent age groups, their disabilities and lethality rates. METHOD: Assessment and notification of 555 medical files from victims with head injury assisted at the General Hospital of Bahia during 2001. RESULTS: 82.9% from all victims were male and 17.1% female; the most frequent age group was 21 to 30 years; the most relevant cause of head injury was traffic accident (40.7%, followed by physical violence with or without weapons (25.4% and falls (24%. CONCLUSION: The most evident profile group involved in accidents with head trauma implications was young male that usually had traffic injuries, with expressive rates of disabilities and lethality.

  17. Accelerated recovery of renal mitochondrial and tubule homeostasis with SIRT1/PGC-1α activation following ischemia–reperfusion injury

    Energy Technology Data Exchange (ETDEWEB)

    Funk, Jason A., E-mail: [Center for Cell Death, Injury, and Regeneration, Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425 (United States); Schnellmann, Rick G., E-mail: [Center for Cell Death, Injury, and Regeneration, Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425 (United States); Ralph H. Johnson VA Medical Center, Charleston, SC 29401 (United States)


    Kidney ischemia–reperfusion (I/R) injury elicits cellular injury in the proximal tubule, and mitochondrial dysfunction is a pathological consequence of I/R. Promoting mitochondrial biogenesis (MB) as a repair mechanism after injury may offer a unique strategy to restore both mitochondrial and organ function. Rats subjected to bilateral renal pedicle ligation for 22 min were treated once daily with the SIRT1 activator SRT1720 (5 mg/kg) starting 24 h after reperfusion until 72 h–144 h. SIRT1 expression was elevated in the renal cortex of rats after I/R + vehicle treatment (IRV), but was associated with less nuclear localization. SIRT1 expression was even further augmented and nuclear localization was restored in the kidneys of rats after I/R + SRT1720 treatment (IRS). PGC-1α was elevated at 72 h–144 h in IRV and IRS kidneys; however, SRT1720 treatment induced deacetylation of PGC-1α, a marker of activation. Mitochondrial proteins ATP synthase β, COX I, and NDUFB8, as well as mitochondrial respiration, were diminished 24 h–144 h in IRV rats, but were partially or fully restored in IRS rats. Urinary kidney injury molecule-1 (KIM-1) was persistently elevated in both IRV and IRS rats; however, KIM-1 tissue expression was attenuated in IRS rats. Additionally, sustained loss of Na{sup +},K{sup +}–ATPase expression and basolateral localization and elevated vimentin in IRV rats was normalized in IRS rats, suggesting restoration of a differentiated, polarized tubule epithelium. The results suggest that SRT1720 treatment expedited recovery of mitochondrial protein expression and function by enhancing MB, which was associated with faster proximal tubule repair. Targeting MB may offer unique therapeutic strategy following ischemic injury. - Highlights: • We examined recovery of mitochondrial and renal function after ischemia–reperfusion. • SRT1720 treatment after I/R induced mitochondrial biogenesis via SIRT1/PGC-1α. • Recovery of mitochondrial function was

  18. Is the spatial distribution of brain lesions associated with closed-head injury predictive of subsequent development of attention-deficit/hyperactivity disorder? Analysis with brain-image database (United States)

    Herskovits, E. H.; Megalooikonomou, V.; Davatzikos, C.; Chen, A.; Bryan, R. N.; Gerring, J. P.


    PURPOSE: To determine whether there is an association between the spatial distribution of lesions detected at magnetic resonance (MR) imaging of the brain in children after closed-head injury and the development of secondary attention-deficit/hyperactivity disorder (ADHD). MATERIALS AND METHODS: Data obtained from 76 children without prior history of ADHD were analyzed. MR images were obtained 3 months after closed-head injury. After manual delineation of lesions, images were registered to the Talairach coordinate system. For each subject, registered images and secondary ADHD status were integrated into a brain-image database, which contains depiction (visualization) and statistical analysis software. Using this database, we assessed visually the spatial distributions of lesions and performed statistical analysis of image and clinical variables. RESULTS: Of the 76 children, 15 developed secondary ADHD. Depiction of the data suggested that children who developed secondary ADHD had more lesions in the right putamen than children who did not develop secondary ADHD; this impression was confirmed statistically. After Bonferroni correction, we could not demonstrate significant differences between secondary ADHD status and lesion burdens for the right caudate nucleus or the right globus pallidus. CONCLUSION: Closed-head injury-induced lesions in the right putamen in children are associated with subsequent development of secondary ADHD. Depiction software is useful in guiding statistical analysis of image data.

  19. Effect analysis of nursing intervention on depression after head injury%护理干预在防治脑外伤后抑郁发生中的应用效果

    Institute of Scientific and Technical Information of China (English)

    李继红; 宋明浩; 李志祥; 马文斌


    目的:探讨导致脑外伤后出现抑郁的临床因素,分析早期护理干预对防止脑外伤后抑郁的临床效果。方法回顾分析2005年1月至2011年6月脑外伤出院患者接受电话随访及Beck-13抑郁自评问卷调查的资料。结果未干预组中无抑郁者142例,轻度抑郁者42例,中度抑郁者22例,重度抑郁者7例;干预组中无抑郁者167例,轻度抑郁者9例,中度抑郁者3例,无重度抑郁者,两组比较差异有统计学意义( P<0.05)。结论脑外伤后抑郁的发生直接关系到患者的整体康复,早期护理干预能够降低抑郁的发生,所以,心理护理应贯彻到患者的整个临床治疗中。%Objective To explore the clinical risk of depression after head injury and analyze the clinical effect of early nursing intervention on preventing depression after head injury and prompting the importance of nursing in-tervention to psychological rehabilitation of patients with head injury. Methods The data of telephone follow-up and Beck-13 questionnaire of self rating depressive scale by leaving hospital patients with head injury were analyzed retro-spectively from January 2005 to June 2011. Results In non intervention group there were without depressive in 142 ca-ses, mild depression in 42 cases, moderate depression 22 cases, severe depression in 7 cases. In intervention group there were without depressive in 167 cases, mild depression in 9 cases, moderate depression 3 cases and no severe de-pression. The 2 groups were compared, the difference had statistical significance. Conclusions Depression after head injury had a close bearing on patients' integral rehabilitation. Early nursing intervention can reduce the incidence of de-pression, so mental nursing should be carried out all the clinical treatment.

  20. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer

    DEFF Research Database (Denmark)

    Mortensen, Hanna Rahbek; Overgaard, Jens; Jensen, Kenneth;


    Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on informatio...

  1. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... Brain Tumor Treatment Magnetic Resonance Imaging (MRI) Safety Alzheimer's Disease Head Injury Brain Tumors Images related to ...

  2. Radiation-Free Weekend Rescued! Continuous Accelerated Irradiation of 7-Days per Week Is Equal to Accelerated Fractionation With Concomitant Boost of 7 Fractions in 5-Days per Week: Report on Phase 3 Clinical Trial in Head-and-Neck Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Skladowski, Krzysztof, E-mail: [Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Branch in Gliwice (Poland); Hutnik, Marcin; Wygoda, Andrzej; Golen, Maria; Pilecki, Boleslaw; Przeorek, Wieslawa; Rutkowski, Tomasz; Lukaszczyk-Widel, Beata; Heyda, Alicja; Suwinski, Rafal; Tarnawski, Rafal; Maciejewski, Boguslaw [Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Branch in Gliwice (Poland)


    Purpose: To report long-term results of randomized trial comparing 2 accelerated fractionations of definitive radiation therapy assessing the need to irradiate during weekend in patients with head and neck squamous cell carcinoma. Methods and Materials: A total of 345 patients with SCC of the oral cavity, larynx, and oro- or hypo-pharynx, stage T2-4N0-1M0, were randomized to receive continuous accelerated irradiation (CAIR: once per day, 7 days per week) or concomitant accelerated boost (CB: once per day, 3 days per week, and twice per day, 2 days per week). Total dose ranged from 66.6-72 Gy, dose per fraction was 1.8 Gy, number of fractions ranged from 37-40 fractions, and overall treatment time ranged from 37-40 days. Results: No differences for all trial end-points were noted. At 5 and 10 years, the actuarial rates of local-regional control were 63% and 60% for CAIR vs 65% and 60% for CB, and the corresponding overall survival were 40% and 25% vs 44% and 25%, respectively. Confluent mucositis was the main acute toxicity, with an incidence of 89% in CAIR and 86% in CB patients. The 5-year rate of grade 3-4 late radiation morbidity was 6% for both regimens. Conclusions: Results of this trial indicate that the effects of accelerated fractionation can be achieve by delivering twice-per-day irradiation on weekday(s). This trial has also confirmed that an accelerated, 6-weeks schedule is a reasonable option for patients with intermediate-stage head-and-neck squamous cell carcinoma because of the associated high cure rate and minimal severe late toxicity.

  3. Biophysical mechanisms of traumatic brain injuries. (United States)

    Young, Lee Ann; Rule, Gregory T; Bocchieri, Robert T; Burns, Jennie M


    Despite years of effort to prevent traumatic brain injuries (TBIs), the occurrence of TBI in the United States alone has reached epidemic proportions. When an external force is applied to the head, it is converted into stresses that must be absorbed into the brain or redirected by a helmet or other protective equipment. Complex interactions of the head, neck, and jaw kinematics result in strains in the brain. Even relatively mild mechanical trauma to these tissues can initiate a neurochemical cascade that leads to TBI. Civilians and warfighters can experience head injuries in both combat and noncombat situations from a variety of threats, including ballistic and blunt impact, acceleration, and blast. It is critical to understand the physics created by these threats to develop meaningful improvements to clinical care, injury prevention, and mitigation. Here the authors review the current state of understanding of the complex loading conditions that lead to TBI and characterize how these loads are transmitted through soft tissue, the skull and into the brain, resulting in TBI. In addition, gaps in knowledge and injury thresholds are reviewed, as these must be addressed to better design strategies that reduce TBI incidence and severity.

  4. The clinical experience in treatment of 49 pediatric patients with severe head injury%小儿重型颅脑损伤49例救治的临床体会

    Institute of Scientific and Technical Information of China (English)

    欧阳锡华; 贾军; 刘政委; 彭文君


    目的 总结小儿重型颅脑损伤的救治体会.方法 回顾性分析49例小儿重型颅脑损伤患者的临床资料,对其救治过程和效果进行记录并且统计,出院时按GOS评分进行疗效判定.结果 根据格拉斯预后评分(GOS)判定疗效:存活44例,经4至12个月随访,恢复良好25例,中残11例,重残8例,植物状态生存0例,死亡5例.结论 小儿重型颅脑损伤的临床表现与损伤程度不一致,低血压发生率高,通过积极治疗,预后较成人好.%Objective To summarize the experience in treatment of pediatric patients with severe head injury. Methods The clinical data of 49 pediatric patients with severe head injury treated in this hospital were retrospectively reviewed and analyzed. The process of treatment and its effects were recorded, and their therapeutic efficacy was evaluated according to GOS scores at discharge. Results After the treatment, 44 cases survived and 5 cases died. The results of follow - up for 4 months to 1 year indicated that 25 cases had got good recovery; 11 cases with moderate disability, 8 cases with severe disability and no one with persistent vegetative state ( PVS ) according to Glasgow outcome scale ( GOS ) scores. Conclusion The manifestations of severe head injury are inconsistent with the degree of injury in pediatric patients, while they are usually with high incidence of low blood pressure. But through active treatment, their prognosis is better than that of adults.

  5. Quantification and visualization of cardiovascular 4D velocity mapping accelerated with parallel imaging or k-t BLAST: head to head comparison and validation at 1.5 T and 3 T

    Directory of Open Access Journals (Sweden)

    Ståhlberg Freddy


    Full Text Available Abstract Background Three-dimensional time-resolved (4D phase-contrast (PC CMR can visualize and quantify cardiovascular flow but is hampered by long acquisition times. Acceleration with SENSE or k-t BLAST are two possibilities but results on validation are lacking, especially at 3 T. The aim of this study was therefore to validate quantitative in vivo cardiac 4D-acquisitions accelerated with parallel imaging and k-t BLAST at 1.5 T and 3 T with 2D-flow as the reference and to investigate if field strengths and type of acceleration have major effects on intracardiac flow visualization. Methods The local ethical committee approved the study. 13 healthy volunteers were scanned at both 1.5 T and 3 T in random order with 2D-flow of the aorta and main pulmonary artery and two 4D-flow sequences of the heart accelerated with SENSE and k-t BLAST respectively. 2D-image planes were reconstructed at the aortic and pulmonary outflow. Flow curves were calculated and peak flows and stroke volumes (SV compared to the results from 2D-flow acquisitions. Intra-cardiac flow was visualized using particle tracing and image quality based on the flow patterns of the particles was graded using a four-point scale. Results Good accuracy of SV quantification was found using 3 T 4D-SENSE (r2 = 0.86, -0.7 ± 7.6% and although a larger bias was found on 1.5 T (r2 = 0.71, -3.6 ± 14.8%, the difference was not significant (p = 0.46. Accuracy of 4D k-t BLAST for SV was lower (p 2 = 0.65, -15.6 ± 13.7% compared to 3 T (r2 = 0.64, -4.6 ± 10.0%. Peak flow was lower with 4D-SENSE at both 3 T and 1.5 T compared to 2D-flow (p Conclusions The present study showed that quantitative 4D flow accelerated with SENSE has good accuracy at 3 T and compares favourably to 1.5 T. 4D flow accelerated with k-t BLAST underestimate flow velocities and thereby yield too high bias for intra-cardiac quantitative in vivo use at the present time. For intra-cardiac 4D-flow visualization, however, 1.5 T

  6. Magnetic Resonance Imaging (MRI) -- Head

    Medline Plus

    Full Text Available ... bear denotes child-specific content. Related Articles and Media MR Angiography (MRA) Magnetic Resonance, Functional (fMRI) - Brain Head and Neck Cancer Treatment Brain Tumor Treatment Magnetic Resonance Imaging (MRI) Safety Alzheimer's Disease Head Injury Brain Tumors Images related to Magnetic ...

  7. Preventing head injuries in children (United States)

    ... when they are in a car or other motor vehicle. Use a child safety seat or booster seat that is best ... Helmet Helmets help to ... baseball or softball games Riding a horse Riding a bike Sledding, skiing, ...

  8. Responses and Injuries to PMHS in Side-Facing and Oblique Seats in Horizontal Longitudinal Sled Tests per FAA Emergency Landing Conditions. (United States)

    Humm, John R; Yoganandan, Narayan; Pintar, Frank A; DeWeese, Richard L; Moorcroft, David M; Taylor, Amanda M; Peterson, Brian


    The objective of the present exploratory study is to understand occupant responses in oblique and side-facing seats in the aviation environment, which are increasingly installed in modern aircrafts. Sled tests were conducted using intact Post Mortem Human Surrogates (PMHS) seated in custom seats approximating standard aircraft geometry. End conditions were selected to represent candidate aviation seat and restraint configurations. Three-dimensional head center-of-gravity linear accelerations, head angular velocities, and linear accelerations of the T1, T6, and T12 spinous processes, and sacrum were obtained. Three-dimensional kinematics relative to the seat were obtained from retroreflective targets attached to the head, T1, T6, T12, and sacrum. All specimens sustained spinal injuries, although variations existed by vertebral level. While the tension mechanism was associated with cervical spine injuries, complex distraction-coupled with bending and tension was attributed to thoracolumbar spine injuries. Skeletal fractures to the ribcage were attributed to compression induced by the restraint from the seatbelt, the presence of the armrest, and/or severe motions of the unconstrained torso. Pelvic injuries were also attributed to restraint offered by the lap belt on the accelerating torso-pelvis complex in the absence of the armrest. Lower extremity injuries occurred due to the unconstrained motion (flailing mechanism). These results serve as an initial dataset to understand the kinematics of different body regions, injuries and patterns, and potential injury mechanisms describing PMHS responses in the aviation environment.

  9. Building Infrastructure to Accelerate Transfer of Basic Research in Spinal Cord Injury (SCI) to Clinical Practice: North American Clinical Trials Network (United States)


    traumatic acute spinal cord injury from C4 to T12. Most patients were male (83 percent) and had a cervical injury (78 percent). All were treated within 12...Injury Study – will include 350 patients with cervical injuries, the group that seems to benefit most from the drug, at as many as 20 clinical centers... Biomechanical , Anatomical and Neurological Differences between Military and Civilian Injuries and Differences in their Outcomes 5 A list of patients

  10. 重型颅脑损伤患者并发肺炎因素的分析及护理%Factor nalysis and nursing of severe head injury patients complicated pneumonia

    Institute of Scientific and Technical Information of China (English)



    目的:分析重型颅脑损伤患者并发肺炎的因素,总结护理经验,降低患者死亡率.方法:对32例重型颅脑损伤并发肺炎患者实施重点监护并总结护理干预措施.结果:32例经有效地治疗和积极地护理干预后,其中24例病情得到了有效控制,治愈出院,8例因病情严重,抢救无效死亡.结论:针对重型颅脑损伤患者并发肺炎的不同因素,进行科学、有效地治疗和护理干预,可以降低患者的死亡率.%Objective: To analysis the factors of severe head injury patients complicated pneumonia, and summarize nursing experience, reduce patients mortality.Methods: 32 patients with severe head injury complicated pneumonia were given intensive care and nursing intervention.Results: 32 cases by effective therapy and nursing intervention, which actively 24 cases were cured illness is effectively controlled, discharge, 8 cases because of illness is serious, the rescue invalid death.Conclusion: The results for severe head injury patients complicated pneumonia of different factors, scientific and effective therapy and nursing intervention, reduce patients mortality.

  11. 颅脑损伤并发肺部感染患者病原菌耐药性分析%Analysis of bacterial drug resistance in patients with sputum bacteria distribution of severe head injury

    Institute of Scientific and Technical Information of China (English)



    Objective To understand the sputum bacteria distribution of severe head injury patients with lung infection and the drug resistance, and provide reference to infection control and rational drug use in hospital. Methods The sputum bacterial culture of 92 severe head injury patients from January 2010 to September 2011 in our hospital was made,the 301 cultured pathogenic bacteria was classified,and the antimicrobial susceptibility tests was chose. Results Gram-negative bacteria was the main pathogenic bacteria( 78. 74% ), gram-positive bacteria was in the second place ( 21. 26% ),and the bacteria showed multiple resistance. Conclusion There are important means to improve the survival rates of severe head injury patients by strengthening the care for severe head injury patients, preventing alternate infections,avoiding the drug-resistant strains,and rational use of antibacterial drugs.%目的 了解我院重型颅脑损伤并发肺部感染患者痰液细菌的分布及耐药情况,为医院感染控制和合理用药提供参考.方法 对2010年1月-2011年12月我院92例重型颅脑损伤患者的痰液进行细菌培养,并对培养出的301株致病菌进行分类及药敏试验.结果 革兰阴性菌为主要致病菌,占78.74%,革兰阳性菌占21.26%,细菌多表现为多重耐药性.结论 加强对重型颅脑损伤患者的监护,防止交叉感染,避免耐药菌株的产生,合理使用抗菌药物是提高重型颅脑损伤患者生存率的重要手段.

  12. Hand injuries as an indicator of other associated severe injuries. (United States)

    Vossoughi, Faranak; Krantz, Brent; Fann, Stephen


    The purpose of this study was to investigate the incidence of disabling or life-threatening injuries in patients with hand injuries. Retrospective data were collected from a level 1 trauma center registry. A total of 472 patients with hand injuries were admitted to the trauma unit between January 2000 and March 2004. Forty-four per cent of patients with hand injuries had life-threatening injuries. Fifty-one per cent of them had motor vehicle crash-related injuries. Motorcycle crashes were the next most common cause followed by explosions, falls, gunshots, machinery, stabs, bites, crushes, and so on. Frequency of associated injuries was as follows: head injuries, 31 per cent, including skull fractures, 22 per cent; spine injuries, 18 per cent, including spine fractures 18 per cent; chest injuries, 36 per cent, including rib fractures, 15 per cent; and abdominal injuries, 13 per cent. The authors focused on the incidence of disabling or life-threatening injuries in patients with hand injuries. Motor vehicle crashes were most common cause of hand injuries. The most common organs to be injured were chest and head. The most common head injury was skull fracture. Other injuries in decreasing order were spine and rib fractures. These data may be helpful in assessing ambulatory patients in the emergency room, in those hand injuries maybe indicative of other simultaneous life-threatening or disabling injuries.

  13. Measures recommended to verify the placement of a DAVID detector in the accelerator head; Medidas recomendadas para la verificacion de la colocacion de un detector DAVID en el cabezal del acelerador

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez Galinanes, A.; Sanz Freire, C. J.; Diaz Pascual, V.; Collado Chamorro, P.; Gomez Amez, J.; Tomey Montesinos, A.; Ossola Lentati, G. A.


    The technological development affects not only the equipment used to perform radiation therapy treatments, but also to teams that are at our disposal to verify the proper administration of the same. One of these new teams is the 'device for verification of IMRT Deliveries advanced' (DAVID). The DAVID chamber is a multi-wire transmission is placed in a linear accelerator head are firmly anchored to it. The design is intended to be one of the wires passing through the center of each pair of collimator blades along its entire length. This forces each has a design for multi leaf collimator system. In addition, each team has a set of screws that allow fine tuning of both the source-wire distance and the center of the transmission chamber in the radiation field of the accelerator. The work aims make a recommendation, based on our experience, a set of measures to be taken to verify the correct placement of DAVID in the field of treatment, or alternatively, help to make the necessary adjustment. (Author)

  14. Surrogate headform accelerations associated with stick checks in girls' lacrosse. (United States)

    Crisco, Joseph J; Costa, Laura; Rich, Ryan; Schwartz, Joel B; Wilcox, Bethany


    Girls' lacrosse is fundamentally a different sport than boys' lacrosse, and girls are not required to wear protective headgear. Recent epidemiological studies have found that stick checks are the leading cause of concussion injury in girls' lacrosse. The purpose of this study was to determine stick check speeds and estimate the head acceleration associated with direct checks to the head. In addition, we briefly examine if commercially available headgear can mitigate the accelerations. Seven (n = 7) experienced female lacrosse players checked, with varying severity, a NOSCAE and an ASTM headform. Stick speed at impact and the associated peak linear accelerations of the headform were recorded. The NOCSAE headform was fitted with four commercially available headgear and similar stick impact testing was performed. The median stick impact speed was 8.1 m/s and 777 deg/s. At these speeds, peak linear acceleration was approximately 60g. Three out of the four headgear significantly reduced the peak linear acceleration when compared with the bare headform. These data serve as baseline for understanding the potential mechanism and reduction of concussions from stick impacts in girls' lacrosse.

  15. Reduction of oxidative stress during recovery accelerates normalization of primary cilia length that is altered after ischemic injury in murine kidneys. (United States)

    Kim, Jee In; Kim, Jinu; Jang, Hee-Seong; Noh, Mi Ra; Lipschutz, Joshua H; Park, Kwon Moo


    The primary cilium is a microtubule-based nonmotile organelle that extends from the surface of cells, including renal tubular cells. Here, we investigated the alteration of primary cilium length during epithelial cell injury and repair, following ischemia/reperfusion (I/R) insult, and the role of reactive oxygen species in this alteration. Thirty minutes of bilateral renal ischemia induced severe renal tubular cell damage and an increase of plasma creatinine (PCr) concentration. Between 8 and 16 days following the ischemia, the increased PCr returned to normal range, although without complete histological restoration. Compared with the primary cilium length in normal kidney tubule cells, the length was shortened 4 h and 1 day following ischemia, increased over normal 8 days after ischemia, and then returned to near normal 16 days following ischemia. In the urine of I/R-subjected mice, acetylated tubulin was detected. The cilium length of proliferating cells was shorter than that in nonproliferating cells. Mature cells had shorter cilia than differentiating cells. Treatment with Mn(III) tetrakis(1-methyl-4-pyridyl) porphyrin (MnTMPyP), an antioxidant, during the recovery of damaged kidneys accelerated normalization of cilia length concomitant with a decrease of oxidative stress and morphological recovery in the kidney. In the Madin-Darby canine kidney (MDCK) cells, H(2)O(2) treatment caused released ciliary fragment into medium, and MnTMPyP inhibited the deciliation. The ERK inhibitor U0126 inhibited elongation of cilia in normal and MDCK cells recovering from H(2)O(2) stress. Taken together, our results suggest that primary cilia length reflects cell proliferation and the length of primary cilium is regulated, at least, in part, by reactive oxygen species through ERK.

  16. 9 April 2013 - Minister for Universities and Science United Kingdom of Great Britain and Northern Ireland D. Willetts in the ATLAS experimental cavern with ATLAS Collaboration Spokesperson D. Charlton and in the LHC tunnel at Point 1 with Beams Department Head P. Collier. Director for Accelerators and Technology S. Myers, Editor at the Communication Group K. Kahle and Beams Department Engineer R. Veness present.

    CERN Multimedia

    Jean-Claude Gadmer


    9 April 2013 - Minister for Universities and Science United Kingdom of Great Britain and Northern Ireland D. Willetts in the ATLAS experimental cavern with ATLAS Collaboration Spokesperson D. Charlton and in the LHC tunnel at Point 1 with Beams Department Head P. Collier. Director for Accelerators and Technology S. Myers, Editor at the Communication Group K. Kahle and Beams Department Engineer R. Veness present.

  17. 2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice


    2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.


    Directory of Open Access Journals (Sweden)

    S. Y. Dokolin


    Full Text Available Damage of the long head of the biceps at the place of attachment to the articular tubercle supraglenoidal lip of shoulder, to the entrance and throughout intertubercle furrows are common causes of pain and dysfunction of the shoulder joint. At the same clinical manifestations of the morphology of such lesions may be different. The current literature discusses various options of surgical correction of the biceps injury. Variety of methods of surgical treatment and the lack of consensus in support of their application in different patients in different types of injuries were the basis for the present study. A prospective analysis of the functional results of surgical treatment of the 34 - year’s patients with associated rotator cuff (SSP+ISP+SSC+ and the tendon of the biceps muscle in age from 34 to 75 years. Options for surgical correction of the damaged part of the biceps were: biceps tenotomy, biceps tenotomy with intraarticular tenodez of the shoulder to the head before entering intertubercle furrow, biceps tenotomy and extraarticular subpectorialtenodez to the proximal humerus is intertubercle interferrent screw groove, as well as its attachment to the tendon suture large pectoral muscle. Choice of surgical approach depended on the patient's age, level of daily physical activity, morphology and localization of lesions. The best results were obtained when the extra-articular subpectorialtenodez of long head of the biceps to the proximal humerus interferrent screw and suture fixation to the pectoralis major muscle, the average follow-up was 16,6 ± 4,7 months.


    Institute of Scientific and Technical Information of China (English)



    Objective To explore the therapeutic apparatus at low temperature with comprehensive nurs‐ing intervention in patients with severe craniocerebral injury ,the application of clinical nursing and cura‐tive effect .Methods Junan county board springs center hospital diagnosis and treatment of 69 cases of se‐vere craniocerebral injury patients according to random number table method is divided into observation group and control group ,the observation group of 35 cases ,34 cases in the placebo group .Control group adopted routine craniocerebral trauma treatment methods ,including application of dehydrating agent ,diu‐retics ,hemostatic agent ,antibiotic ,hormone and cranial nerve nutrition agent ,calcium antagonists ,etc;Observation group on the basis of conventional treatment within 24 h after the onset of using the low tem‐perature treatment and cooperate with the comprehensive nursing measures .3 months after treatment by the method of Glasgow coma scale (GCS) according to the patients with open ,language and movement re‐sponse evaluation of clinical curative effect .Results Observation group with 88 .6% regained certain self‐care ability ,8 .6% of the need to care others ,1 death ,accounting for 2 .9% .The control group 64 .7% re‐gained certain self‐care ability ,29 .4% of the need to care others ,killed 2 people ,accounting for 5 .9% , the total curative effect compare similar between the two groups have statistical significance ( P< 0 .05) . Conclusion Comprehensive nursing measures using the low temperature ,an instrument with good clinical nursing curative effect ,can effectively reduce the morbidity and mortality in patients with severe head inju‐ry ,improve the patients'self‐care ability , w orthy of clinical popularization and application .%目的:探索亚低温治疗仪配合综合护理措施在重型颅脑损伤患者临床护理中的应用及疗效。方法将莒南县板泉中心卫生院诊治的重型颅脑损伤患者69例按

  20. 高压氧技术在青少年重度脑损伤治疗中的应用%Role of hyperbaric oxygen therapy in severe head injury of teenagers

    Institute of Scientific and Technical Information of China (English)



    Objective A brain injury results in a temporary or permanent impairment of cognitive ,emotional ,and/or physical function , the outcome of which is difficult to predict .Prognostic instruments are not precise enough to reliably predict individual patient 's mortality and long-term functional status .The purpose of this article is to provide a guidance to the strengths and limitations of the use of hyper -baric oxygen therapy ( HBOT) in treating pediatric patients with severe brain injury .Methods We studied 56 patients of head injury , 28 of whom received HBOT.Only cases with severe head injury[Glasgow Coma Scale (GCS) <8]with no other associated injury were included in the study group.After an initial period of resuscitation and conservative management (10~12 days),all were subjected to three sessions of HBOT at 1-week interval .This study group was compared with a control group of similar severity of head injury ( GCS<8).Results The study and control groups were compared in terms of duration of hospitalization ,GCS,disability reduction,and so-cial behavior .Patients who received HBOT were significantly better than the control group on all the parameters with decreased hospital stay,better GCS,and drastic reduction in disability.Conclusions Among teenagers with traumatic brain injury ,the application of HBOT significantly improves the outcome and quality of life and reduces the risk of complications .%目的:脑损伤可导致暂时性或永久性的认知,情感障碍和/或机体功能损伤,要预测脑损伤可能造成的后果是有难度的。另外预后监测工具也并不能够精确可靠地预测个体病人的死亡率以及长期的功能状态。该文的目的在于分析高压氧技术( HBOT)对青少年重度脑损伤治疗的应用优势及局限性。方法该文研究了56例脑损伤患者情况,其中28例接受了高压氧治疗。治疗组中只包括无其它合并伤的重度脑损伤病例[格拉斯哥昏迷评分(GCS)

  1. Accelerated split-course radiotherapy and concomitant cis-platinum and 5-fluorouracil chemotherapy with folinic acid enhancement in unresectable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wendt, T.G.; Wustrow, T.P.U.; Hartenstein, R.C.; Trott, K.R.


    In patients suffering from locally advanced, unresectable squamous cell carcinoma (SCC) of the base of the tongue, the floor of the mouth, the mobile part of the tongue, the tonsils, the hypopharynx and the larynx radiotherapy yields poor results, due to local failure rather than to distant metastases. Since toxicity of radiotherapy and cytotoxic chemotherapy do not overlap entirely efforts were made to achieve better results combining these two treatment modalities. Clinical trials on simultaneous radiotherapy/chemotherapy focussed on two cytotoxic agents: Cis-dichlorodiammineplatinum(II) (cis-DDP) and 5-flourouracil (5-FU). Another approach to overcome the radioresistance of large SCC adopts accelerated fractionation. The potential tumor doubling time of sqamous cell carcinomas is about four days, and thus repopulation of surviving clonogenic tumor cells during fractionated radiotherapy may be the cause of poor treatment results. In this pilot study a twice daily fractionated split-course radiotherapy is combined with simultaneous administration of cis-DDP and 5-FU with folinic acid (FA) enhancement.

  2. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper G; Krogdahl, Annelise


    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  3. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: Evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper Grau; Krogdahl, Annelise


    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  4. Traumatic Brain Injury Studies in Britain during World War II. (United States)

    Lanska, Douglas J


    As a result of the wartime urgency to understand, prevent, and treat patients with traumatic brain injury (TBI) during World War II (WWII), clinicians and basic scientists in Great Britain collaborated on research projects that included accident investigations, epidemiologic studies, and development of animal and physical models. Very quickly, investigators from different disciplines shared information and ideas that not only led to new insights into the mechanisms of TBI but also provided very practical approaches for preventing or ameliorating at least some forms of TBI. Neurosurgeon Hugh Cairns (1896-1952) conducted a series of influential studies on the prevention and treatment of head injuries that led to recognition of a high rate of fatal TBI among motorcycle riders and subsequently to demonstrations of the utility of helmets in lowering head injury incidence and case fatality. Neurologists Derek Denny-Brown (1901-1981) and (William) Ritchie Russell (1903-1980) developed an animal model of TBI that demonstrated the fundamental importance of sudden acceleration (i.e., jerking) of the head in causing concussion and forced a distinction between head injury associated with sudden acceleration/deceleration and that associated with crush or compression. Physicist A.H.S. Holbourn (1907-1962) used theoretical arguments and simple physical models to illustrate the importance of shear stress in TBI. The work of these British neurological clinicians and scientists during WWII had a strong influence on subsequent clinical and experimental studies of TBI and also eventually resulted in effective (albeit controversial) public health campaigns and legislation in several countries to prevent head injuries among motorcycle riders and others through the use of protective helmets. Collectively, these studies accelerated our understanding of TBI and had subsequent important implications for both military and civilian populations. As a result of the wartime urgency to understand

  5. Treatment of head injuries and neck with VMAT of a single arch; Tratamiento de lesiones de cabeza y cuello mediante VMAT de un solo arco

    Energy Technology Data Exchange (ETDEWEB)

    Casa de Julian, M. A. de la; Alonso Iracheta, L.; Penas Cabrera, M. D. de las; Jimenez Gonzalez, J. M.; Samper Ots, P.


    In this work we present the dosimetric results of first head and neck treatments performed in our Center with volumetric arcoterapia of intensity-modulated (VMAT) and we show that adequate in such quality can be achieved treatments with the use of a single arch. (Author)

  6. Effect of early rehabilitation training on the hemiplegic limbs of the patients with severe head injury%早期康复训练对重型颅脑损伤患者偏瘫肢体的影响

    Institute of Scientific and Technical Information of China (English)



    Objective: To investigate the rehabilitation effect of early rehabilitation training on the hemiplegic limbs of the patients with severe head injury. Methods: 62 hemiplegic patients induced by severe head injury were randomly divided into an observation group and a control group ( 31 cases for each group ). The prescription was almost the same in the two groups, and the patients in the observation group were provided the rehabilitation training of limb function at the early stage of the disease ( brain edema stage ) and in the stable period of the patient's condition based on routine treatment and nursing care; the patients in the control group received routine treatment and nursing care and had random functional exercise. Results: The muscle strength recovery progress of the patient's hemiplegic limbs was significantly faster in the observation group than the control group ( P < 0.01 ). Conclusions: The early rehabilitation training can obviously reduce the degree of disability of the patients with hemiplegic limbs induced by severe head injury and markedly improve their quality of life.%目的:探讨早期康复训练对重型颅脑损伤偏瘫肢体的康复效果.方法:将62例重型颅脑损伤偏瘫患者随机分为观察组和对照组各31例,两组药物治疗基本相同,观察组按常规治疗护理的同时,于病情早期(脑水肿期)及病情稳定期分阶段进行肢体功能康复训练,对照组进行常规护理并随意进行功能锻炼.结果:观察组患者偏瘫肢体肌力恢复进展明显优于对照组(P<0.01).结论:对重型颅脑损伤偏瘫肢体进行早期康复训练可明显减轻患者偏瘫肢体的致残程度,显著提高患者的生活质量.

  7. Do technological advances in linear accelerators improve dosimetric outcomes in stereotaxy? A head-on comparison of seven linear accelerators using volumetric modulated arc therapy-based stereotactic planning

    Directory of Open Access Journals (Sweden)

    B Sarkar


    Full Text Available Introduction: Linear accelerator (Linac based stereotactic radiosurgery (SRS and stereotactic radiotherapy (SRT using volumetric modulated arc therapy (VMAT has been used for treating small intracranial lesions. Recent development in the Linacs such as inbuilt micro multileaf collimator (MLC and flattening filter free (FFF beam are intended to provide a better dose conformity and faster delivery when using VMAT technique. This study was aimed to compare the dosimetric outcomes and monitor units (MUs of the stereotactic treatment plans for different commercially available MLC models and beam profiles. Materials and Methods: Ten patients having 12 planning target volume (PTV/gross target volume's (GTVs who received the SRS/SRT treatment in our clinic using Axesse Linac (considered reference arm gold standard were considered for this study. The test arms comprised of plans using Elekta Agility with FFF, Elekta Agility with the plane beam, Elekta APEX, Varian Millennium 120, Varian Millennium 120HD, and Elekta Synergy in Monaco treatment planning system. Planning constraints and calculation grid spacing were not altered in the test plans. To objectively evaluate the efficacy of MLC-beam model, the resultant dosimetric outcomes were subtracted from the reference arm parameters. Results: V95%, V100%, V105%, D1%, maximum dose, and mean dose of PTV/GTV showed a maximum inter MLC - beam model variation of 1.5% and 2% for PTV and GTV, respectively. Average PTV conformity index and heterogeneity index shows a variation in the range 0.56–0.63 and 1.08–1.11, respectively. Mean dose difference (excluding Axesse for all organs varied between 1.1 cGy and 74.8 cGy (mean dose = 6.1 cGy standard deviation [SD] = 26.9 cGy and 1.7 cGy–194.5 cGy (mean dose 16.1 cGy SD = 57.2 cGy for single and multiple fraction, respectively. Conclusion: The dosimetry of VMAT-based SRS/SRT treatment plan had minimal dependence on MLC and beam model variations. All tested MLC

  8. Real-time, whole-brain, temporally resolved pressure responses in translational head impact. (United States)

    Zhao, Wei; Ji, Songbai


    Theoretical debate still exists on the role of linear acceleration ( a lin) on the risk of brain injury. Recent injury metrics only consider head rotational acceleration ( a rot) but not a lin, despite that real-world on-field head impacts suggesting a lin significantly improves a concussion risk function. These controversial findings suggest a practical challenge in integrating theory and real-world experiment. Focusing on tissue-level mechanical responses estimated from finite-element (FE) models of the human head, rather than impact kinematics alone, may help address this debate. However, the substantial computational cost incurred (runtime and hardware) poses a significant barrier for their practical use. In this study, we established a real-time technique to estimate whole-brain a lin-induced pressures. Three hydrostatic atlas pressures corresponding to translational impacts (referred to as 'brain print') along the three major axes were pre-computed. For an arbitrary a lin profile at any instance in time, the atlas pressures were linearly scaled and then superimposed to estimate whole-brain responses. Using 12 publically available, independently measured or reconstructed real-world a lin profiles representative of a range of impact/injury scenarios, the technique was successfully validated (except for one case with an extremely short impulse of approx. 1 ms). The computational cost to estimate whole-brain pressure responses for an entire a lin profile was less than 0.1 s on a laptop versus typically hours on a high-end multicore computer. These findings suggest the potential of the simple, yet effective technique to enable future studies to focus on tissue-level brain responses, rather than solely relying on global head impact kinematics that have plagued early and contemporary brain injury research to date.

  9. Lateral neck injury assessments in side impact using post mortem human subject tests. (United States)

    Yoganandan, Narayan; Humm, John; Pintar, Frank A; Wolfla, Christopher E; Maiman, Dennis J


    Current neck injury criteria are based on matching upper cervical spine injuries from piglet tests to airbag deployment loads and pairing kinematics from child dummies. These "child-based" scaled data together with adult human cadaver tolerances in axial loading are used to specify neck injury thresholds in axial compression and tension, and flexion and extension moment about the occipital condyles; no thresholds are specified for any other force or moment including lateral bending. The objective of this study was to develop a testing methodology and to determine the lateral bending moment injury threshold under coronal loading. Post mortem human subjects (PMHS) were used. Specimens consisted of whole body and isolated head-neck complexes with intact musculature. Intact specimen positioning included: sitting PMHS upright on a rigid seat, supporting the torso by a plate, maintaining Frankfurt plane horizontal. Isolated head-neck complexes were fixed at T1 with the occiput connected via a custom apparatus to a testing device to induce lateral bending motion. Head angular and linear accelerations and angular velocities were computed using a pyramid nine accelerometer package on the head; specimen-specific physical properties including center of gravity and moments of inertia in the three-dimensions; and equations of equilibrium. These data were used to determine neck loads at the occipital condyles. No specimens sustained injuries, identified by palpation, x-rays, CT, and autopsy. Results from 24 tests indicated that PMHS head-neck complexes can tolerate 75 Nm of coronal moment at low axial load without failure, and this level may be used as an initial estimate of the injury reference value under lateral loading to the human head-neck complex.

  10. Accuracy of a Wearable Sensor for Measures of Head Kinematics and Calculation of Brain Tissue Strain. (United States)

    Knowles, Brooklynn M; Yu, Henry; Dennison, Christopher R


    Wearable kinematic sensors can be used to study head injury biomechanics based on kinematics and, more recently, based on tissue strain metrics using kinematics-driven brain models. These sensors require in-situ calibration and there is currently no data conveying wearable ability to estimate tissue strain. We simulated head impact (n = 871) to a 50th percentile Hybrid III (H-III) head wearing a hockey helmet instrumented with wearable GForceTracker (GFT) sensors measuring linear acceleration and angular velocity. A GFT was also fixed within the H-III head to establish a lower boundary on systematic errors. We quantified GFT errors relative to H-III measures based on peak kinematics and cumulative strain damage measure (CSDM). The smallest mean errors were 12% (peak resultant linear acceleration) and 15% (peak resultant angular velocity) for the GFT within the H-III. Errors for GFTs on the helmet were on average 54% (peak resultant linear acceleration) and 21% (peak resultant angular velocity). On average, the GFT inside the helmet overestimated CSDM by 0.15.

  11. Aggressive simultaneous radiochemotherapy with cisplatin and paclitaxel in combination with accelerated hyperfractionated radiotherapy in locally advanced head and neck tumors. Results of a phase I-II trial

    Energy Technology Data Exchange (ETDEWEB)

    Kuhnt, T.; Pigorsch, S.; Pelz, T.; Haensgen, G.; Dunst, J. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Becker, A. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Dept. of Radiotherapy, Municipial Hospital, Dessau (Germany); Bloching, M.; Passmann, M. [Dept. of Head and Neck Surgery, Martin Luther Univ., Halle (Germany); Lotterer, E. [Dept. of Internal Medicine I, Martin Luther Univ., Halle (Germany)


    We have tested a very aggressive combination protocol with cisplatin and escalated paclitaxel in combination with accelerated hyperfractionated radiotherapy to assess the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), overall toxicity, and response rate. Patients and Methods: The trial recruited 24 patients (21 males, three females, mean age 57 years) treated at our department from 1998 through 2001. Irradiation was administered in daily doses of 2 Gy up to 30 Gy followed by 1.4 Gy twice daily up to 70.6 Gy to the primary tumor and involved nodes and 51 Gy to the clinically negative regional nodes. The chemotherapy schedule included cisplatin in a fixed dose of 20 mg/m{sup 2} on days 1-5 and 29-33 and paclitaxel at increasing dose levels of 20, 25, 30 mg/m{sup 2} twice weekly over the whole treatment time. Patients were recruited in cohorts of three to six, and the MTD was reached if two out of six patients in one cohort developed DLT. DLT was defined as any grade 4 toxicity or any grade 3 toxicity requiring treatment interruption or unplanned hospitalization or any grade 3 neurotoxicity. We recruited mainly patients with large tumors for this protocol; all patients were stage IV, and the mean tumor volume (primary + metastases) amounted to 72 {+-} 61 cm{sup 3}. The mean follow-up was 30 months (range 4-39 months). Results: One early death (peritonitis and sepsis a t day 10) occurred, and 23 patients were evaluable for acute toxicity and response. The MTD of paclitaxel was reached at the third dose level (30 mg/m{sup 2} paclitaxel twice weekly). The DLT was severe mucositis grade 3 (n = 1) and skin erythema grade 4 (n = 2). After determining the MTD, another 14 patients were treated at the recommended dose level of paclitaxel with 25 mg/m{sup 2} twice weekly. In summary, 13/23 patients (57%) developed grade 3 and 10/23 (43%) grade 2 mucositis. Two patients (9%) had grade 4, five (22%) grade 3, and 16 (69%) grade 2 dermatitis. One patient died at day 30

  12. Ear Injuries (For Parents) (United States)

    ... head, sports injuries, and even listening to loud music can cause ear damage, which can affect hearing and balance. That's because the ear not ... Hearing Loss or Balance Problems Ear injuries can affect kids differently. ... sounds or music notes hearing only certain or muffled sounds ringing ...

  13. Occurrence and mechanism of cervical vertigo in head injury patients%颅脑外伤患者颈性眩晕的发生情况及其机制探讨

    Institute of Scientific and Technical Information of China (English)

    鲍洪; 丁轩; 吴开华; 招建华; 兰蒙


    目的 探讨轻、中型颅脑外伤患者颈性眩晕的发生情况及其机制.方法 全部患者早期分别行颈椎X线和TCD检查.部分患者行计算机断层螺旋扫描(SET)检查.结果先行单因素分析,然后对单因素分析有意义的自变量进行多因素非条件Logistic回归分析,了解检查异常的自变量与发生颈性眩晕的关系.结果 312例轻、中型颅脑外伤患者中并发颈性眩晕84例.单因素分析颈椎X线异常、SCT异常、TCD巾度以上异常组颈性眩晕发生率差异有统计学意义.通过回归分析发现,SCT表现异常及TCD中度以上异常是颈性眩晕发生的独立危险因素,发现单项异常者有可能并发颈性眩晕,若二者以上同时异常,就应高度重视可能并发颈性眩晕.结论 颈椎SCT异常和TCD中度以上异常的轻、中型颅脑外伤患者极有可能并发颈性眩晕.颈椎SCT和TCD检查可预测是否发生颈性眩晕.%Objective To investigate the occurrence of cervical vertigo in patients with mild or moderate head injury and the related mechanism. Methods 312 cases suffering from mild or moderate head injury were examined by cervical spine X-ray and transcranial Doppler (TCD), or spinal computed tomography (SCT) in some. The examination results were analyzed by single factor analysis first, then the independent variables which had statistical meaning were analyzed by unconditional multivariate Logistic regression analysis to find out the relationship between abnormity of their results and cervical vertigo. Results By single factor analysis, the abnormity of cervical spine X-ray, SCT and over moderate abnormity of TCD had statistical significance with cervical vertigo. Logistic regression analysis indicated that the abnormity of SCT and over moderate abnormity of TCD had statistical significance with cervical vertigo. Cervical vertigo may be occurred when one of the two examination results were abnormaL, and it must be attached importance to

  14. Measurement of six degrees of freedom head kinematics in impact conditions employing six accelerometers and three angular rate sensors (6aω configuration). (United States)

    Kang, Yun-Seok; Moorhouse, Kevin; Bolte, John H


    The ability to measure six degrees of freedom (6 DOF) head kinematics in motor vehicle crash conditions is important for assessing head-neck loads as well as brain injuries. A method for obtaining accurate 6 DOF head kinematics in short duration impact conditions is proposed and validated in this study. The proposed methodology utilizes six accelerometers and three angular rate sensors (6aω configuration) such that an algebraic equation is used to determine angular acceleration with respect to the body-fixed coordinate system, and angular velocity is measured directly rather than numerically integrating the angular acceleration. Head impact tests to validate the method were conducted using the internal nine accelerometer head of the Hybrid III dummy and the proposed 6aω scheme in both low (2.3 m/s) and high (4.0 m/s) speed impact conditions. The 6aω method was compared with a nine accelerometer array sensor package (NAP) as well as a configuration of three accelerometers and three angular rate sensors (3aω), both of which have been commonly used to measure 6 DOF kinematics of the head for assessment of brain and neck injuries. The ability of each of the three methods (6aω, 3aω, and NAP) to accurately measure 6 DOF head kinematics was quantified by calculating the normalized root mean squared deviation (NRMSD), which provides an average percent error over time. Results from the head impact tests indicate that the proposed 6aω scheme is capable of producing angular accelerations and linear accelerations transformed to a remote location that are comparable to that determined from the NAP scheme in both low and high speed impact conditions. The 3aω scheme was found to be unable to provide accurate angular accelerations or linear accelerations transformed to a remote location in the high speed head impact condition due to the required numerical differentiation. Both the 6aω and 3aω schemes were capable of measuring accurate angular displacement while the

  15. Radial head button holing: a cause of irreducible anterior radial head dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Su-Mi; Chai, Jee Won; You, Ja Yeon; Park, Jina [Seoul National University Seoul Metropolitan Government Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Bae, Kee Jeong [Seoul National University Seoul Metropolitan Government Boramae Medical Center, Department of Orthopedic Surgery, Seoul (Korea, Republic of)


    ''Buttonholing'' of the radial head through the anterior joint capsule is a known cause of irreducible anterior radial head dislocation associated with Monteggia injuries in pediatric patients. To the best of our knowledge, no report has described an injury consisting of buttonholing of the radial head through the annular ligament and a simultaneous radial head fracture in an adolescent. In the present case, the radiographic findings were a radial head fracture with anterior dislocation and lack of the anterior fat pad sign. Magnetic resonance imaging (MRI) clearly demonstrated anterior dislocation of the fractured radial head through the torn annular ligament. The anterior joint capsule and proximal portion of the annular ligament were interposed between the radial head and capitellum, preventing closed reduction of the radial head. Familiarity with this condition and imaging findings will aid clinicians to make a proper diagnosis and fast decision to perform an open reduction. (orig.)

  16. 急性颅脑损伤术后非术区迟发出血的临床分析及防治%Analysisand Treatment of the cause of hemorrhage in non-operation area after acute head injury

    Institute of Scientific and Technical Information of China (English)

    杜春富; 曹毅; 高晋健


    Objective To analyze the cause of delayed hemorrhage in non-operation area after acute head injury and the treatment. Methods The clinical data of 30 cases of acute head injury from January 2006 to December 2011 were reviewed. The cause of delayed hemorrhage and the treatment results were analyzed. Results According to GOS, 12 cases acquired complete rehabilitation, 13 cases survived only as light handicap,3 cases mild handicap,1 case severe handicap and 1 case died. Conclusion It's the key point to improve the prognosis greatly by early diagnosis and management,especially before the brain herniation.%目的 探讨急性颅脑损伤术后非术区迟发出血的原因及防治.方法 回顾我院2006年1月~2011年12月收治的30例颅脑损伤患者,为术中发现颅压下降后再次升高,而术区无出血,或术后1d内患者意识加深,复查CT时非术区迟发出血,并具备手术指征而再次手术.结果 根据GOS评分,治愈12例,轻残13例,中残3例,重残1例,死亡1例.结论 早期诊断和及时治疗,尤其是在非手术区迟发出血引起的脑疝之前,并提高手术操作水平,这是提高治愈率、降低病死率的关键.

  17. Karate and karate injuries.


    McLatchie, G


    The origins of karate and its evolution as a sport are described. Karate injuries tend to occur in three main areas: the head and neck, the viscera, and the limbs. Effective legislation controlling karate, which could help prevent injuries, is lacking at the moment and should be established. Recommendations for the prevention of injury include the introduction of weight classes, mandatory provision of protective equipment such as padded flooring, and the outlawing of certain uncontrollable m...

  18. Evaluation after Traumatic Brain Injury (United States)

    Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine


    It is important to determine if a traumatic brain injury (TBI) has occurred when an individual is assessed in a hospital emergency room after a car accident, fall, or other injury that affects the head. This determination influences decisions about treatment. It is essential to screen for the injury, because the sooner they begin appropriate…

  19. Imaging of accidental paediatric head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Phua Hwee [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Lim, Choie Cheio Tchoyoson [National Neuroscience Institute, Department of Neuroradiology, Singapore (Singapore)


    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  20. Advanced glycation end products accelerate ischemia/reperfusion injury through receptor of advanced end product/nitrative thioredoxin inactivation in cardiac microvascular endothelial cells. (United States)

    Liu, Yi; Ma, Yanzhuo; Wang, Rutao; Xia, Chenhai; Zhang, Rongqing; Lian, Kun; Luan, Ronghua; Sun, Lu; Yang, Lu; Lau, Wayne B; Wang, Haichang; Tao, Ling


    The advanced glycation end products (AGEs) are associated with increased cardiac endothelial injury. However, no causative link has been established between increased AGEs and enhanced endothelial injury after ischemia/reperfusion. More importantly, the molecular mechanisms by which AGEs may increase endothelial injury remain unknown. Adult rat cardiac microvascular endothelial cells (CMECs) were isolated and incubated with AGE-modified bovine serum albumin (BSA) or BSA. After AGE-BSA or BSA preculture, CMECs were subjected to simulated ischemia (SI)/reperfusion (R). AGE-BSA increased SI/R injury as evidenced by enhanced lactate dehydrogenase release and caspase-3 activity. Moreover, AGE-BSA significantly increased SI/R-induced oxidative/nitrative stress in CMECs (as measured by increased inducible nitric oxide synthase expression, total nitric oxide production, superoxide generation, and peroxynitrite formation) and increased SI/R-induced nitrative inactivation of thioredoxin-1 (Trx-1), an essential cytoprotective molecule. Supplementation of EUK134 (peroxynitrite decomposition catalyst), human Trx-1, or soluble receptor of advanced end product (sRAGE) (a RAGE decoy) in AGE-BSA precultured cells attenuated SI/R-induced oxidative/nitrative stress, reduced SI/R-induced Trx-1 nitration, preserved Trx-1 activity, and reduced SI/R injury. Our results demonstrated that AGEs may increase SI/R-induced endothelial injury by increasing oxidative/nitrative injury and subsequent nitrative inactivation of Trx-1. Interventions blocking RAGE signaling or restoring Trx activity may be novel therapies to mitigate endothelial ischemia/reperfusion injury in the diabetic population.

  1. Injury in rugby league. (United States)

    Hoskins, W; Pollard, H; Hough, K; Tully, C


    It was the purpose of this review to document the range, incidence, location and mechanism of injury occurring in the sport of rugby league. Rugby league is a collision sport played in Europe and the Pacific regions including Australia. The sport is well established and has competitions ranging from junior to elite professional. Due to the contact nature of the game, injury is relatively common. The most common injuries are musculotendinous in nature and afflict the lower limb more frequently than elsewhere. Despite the high incidence of minor (sprains/strains) to moderate musculoskeletal injury (fracture, ligament and joint injury) and minor head injuries such as lacerations, nasal fractures and concussions, rare more serious spinal cord and other injuries causing death have also been recorded. The literature on rugby league injury is small but growing and suffers from a lack of consistent definition of what an injury is, thereby causing variability in the nature and incidence/prevalence of injury. Information is lacking on the injury profiles of different age groups. Importantly, there has been little attempt to establish a coordinated injury surveillance program in rugby league in the junior or professional levels. The implementation of such programs would require a universal definition of injury and a focus on important events and competitions. The implementation could provide important information in the identification and prevention of risk factors for injury.

  2. TH-E-BRF-09: Gaussian Mixture Model Analysis of Radiation-Induced Parotid-Gland Injury: An Ultrasound Study of Acute and Late Xerostomia in Head-And-Neck Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Liu, T [Department of Radiation Oncology and Winship Cancer Institute, Emory Univ, Atlanta, GA (United States); Yu, D; Beitler, J; Curran, W; Yang, X [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA (United States); Tridandapani, S [Department of Radiology and Imaging Sciences and Winship Cancer Institute, Emory University, Atlanta, GA (United States); Bruner, D [School of Nursing and Winship Cancer Institute, Emory Univesity, Atlanta, GA (United States)


    Purpose: Xerostomia (dry mouth), secondary to parotid-gland injury, is a distressing side-effect in head-and-neck radiotherapy (RT). This study's purpose is to develop a novel ultrasound technique to quantitatively evaluate post-RT parotid-gland injury. Methods: Recent ultrasound studies have shown that healthy parotid glands exhibit homogeneous echotexture, whereas post-RT parotid glands are often heterogeneous, with multiple hypoechoic (inflammation) or hyperechoic (fibrosis) regions. We propose to use a Gaussian mixture model to analyze the ultrasonic echo-histogram of the parotid glands. An IRB-approved clinical study was conducted: (1) control-group: 13 healthy-volunteers, served as the control; (2) acutetoxicity group − 20 patients (mean age: 62.5 ± 8.9 years, follow-up: 2.0±0.8 months); and (3) late-toxicity group − 18 patients (mean age: 60.7 ± 7.3 years, follow-up: 20.1±10.4 months). All patients experienced RTOG grade 1 or 2 salivary-gland toxicity. Each participant underwent an ultrasound scan (10 MHz) of the bilateral parotid glands. An echo-intensity histogram was derived for each parotid and a Gaussian mixture model was used to fit the histogram using expectation maximization (EM) algorithm. The quality of the fitting was evaluated with the R-squared value. Results: (1) Controlgroup: all parotid glands fitted well with one Gaussian component, with a mean intensity of 79.8±4.9 (R-squared>0.96). (2) Acute-toxicity group: 37 of the 40 post-RT parotid glands fitted well with two Gaussian components, with a mean intensity of 42.9±7.4, 73.3±12.2 (R-squared>0.95). (3) Latetoxicity group: 32 of the 36 post-RT parotid fitted well with 3 Gaussian components, with mean intensities of 49.7±7.6, 77.2±8.7, and 118.6±11.8 (R-squared>0.98). Conclusion: RT-associated parotid-gland injury is common in head-and-neck RT, but challenging to assess. This work has demonstrated that the Gaussian mixture model of the echo-histogram could quantify acute and

  3. Patología forense y neurología asociada de los traumatismos craneoencefálicos: Estudio práctico Forensic pathology and associated neurology of head injury: Practical aspects

    Directory of Open Access Journals (Sweden)

    J.L. Palomo Rando


    Full Text Available Se reúnen en este trabajo de forma sucinta los conocimientos más útiles en la resolución forense de los traumatismos craneoencefálicos (TCE letales. El estudio está orientado hacia la identificación macroscópica, la causalidad y los mecanismos de producción de las lesiones, con apoyo iconográfico. Se hace especial hincapié en la valoración de las fracturas craneales, las hemorragias subaracnoideas por lesión de la arteria vertebral, el edema y la hiperemia cerebral postraumáticos, así como algunas recomendaciones para la práctica de la autopsia de los fallecidos por trauma cefálico, incluida la retención y fijación del encéfalo. Algunos de estos conocimientos son antiguos y aunque olvidados o desconocidos por muchos han resistido el paso del tiempo, manteniendo plena vigencia. Igualmente se incluyen las características clínicas esenciales de cada trastorno, los nuevos avances en el diagnóstico neuropatológico de los TCE, en su fisiopatología y sus sospechadas relaciones con la posterior aparición de enfermedad degenerativa tipo Alzheimer y las alteraciones genómicas que predisponen a una evolución fatal de TCE ligeros o moderados.This review summarizes in a brief format the most useful tips in the forensic evaluation of fatal head trauma. This study is aimed at the macroscopic evaluation, causality and production mechanisms of the lesions, with image-based support. Skull fractures, subarachnoid hemorrhage due to lesion of the vertebral artery, posttraumatic cerebral edema and hyperaemia as well as basic recommendations to carry out the autopsy procedure (including the retention and fixation of the brain in bodies with a lethal traumatic brain injury (TBI will be analyzed. Some of this knowledge has been developed a long time ago, and although sometimes forgotten, their meaning is still fully patent. This study also points out the essential clinical characteristics of each condition and recent advances in the

  4. Brain Injury Safety Tips and Prevention (United States)

    ... Address What's this? Submit What's this? Submit Button Brain Injury Safety Tips and Prevention Recommend on Facebook ... not grass or dirt. More HEADS UP Video: Brain Injury Safety and Prevention frame support disabled and/ ...

  5. Blunt Head Trauma and Headache

    Directory of Open Access Journals (Sweden)

    Ana B Chelse


    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  6. Head impact exposure in youth football: high school ages 14 to 18 years and cumulative impact analysis. (United States)

    Urban, Jillian E; Davenport, Elizabeth M; Golman, Adam J; Maldjian, Joseph A; Whitlow, Christopher T; Powers, Alexander K; Stitzel, Joel D


    Sports-related concussion is the most common athletic head injury with football having the highest rate among high school athletes. Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level. Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16,502 head impacts were collected over the course of the season. Biomechanical data were analyzed by team and by player. The median impact for each player ranged from 15.2 to 27.0 g with an average value of 21.7 (±2.4) g. The 95th percentile impact for each player ranged from 38.8 to 72.9 g with an average value of 56.4 (±10.5) g. Next, an impact exposure metric utilizing concussion injury risk curves was created to quantify cumulative exposure for each participating player over the course of the season. Impacts were weighted according to the associated risk due to linear acceleration and rotational acceleration alone, as well as the combined probability (CP) of injury associated with both. These risks were summed over the course of a season to generate risk weighted cumulative exposure. The impact frequency was found to be greater during games compared to practices with an average number of impacts per session of 15.5 and 9.4, respectively. However, the median cumulative risk weighted exposure based on combined probability was found to be greater for practices vs. games. These data will provide a metric that may be used to better understand the cumulative effects of repetitive head impacts, injury mechanisms, and head impact exposure of

  7. Head protection for horse riders: a cause for concern.


    Muwanga, L C; Dove, A F


    We report the frequency with which horse riders with a significant head injury present to a large accident and emergency department. We have also recorded details about the use of headwear and conclude that horse-riding is associated with a serious risk of head injury and 'protective' headwear may not always protect.

  8. Head protection for horse riders: a cause for concern. (United States)

    Muwanga, L C; Dove, A F


    We report the frequency with which horse riders with a significant head injury present to a large accident and emergency department. We have also recorded details about the use of headwear and conclude that horse-riding is associated with a serious risk of head injury and 'protective' headwear may not always protect.

  9. Head Lice (United States)

    ... months of age and older, this medicine offers convenience. Invermectin treats most head lice with just one ... Support AAD Donate Shop AAD Product catalog Store customer service Publications Dermatology World JAAD JAAD Case Reports ...

  10. Head MRI (United States)

    ... heart valves Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis (you may not ... to: Abnormal blood vessels in the brain ( arteriovenous malformations of the head ) Tumor of the nerve that ...

  11. Head Tilt (United States)

    ... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & ... When this happens, the neck muscles go into spasm, causing the head to tilt to one side. ...

  12. The comparison of the predictive value of different trauma scores on the head injury prognosis%不同创伤评分法对颅脑损伤预后预测价值的比较

    Institute of Scientific and Technical Information of China (English)

    沈光建; 邹咏文; 许民辉


    目的 比较格拉斯哥昏迷评分(GCS)、修正的创伤记分(RTS)、急性生理和既往健康状况评定Ⅱ(APACHEⅡ)系统在颅脑损伤预后预测中的价值,探索适合颅脑损伤预后预测的创伤评分。 方法 回顾性分析1994~2000年116例颅脑损伤患者的临床资料,采用Spearman 等级相关分析,观察入院时GCS、RTS、APACHEⅡ与预后的相关关系。以GOS Ⅰ~Ⅲ级为危险事件,GCS、呼吸频率、收缩压、年龄、既往健康状况等为变量进行Logistic回归分析,判定半年预后独立的预计指标。 结果 GCS、RTS、APACHEⅡ均与预后显著相关(r分别为0.660,0.676和-0.578);Logistic回归分析表明,GCS、年龄为独立的预后预计指标。 结论 RTS系统并未表现出比GCS系统更大的优越性。APACHE Ⅱ适当地与GCS结合应用,可提高对颅脑损伤预后预测的准确性。%Objective To compare the predictive value of Glasgow coma scale (GCS), revised trauma score (RTS) and acute phsiology and chronic health evaluation (APACHEⅡ) system on head injury prognosis, and selectscoring systems apt to predicting prognosis of the head injury.  Methods The data of 116 case of head injury were reviewed. The correlation between the score of GCS, RTS, or APACHEⅡ and the patients' prognosis was determined by Spearman rank relation test on admission. Then, the logistic regression analysis was administered, in which GOS I~Ⅲ in half year were regarded as risk event. The independent predictive varieties were determined from following varieties: GCS, systolic pressure, respiratory rate, age, and chronic health condition.  Results GCS, RTS and APACHEⅡ were significantly related with the prognosis (r=0.660,0.676 and -0.578, respectively). GCS and age were independent predictive indexes.  Conclusions RTS system doesn't show the superiority to GCS system. The predictive accuracy may improve if GCS system is

  13. Mechanisms for triceps surae injury in high performance front row rugby union players: a kinematic analysis of scrummaging drills. (United States)

    Flavell, Carol A; Sayers, Mark G L; Gordon, Susan J; Lee, James B


    The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS), greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players. Key pointsFront rowers exhibited patterns of single leg weight bearing, in a position of greater ankle plantar flexion and knee extension at toe off during scrummaging, which is a risk position for TS injury.Front rowers also exhibited greater acceleration at the ankle, knee, and hip joints, and greater changes in ankle ROM from toe strike to toe off during attacking scrum drills.These reported accelerations and joint displacements may be risk factors for TS injury, as the ankle is accelerating into plantar flexion at final push off and the muscle is shortening from an elongated state.

  14. The complexity of biomechanics causing primary blast-induced traumatic brain injury: a review of potential mechanisms.

    Directory of Open Access Journals (Sweden)

    Amy eCourtney


    Full Text Available Primary blast induced traumatic brain injury (bTBI is a prevalent battlefield injury in recent conflicts, yet biomechanical mechanisms of bTBI remain unclear. Elucidating specific biomechanical mechanisms is essential to developing animal models for testing candidate therapies and for improving protective equipment. Three hypothetical mechanisms of primary bTBI have received the most attention. Because translational and rotational head accelerations are primary contributors to TBI from non-penetrating blunt force head trauma, the acceleration hypothesis suggests that blast-induced head accelerations may cause bTBI. The hypothesis of direct cranial transmission suggests that a pressure transient traverses the skull into the brain and directly injures brain tissue. The thoracic hypothesis of bTBI suggests that some combination of a pressure transient reaching the brain via the thorax and a vagally mediated reflex result in bTBI. These three mechanisms may not be mutually exclusive, and quantifying exposure thresholds (for blasts of a given duration is essential for determining which mechanisms may be contributing for a level of blast exposure. Progress has been hindered by experimental designs which do not effectively expose animal models to a single mechanism and by over-reliance on poorly validated computational models. The path forward should be predictive validation of computational models by quantitative confirmation with blast experiments in animal models, human cadavers, and biofidelic human surrogates over a range of relevant blast magnitudes and durations coupled with experimental designs which isolate a single injury mechanism.

  15. Analysis on factors affecting osteonecrosis of femoral head secondary to periacetabular injury%髋周创伤后致股骨头坏死的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    冷燕奎; 江建明; 李建军; 金宪政; 张旭生


    目的 探讨髋周创伤后可能导致股骨头坏死的影响因素.方法 回顾性分析2003年11月至2010年12月在临床诊疗及伤残鉴定工作中发现的继发于髋周创伤后的股骨头坏死病例28例,对诊疗过程缺陷及可能导致股骨头坏死的影响因素进行分析.结果 存在漏诊、复位不良及内固定安放不当等明显医疗缺陷因素的有9例,可能由于高能量损伤、负重过早等因素导致股骨头坏死的有19例.结论 虽然股骨头坏死的原因是多方面和多因素的,但有些能够控制的危险因素应该尽量避免,特别是存在明显的诊疗缺陷时,更需要及时总结教训,最大可能地减少股骨头坏死发生,避免医疗纠纷的产生.%Objective To explore the factors influencing the osteonecrosis of femoral head secondary to periacetabular injury.Methods A retrospective study was carried out in 28 patients with osteonecrosis of femoral head secondary to periacetabular trauma between November 2003 and Decemher 2010. The obvious faults in diagnosis and treatment as well as possible influencing factors were all investigated. Results The obvious medical faults such as poor reduction and internal fixation selection existed in nine cases. The osteonecrosis in other 19 cases was possibly caused by high energy injury and too early load. Conclusions Although the causes of osteonecrosis were multiple and complicated, but we should try to avoid the risk factors as possible as we can to reduce the rate of osteonecrosis and the medical disputes.

  16. The Application of Temporalis Partial Resection in Treatment of Patients with Severe Head Injury%颞肌部分切除术在重型颅脑损伤患者治疗中的应用

    Institute of Scientific and Technical Information of China (English)


    Objective:To explore clinical value of standard large trauma craniotomy and temporalis partial resection in the treatment of patients with severe head injury. Method: 62 patients with severe head injury were randomly divided into control group and observation group, and each group was 31 cases from Jan 2010 to Oct 2012. Observation group was treated with standard large trauma craniotomy and temporalis partial resection, control group was treated with standard large trauma craniotomy. The clinical effect was compared between the two groups. Results:Compared with control group, postoperative complications, mortality and disability were significantly lower, and postoperative self-care ability improved in treatment group, all P <0.05. Conclusion: Standard large trauma craniotomy and temporalis partial resection can increase the rescue success rate and cure rate.%  目的:探讨去标准外伤大骨瓣减压+颞肌部分切除术在重型颅脑损伤患者治疗中的应用价值。方法:将2010年1月至2012年10月收治的重型颅脑损伤患者62例随机分成对照组和观察组各31例,观察组采用去标准外伤大骨瓣减压+颞肌部分切除术治疗,对照组采用去标准外伤大骨瓣减压术治疗,比较两组的疗效。结果:与对照组相比,治疗组术后并发症、病死率、致残率明显下降,术后生活自理能力明显提高,P均<0.05。结论:去外伤大骨瓣减压+颞肌部分切除术可提高重型颅脑损伤患者的抢救成功率及治愈率。

  17. Some observations on whiplash injuries. (United States)

    Evans, R W


    Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always

  18. Penetrating nontorso trauma: the head and the neck. (United States)

    Ball, Chad G


    Acute penetrating injuries to the head and neck cause considerable anxiety for most clinicians owing to concern for airway control and neurologic injury and to limited clinician experience in most centres. This article discusses an organized approach to the evaluation and initial treatment of penetrating injuries to the head and neck based on regional anatomy and clinical examination. The approach is particularly helpful in the context of ongoing hemorrhage and/or airway compromise.

  19. Initiating running barefoot: Effects on muscle activation and impact accelerations in habitually rearfoot shod runners. (United States)

    Lucas-Cuevas, Angel Gabriel; Priego Quesada, José Ignacio; Giménez, José Vicente; Aparicio, Inma; Jimenez-Perez, Irene; Pérez-Soriano, Pedro


    Runners tend to shift from a rearfoot to a forefoot strike pattern when running barefoot. However, it is unclear how the first attempts at running barefoot affect habitually rearfoot shod runners. Due to the inconsistency of their recently adopted barefoot technique, a number of new barefoot-related running injuries are emerging among novice barefoot runners. The aim of this study was therefore to analyse the influence of three running conditions (natural barefoot [BF], barefoot with a forced rearfoot strike [BRS], and shod [SH]) on muscle activity and impact accelerations in habitually rearfoot shod runners. Twenty-two participants ran at 60% of their maximal aerobic speed while foot strike, tibial and head impact accelerations, and tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscle activity were registered. Only 68% of the runners adopted a non-rearfoot strike pattern during BF. Running BF led to a reduction of TA activity as well as to an increase of GL and GM activity compared to BRS and SH. Furthermore, BRS increased tibial peak acceleration, tibial magnitude and tibial acceleration rate compared to SH and BF. In conclusion, 32% of our runners showed a rearfoot strike pattern at the first attempts at running barefoot, which corresponds to a running style (BRS) that led to increased muscle activation and impact accelerations and thereby to a potentially higher risk of injury compared to running shod.

  20. 近30年江苏省水稻抽穗灌浆期低温冷害时空变化及对水稻产量的影响%Temporal and Spatial Variation ofC hilling Injury at Rice Heading~Filling Stage and Its Influence on Rice Yield in Jiangsu Province in Recent 30 Years

    Institute of Scientific and Technical Information of China (English)

    尹思慧; 徐蒋来; 朱利群


    利用江苏省14个气象站点1981~2010年的气象资料,采用Excel和GIS反距离权重插值法,研究了江苏省近30年单季稻抽穗灌浆期低温冷害的时空变化特征,并分析了低温冷害对水稻产量的影响。结果表明:江苏省近30年来单季稻抽穗灌浆期的总冷害次数达155次,其中轻度冷害109次,中度冷害28次,重度冷害18次,以轻度冷害为主;在时间尺度上,以20世纪80年代冷害频次最多,之后20年呈减少趋势;在空间分布上,除轻度冷害在20世纪80年代呈“北少南多”的特征外,中等冷害及重度冷害在30年里多呈“北多南少”的特征;江苏省单季稻抽穗灌浆期累计低温对产量的抑制作用不显著。综合来看,近30年来江苏省水稻抽穗灌浆期低温冷害的危险性较小,其对水稻产量的影响不大。%The article used the meteorology data of 14 meteorological stations from 1981 to 2010 in Jiangsu province, studied the temporal and spatial variation characteristic of rice chilling injuries during its heading stage and filling stage for 30 years in Jiangsu province with excel and the method of IDW ( Inverse distance weight ) , and analyzed the influence on yield caused by chilling injuries.The results showed that the time of total chilling injuries for 30 years during single-season rice’ s heading stage and chilling stage in Jiangsu province was 155, including 109 mild chilling injuries, 28 moderate chilling injuries and 18 severe chilling injuries, the mild chilling injury was the maximum number of occurrences .Judging from the temporal and spatial charac-teristic of rice chilling injuries, the chilling injuries account of 1980s was the most time, and in the later 20 years, the chilling in-juries showed a decreasing tendency.From the point of different level chilling injuries’ temporal and spatial characteristic, the mild chilling injuries showed a increasing tendency from north to south

  1. Establishment of the model of motorcyclist ejection injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Hai-bin; HANG Jian-jin; ZHANG Bo; LIU Da-wei; YANG Guang-yu; WANG Zheng-guo


    Objective: To establish the device and model of motorcyclist ejection injury.Methods: Based on our laboratory devices, a motorcy-clist ejection injury simulation system was developed.A total of 18 pigs were approved by the local animal experi-mentation and ethics committee to serve as the motorcy-clist substitutes.In this ejection motion, the animal rode freely at the motor driver seat and was straightly acceler-ated by means of our custom motorcyclist ejection injury simulation system.When it was speeded up to the preset velocity (v=30, 40 or 50 kin/h) at the preset position, the animal was ejected forward.Pathological and dynamic analy-ses were conducted, accompanied with the high-speed photograph, acceleration/velocity signal test, gross obser-vation and light microscope examination as well as the ab-breviated injury score-injury severity score (AIS-ISS) scale.Results: The high-speed photograph indicated that during the ejection procedure the motorcycle was first ar-rested and decelerated suddenly, and then the motorcycle driver was ejected forward, accompanied with the rotation motion in the air.Finally, the head, shoulder and thorax of the ejected animal impacted directly on the hard ground.Varying degrees of injury focusing on the liver, heart, lung and spleen were found.There existed a significant positive, correlation between ISS and the ejection velocity of the motorcycle drivers (ISS=16.7+2.9 for 30 kin/h, 25.0±0.0 for 40 km/h and 37.3a=1.0 for 50 kin/h), The detailed injury char-acteristics were as follows: for the mildly injured animals, there were interlobar gaps or leaf gaps and lobar surface blood coagulation blocks in the liver, and mild lung hemorrhage; for the severely injured animals, there were liver comminuted laceration, moderate lung hemorrhage and heart injury.Animals suffering from the most severe injuries died half an hour later.Conclusion: The new injury model stated in this paper has a high stability and good repeatability, and is

  2. A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? (United States)

    Tanriverdi, Fatih; De Bellis, Annamaria; Ulutabanca, Halil; Bizzarro, Antonio; Sinisi, Antonio A; Bellastella, Giuseppe; Amoresano Paglionico, Vanda; Dalla Mora, Liliana; Selcuklu, Ahmed; Unluhizarci, Kursad; Casanueva, Felipe F; Kelestimur, Fahrettin


    Traumatic brain injury (TBI) has been recently recognized as a common cause of pituitary dysfunction. However, there are not sufficient numbers of prospective studies to understand the natural history of TBI induced hypopituitarism. The aim was to report the results of five years' prospective follow-up of anterior pituitary function in patients with mild, moderate and severe TBI. Moreover, we have prospectively investigated the associations between TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women) were included who were prospectively evaluated 12 months and five years after TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH) deficiency is the most common pituitary hormone deficit at one, three, and five years after TBI. Although most of the pituitary hormone deficiencies improve over time, there were substantial percentages of pituitary hormone deficiencies at the fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin deficiencies). Pituitary dysfunction was significantly higher in strongly AHA- and APA-positive (titers ≥1/16) patients at the fifth year. In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over time in a considerable number of patients but, although rarely, may also worsen over the five-year period. However in severe TBI, ACTH and GH status of the patients at the first year evaluation persisted at the fifth year. Therefore, screening pituitary function after TBI for five years is important, especially in patients with mild TBI. Moreover, close strong associations between the presence of high titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the first time.

  3. Overhead shoulder press – In-front of the head or behind the head?

    Directory of Open Access Journals (Sweden)

    Mark R. McKean


    Conclusion: Shoulder ROM was within passive ROM for all measures except external rotation for males with the behind the head technique. To avoid possible injury passive ROM should be increased prior to behind the head protocol. Females showed greater spine movements, suggesting trunk strengthening may assist overhead pressing techniques. For participants with normal trunk stability and ideal shoulder ROM, overhead pressing is a safe exercise (for the shoulder and spine when performed either in-front of or behind the head.

  4. Head Start. (United States)

    Greenman, Geri


    Discusses an art project in which students created drawings of mop heads. Explains that the approach of drawing was more important than the subject. States that the students used the chiaroscuro technique, used by Rembrandt and Caravaggio, in which light appears out of the darkness. (CMK)

  5. Dynamic biomechanics of the human head in lateral impacts


    Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A.


    The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced ...

  6. Activation of ERK accelerates repair of renal tubular epithelial cells, whereas it inhibits progression of fibrosis following ischemia/reperfusion injury. (United States)

    Jang, Hee-Seong; Han, Sang Jun; Kim, Jee In; Lee, Sanggyu; Lipschutz, Joshua H; Park, Kwon Moo


    Extracellular signal-regulated kinase (ERK) signals play important roles in cell death and survival. However, the role of ERK in the repair process after injury remains to be defined in the kidney. Here, we investigated the role of ERK in proliferation and differentiation of tubular epithelial cells, and proliferation of interstitial cells following ischemia/reperfusion (I/R) injury in the mouse kidney. Mice were subjected to 30min of renal ischemia. Some mice were administered with U0126, a specific upstream inhibitor of ERK, daily during the recovery phase, beginning at 1day after ischemia until sacrifice. I/R caused severe tubular cell damage and functional loss in the kidney. Nine days after ischemia, the kidney was restored functionally with a partial restoration of damaged tubules and expansion of fibrotic lesions. ERK was activated by I/R and the activated ERK was sustained for 9days. U0126 inhibited the proliferation, basolateral relocalization of Na,K-ATPase and lengthening of primary cilia in tubular epithelial cells, whereas it enhanced the proliferation of interstitial cells and accumulation of extracellular matrix. Furthermore, U0126 elevated the expression of cell cycle arrest-related proteins, p21 and phospholylated-chk2 in the post-ischemic kidney. U0126 mitigated the post-I/R increase of Sec10 which is a crucial component of exocyst complex and an important factor in ciliogenesis and tubulogenesis. U0126 also enhanced the expression of fibrosis-related proteins, TGF-β1 and phosphorylated NF-κB after ischemia. Our findings demonstrate that activation of ERK is required for both the restoration of damaged tubular epithelial cells and the inhibition of fibrosis progression following injury.

  7. When Physics Meets Biology: Low and High-Velocity Penetration, Blunt Impact, and Blast Injuries to the Brain (United States)

    Young, Leanne; Rule, Gregory T.; Bocchieri, Robert T.; Walilko, Timothy J.; Burns, Jennie M.; Ling, Geoffrey


    The incidence of traumatic brain injuries (TBI) in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems. PMID:25999910

  8. Future accelerators (?)

    Energy Technology Data Exchange (ETDEWEB)

    John Womersley


    I describe the future accelerator facilities that are currently foreseen for electroweak scale physics, neutrino physics, and nuclear structure. I will explore the physics justification for these machines, and suggest how the case for future accelerators can be made.

  9. Neonatal head and torso vibration exposure during inter-hospital transfer (United States)

    Blaxter, Laurence; Yeo, Mildrid; McNally, Donal; Crowe, John; Henry, Caroline; Hill, Sarah; Mansfield, Neil; Leslie, Andrew; Sharkey, Don


    Inter-hospital transport of premature infants is increasingly common, given the centralisation of neonatal intensive care. However, it is known to be associated with anomalously increased morbidity, most notably brain injury, and with increased mortality from multifactorial causes. Surprisingly, there have been relatively few previous studies investigating the levels of mechanical shock and vibration hazard present during this vehicular transport pathway. Using a custom inertial datalogger, and analysis software, we quantify vibration and linear head acceleration. Mounting multiple inertial sensing units on the forehead and torso of neonatal patients and a preterm manikin, and on the chassis of transport incubators over the duration of inter-site transfers, we find that the resonant frequency of the mattress and harness system currently used to secure neonates inside incubators is ~9Hz. This couples to vehicle chassis vibration, increasing vibration exposure to the neonate. The vibration exposure per journey (A(8) using the ISO 2631 standard) was at least 20% of the action point value of current European Union regulations over all 12 neonatal transports studied, reaching 70% in two cases. Direct injury risk from linear head acceleration (HIC15) was negligible. Although the overall hazard was similar, vibration isolation differed substantially between sponge and air mattresses, with a manikin. Using a Global Positioning System datalogger alongside inertial sensors, vibration increased with vehicle speed only above 60 km/h. These preliminary findings suggest there is scope to engineer better systems for transferring sick infants, thus potentially improving their outcomes. PMID:28056712

  10. One-stage reconstruction of orbital roof fracture after head injury%颅脑损伤后眶顶骨折一期重建15例临床分析

    Institute of Scientific and Technical Information of China (English)

    王勇; 卜战云; 史锡文; 梁庆华


    目的 探讨颅脑损伤后粉碎性眶顶骨折的临床特征及治疗.方法 回顾性分析2006年10月至2012年1月河南省人民医院神经外科收治15例眶顶骨折的临床特点及治疗.结果 眶顶缺损面积约为240 ~ 320 mm2.合并额骨骨折15例,脑挫裂伤14例,颅内积气9例,硬膜外血肿8例,额颧缝骨折5例,筛骨骨折4例,鼻骨骨折3例,眶下壁骨折1例,眶内侧壁骨折1例.眶周瘀血肿胀15例,突眼2例,脑组织眼漏2例,脑脊液鼻漏2例,眼球破裂2例.采用冠状切口处理额眶区病变,对眶顶缺损应用钛网一期修补.术后复视1例,经眼肌功能训练后好转;脑脊液眼漏、鼻漏各1例,经腰大池外引流后停止.结论 一期修补眶顶,可减少眼科和神经外科并发症.%Objective To analyze the clinical features and treatments of orbital roof fracture after head injury.Methods A retrospective analysis of 15 patients with orbital roof fracture after head injury in the department of neurosurgery from October 2006 to January 2012 was investigated.Results The defect areas of orbital roof ranged 240 ~ 320 mm2.Frontal fracture in 15 patients,contusion and laceration of brain in 14 patients,pneumatosis in 9 patients,epidural hematoma in 8 patients,frontozygomatic suture fracture in 5 patients,ethmoid fracture in 4 patients,nasal fracture in 3 patients,orbital floor fracture in 1 patients,orbital medial wall fracture in 1 patients;periorbital edema and ecchymosis in 15 patients,exophthalmos in 2 patients,ophthalmorrhea in 2 patients,rhinorrhea in 2 patients,globe rupture in 2 patients.A coronal incision was applied to treat fronto-orbital fracture.Orbital roof fracture was reconstructed with titanium mesh.Only 1 case complained diplopia after operation,but it recovered normal after 6 months.There were 1 case of ophthalmorrhea and 1 case of rhinorrhea,and they were cured after lumber drainage.Conclusions One-stage reconstruction of orbital roof fracture can reduce diplopia

  11. 急性颅脑损伤患者凝血功能变化与颅脑损伤严重程度和预后的关系%The relationship between changes of coagulation functions and cerebral trauma severity and prognosis in pa-tients with acute head injury

    Institute of Scientific and Technical Information of China (English)



    目的:探讨急性颅脑损伤患者凝血功能变化与颅脑损伤严重程度和预后的关系,为诊断该病提供临床参考。方法将68例急性颅脑损伤患者分为轻、中、重型3组,分别测定活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、纤维蛋白原(FBG),并与53例健康体检者进行对比。结果(1)急性颅脑损伤后轻型、中型和重型患者PT、APTT 水平明显高于对照组( P<0.05),且不同损伤程度组指标间也有差异( P<0.05);(2)与 GOS1~3分组比较,GOS4~5分组 PT 和APTT水平显著改善,差异有统计学意义(P<0.05);(3)急性脑损伤患者PT、APTT 与其预后情况正相关(P<0.01)。结论急性颅脑损伤患者凝血功能变化与颅脑损伤严重程度和预后密切相关。%Objective To explore The relationship between changes of coagulation functions and cerebral trauma severity and prognosis in patients with acute head injury ,and provide a reference for diagnosis of the disease .Methods 68 cases of pa-tients with acute head injury were divided into mild head injury group ,moderate head injury group and severe head injury group.APTT(activated partial thrombo-plastin time) ,PT(prothrombin time)and FBG (fibrinogen)were tested.And they were compared with healthy physical examination group (n=53) .Results ①The APTT and PT of mild ,moderate and severe head injury group were higher than those of control group(P<0 .05) ,and there was also a difference between any two groups. ②Compared with GOS1-3 group ,the APTT and PT of GOS4-5 group significantly improved(P<0 .05). ③APTT ,PT were posi-tively correlated with the prognosis.Conclusion The changes of coagulation functions of patients with acute head injury were intimately related to the severity and prognosis of patients with cerebral trauma.

  12. Cerebrospinal fluid enzymes in acute brain injury

    NARCIS (Netherlands)

    A.I.R. Maas (Andrew)


    textabstractSevere brain