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PubMed1996

Is calcium accumulation post-injury an indicator of cell damage?

It is generally agreed that excessive intracellular calcium accumulation is the main culprit for nerve cell damage following brain injury. Many autoradiographic studies of the post-injury brain have demonstrated an accumulation of 45Ca2+ in regions exhibiting neuronal damage. We have recently observed, after cortical contusion trauma [10], that there was a discrepancy between the extent of cell damage and the extent of 45Ca2+ in autoradiograms; rather the distribution of 45Ca2+ followed that of serum proteins. In addition 45Ca2+ was also observed in white matter, which had no signs of damage. We tested the hypothesis that 45Ca2+ accumulation was coupled to the presence of protein by directly injecting albumin into the brain cortex. There was a highly significant correlation between the content of 45Ca2+ and of albumin as measured by ELISA. A similar pattern was found after a cortical freeze-lesion in the contralateral hemisphere. However, in the ipsilateral hemisphere where cell damage was observed, the relation broke down and calcium accumulated in excess. We conclude that calcium accumulation in the brain is not only the result of cell damage but also the presence of calcium-binding proteins, e.g. albumin.

Animals↗
PubMed1996

The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children.

The authors report two cases of post-traumatic uncontrollable intracranial hypertension in children (120 torr in case 1; 90 torr in case 2) who were treated within the first 12 h after trauma by surgery including decompressive craniectomy. The outcome was favourable in both children. Intracranial pressure (ICP) was recorded during the pre-, intra- and postoperative periods and during each specific step of the surgical procedure. Craniectomy alone induced a decrease in ICP of 45% (40 torr) in case 1 and 30% (35 torr) in case 2. Although this method remains controversial, given the lack of controlled trials, it can offer a salvage procedure in children with rapidly worsening intracranial hypertension, allowing survival without disabling neurological sequelae.

Brain Concussion↗
PubMed1987

Post-traumatic diffuse brain swelling: isolated or associated with cerebral axonal injury. Clinical course and intracranial pressure in 18 children.

Eighteen children with severe head injuries and diffuse brain swelling were studied. They were separated into two groups based on the computed tomography (CT) findings. Seven patients had small ventricles in the normal location and small or absent cisterns. Eleven had these signs plus small deep-seated intraparenchymal hemorrhagic foci and/or intraventricular hemorrhage. Patients in the first group were in relatively good neurological condition; their intracranial pressure was easily controlled and all had a favourable outcome. On contrast, children in the second group had a more severe clinical presentation, frequently had uncontrollable intracranial hypertension, and more than 50% died.

Axons↗
PubMed1986

Electroencephalography in minor head injury in children.

EEG and CT scans of 280 cases of minor head injury in children under 15 years of age were studied. Abnormality on initial EEG was shown in 42.5%. Those who lost consciousness had a higher incidence of abnormality than those who did not, and it was higher between 4 and 13 years of age. The sleep state has much influence on the finding. The patients should be awake or in a light sleep stage. The most frequent abnormality was slow waves, seen predominantly in the occipital regions, and which tended to disappear more easily than the paroxysmal ones. The EEGs became or remained normal in 95%, excluding incompletely followed-up cases. There was no case of post-traumatic epilepsy in our series, but 4 cases of post-traumatic early convulsions, in which the EEGs were variable. CT scan disclosed abnormality in 6%.

Adolescent↗
PubMed1993

Function tests on the neuroendocrine hypothalamo-pituitary system following acute midbrain syndrome, with special reference to computertomographical and magnetic resonance imaging results.

Seventeen patients underwent a neuroendocrinological function test at a mean 6.3 years following a severe craniocerebral trauma (CCT) accompanied by midbrain syndrome. An insulin hypoglycaemia test (IHT) and the combined pituitary anterior lobe test (CPALT) were applied. Whereas the IHT as maximum stimulator of the hypothalamo-pituitary system (HPS) showed an adequate reserve capacity, the CPALT yielded a partial limitation of the secretion dynamic in the somatotropic, adrenocorticotropic axis as well as a dysfunction in the FSH secretion. Neuroradiological tests could not establish substantial injury in the regio hypothalamica in any patient.

Adolescent↗
PubMed1976

The excessively small ventricle on computed axial tomography of the brain.

Computed axial tomography has made it possible to observe excessively small ventricles in a variety of disorders of the CNS. This finding is presumably due to non-specific and diffuse swelling of brain parenchyma, and is illustrated in cases of trauma, neoplasm, encephalitis, pseudotumor cerebri, metabolic disorder, and probable dilantin effect. It is likely that other causes will be encountered in the future.

Adolescent↗
PubMed1984

Traumatic and alternating delayed intracranial hematomas.

Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

Adult↗
PubMed1993

Primary brain stem lesions caused by closed head injuries.

Traumatic lesions of the brain stem are of two types: primary, which are considered to be caused at the moment of impact, and secondary, associated with supratentorial mass lesion. Of the 239 patients with a serious head injury who showed a severe disturbance of consciousness upon admission and who had CT scan carried out immediately, 21 cases were considered to have a primary brain stem lesion with initial CT scan. A primary brain stem lesion was found in 21 of 239 (8.8%) of patients with serious head injury. Their injuries were caused primarily by traffic accidents. Sixteen of the 21 cases showed not only brain stem lesions but also other brain injuries such as cerebral contusion of the white and gray matter, callosal injury, intraventricular hemorrhage, and subarachnoid hemorrhage, which are considered to be caused by a diffuse shearing injury. Five cases who showed a single injury to the brain stem with no other brain lesions were considered to have a pure brain stem lesion. Primary brain stem lesions were observed on the dorsal side of the midbrain, where they can be differentiated from secondary brain stem lesions. These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge, or to an injury of the lower brain stem by hyperextension of the cervical vertebrae. The prognosis of patients with a primary brain stem lesion was usually unfavorable, except in those with a single brain stem lesion.

Adolescent↗
PubMed1992

Intraparenchymal blood-fluid levels in traumatic intracerebral haematomas.

Blood-fluid levels within the cerebral parenchyma are observed more frequently on CT and MRI in traumatic intracerebral haematomas than in those of other aetiologies. The intraparenchymal blood-fluid interface can be formed without a fluid cavity. It is suggested that the blood-fluid levels represent layering of red blood cells within areas of contusion necrosis as well as extensive contusion oedema. The more extensive the damage to brain tissue, the more often blood-fluid levels formed. A poorer outcome can be therefore predicted when an intraparenchymal blood-fluid interface is seen.

Arteriovenous Malformations↗
PubMed1975

[Diagnostic value of siderophages in the cytogram of cerebrospinal fluid].

The demonstration of siderophages in the cerebrospinal fluid is a very reliable diagnostic tool for identifying hemorrhage in the subarachnoid space and ventricular system. Siderophages are found 4 days after spontaneous or traumatic subarachnoid hemorrhage and persist in some cases up to 120 days, which makes them a reliable indicator of a previous hemorrhage. These findings are the result of an investigation in which 110 samples of cerebrospinal fluid, obtained from 105 patients, were examined for siderophages by the membrane filtration method.

Brain Concussion↗
PubMed1977

Rotational cerebral injuries near the superior margin of the brain.

Traumatic lesions near the superior margin of the brain frequently are caused by an anterior or posterior blow to the head. The injuries consist of disruptions of one or a few (with subdural bleeding) or of numerous or all (with instant death or immediate unconsciousness and later death because of simultaneous brain stem injuries) parasagittal bridging veins. Cerebral injuries close beneath the superior margin of the brain occur either alone or together with disruptions of parasagittal bridging veins. These injuries consist mainly of subcortical, perivascular or larger, hemorrhages and of injuries to the white matter. No extensive complete necrosis occurs. The lesions are most frequently found in the posterior part of the superior frontal gyrus and the central gyri and often are combined with brain stem injuries. By reconstruction of trauma events the injuries seem to be caused by a rotational acceleration of the head. By model experiments and simulations it is shown that a rotational acceleration of the skull leads to an "inner deformation" of the brain tissue. This deformation may be the explanation of the subcortical injuries, which are therefore designated rotational cerebral injuries (RC-injuries).

Adult↗
PubMed1985

Outcome in children with severe head injuries.

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.

Adolescent↗
PubMed1985

Acute traumatic intraventricular hemorrhage in children.

Four cases are reported of acute traumatic intraventricular hemorrhage in children revealed by computed tomography (CT). In most cases, the intraventricular hemorrhage had been produced by severe sagittal impact. All of the children were 7 or less on the Glasgow Coma Scale (GCS) on admission. Three had hemorrhage in all ventricles, and one had an intraventricular hemorrhage in the lateral and fourth ventricles. One of them showed enhancement of the blood-filled ventricles, with the appearance of increased ventricular size, on the contrast enhancement CT. Two children with ventricular dilation died soon after injury, although ventricular drainage had been performed; one child remained in a persistent vegetative state, and the other enjoyed good recovery with conservative therapy. Certain features of acute traumatic intraventricular hemorrhage in children are discussed in relation to this series.

Brain Concussion↗
PubMed1985

Pediatric head injuries caused by traffic accidents. A prospective study with 5-year follow-up.

In an unselected series of 488 patients with head injuries referred to a general surgical department, there were 126 children aged 0-19 years whose head injuries were a result of traffic accidents. In age group 0-4 years, only 23% of the head injuries were due to traffic accidents. In age groups 5-9, 10-14, and 15-19 years, however, traffic accidents were the main cause of the injuries, being responsible for 47%, 65% and 82% of the cases respectively. Both age groups 5-9 and 10-14 years had an unusually high proportion of bicycle injuries, while motorcycle and automobile accidents were the leading causes of injury in age group 15-19 years. Eight children (6%) died as a result of head trauma. Furthermore, among the survivors there were 8 children with severe head injuries (post-traumatic amnesia lasting 24 h), the rest being minor head injuries. All the survivors but one returned to school and achieved reasonable performances. Repeated follow-up studies at 3 months, 1 and 5 years, including interviews with the parents, disclosed that several of the children had headache, dizziness and other complaints. These subjective complaints subsided with time, but with different patterns, in the younger and older age groups. It is concluded that the "postconcussional syndrome" is not uncommon in children, but it may be better tolerated and resolves more completely with time than in adults. Eight children (7%) had one seizure or more during the 5-year follow-up period.

Accidents, Traffic↗