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PubMed1995

Case report: concordant traumatic brainstem contusion delayed diagnosis in a young man with Wilson's disease.

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism. The corresponding gene locus has been localized on the long arm of chromosome 13. Three different clinical variants of the disease can be distinguished: hepato-cerebral, abdominal/hepatic, and central nervous type. The heterogeneity of symptoms can cause problems in differential diagnosis, especially when another concordant disorder can also explain the pathogenesis of symptoms. The case report of a young man who suffered from brainstem contusion demonstrates the possibilities of misinterpretation because presenting symptoms could be attributed either to traumatic brain injury followed by adjustment disorder or Wilson's disease. Clinical signs included leftsided hemiparesis, bilateral gaze direction nystagmus, marked dysarthria with consecutive pervasive mutism, choreo-athetoid movements, spasmodic torticollis and diplopia dependent on gaze direction. Slit lamp examination showed Kayser-Fleischer's corneal ring. EEG- and computer assisted tomography investigations revealed non-specific findings. The patient was treated with D-Penicillamine. Alternative treatment with oral zinc preparations is discussed.

Adolescent↗
PubMed1993

The isolated posttraumatic aneurysm of the brachiocephalic artery after blunt thoracic contusion.

Most supra-aortic aneurysms are localized in the extracranial carotid and subclavian artery. Aneurysms of the brachiocephalic artery (BCA) represent a rather rare finding. Chronic arteriosclerotic changes are responsible for the majority of cases. Posttraumatic BCA damage is only occasionally encountered, complete vascular dissection by perforating injuries being the dominant causative mechanism. Although isolated BCA trauma after blunt thoracic contusion is rare, brachiocephalic injury in association with aortic lesions seems to be the second most common site of vascular injury after the aorta. Cases of isolated blunt BCA trauma documented in the literature to date usually involved a complete avulsion of the artery from the aortic arch or complete rupture near the aortic origin. We present an isolated case of posttraumatic BCA aneurysm in a woman involved in a car accident who suffered blunt chest trauma with a subtotal, near circumferential vessel wall dissection of only the intima and media. Clinical features, diagnostic procedure, surgical treatment, and trauma mechanisms of postcontusional BCA lesions are described and discussed in reference to the literature.

Accidents, Traffic↗
PubMed1980

[Cardiac contusion after traffic accident? (author's transl)].

A 62-year-old driver died 5 h after a slight traffic accident under the clinical diagnosis of "contusion cordis" in spite of an emergency thoracotomy. The post-mortem examination revealed no evidence of traumatic impact; death was attributed rather to stenosing coronary sclerosis with extensive coronary lesions and detachment of the parietal thrombuses. A causal connection in law could not be presumed; from the insurance point of view the role played by the accident, particularly in regard to the emotional excitement, was estimated at about 30%.

Accidents, Traffic↗
PubMed2000

Finite element analysis of brain contusion: an indirect impact study.

The mechanism of brain contusion has been investigated using a series of three-dimensional (3D) finite element analyses. A head injury model was used to simulate forward and backward rotation around the upper cervical vertebra. Intracranial pressure and shear stress responses were calculated and compared. The results obtained with this model support the predictions of cavitation theory that a pressure gradient develops in the brain during indirect impact. Contrecoup pressure-time histories in the parasagittal plane demonstrated that an indirect impact induced a smaller intracranial pressure (-53.7 kPa for backward rotation, and -65.5 kPa for forward rotation) than that caused by a direct impact. In addition, negative pressures induced by indirect impact to the head were not high enough to form cavitation bubbles, which can damage the brain tissue. Simulations predicted that a decrease in skull deformation had a large effect in reducing the intracranial pressure. However, the areas of high shear stress concentration were consistent with those of clinical observations. The findings of this study suggest that shear strain theory appears to better account for the clinical findings in head injury when the head is subjected to an indirect impact.

Brain Injuries↗
PubMed1980

Pedicle injury masquerading as renal contusion: a possible urographic pitfall.

Renal vascular pedicle injuries are relatively rare, accounting for 1-5% of renal injuries [1]. Intravenous urography is generally the initial procedure used to assess the severity of renal damage and the need for further evaluation. Non-function of the injured kidney is a characteristic finding of renal pedicle injury on excretory urography [1, 2, 3, 4]. This finding generally necessitates further expeditious evaluation with renal arteriography. Opacification of the pelviureteric system during excretory urography genereally implies that the renal vascular pedicle is intact and a major renal injury does not exist. We report a case of a major renal vascular injury associated with excretion of contrast at urography--findings mimicking the radiographic features of renal contusion.

Adult↗
PubMed2003

[Brain and head injury. Part 1: Clinical classification, imaging modalities, extra-axial injuries, and contusions].

This article describes the imaging tools for efficient diagnostic management of head trauma victims. The basic mechanisms of brain injuries are explained and the imaging features are described. Computed tomography remains the most important method for the initial screening and follow-up investigation. Though magnetic resonance imaging has a higher sensitivity to most traumatic lesions, it does not play an important role in the acute phase of head trauma patients. In the first part of this paper clinical classifications, imaging modalities, extra-axial injuries, and contusions are described. In the second part of this paper intra-axial and secondary injuries are discussed.

Brain↗
PubMed1998

Circulating cardiac troponin I in trauma patients without cardiac contusion.

OBJECTIVES: To describe the evolution and the diagnostic value of cardiac troponin I (cTnI) and to relate its concentrations with the indicators of injury in trauma patients. DESIGN: Prospective, observational study of 17 young, previously healthy, mechanically-ventilated patients during the early post-traumatic period in the Surgical ICU of a University Hospital. METHODS: Serial measurements of serum cTnI, total creatine kinase activity (CKtot) and its isoenzyme MB (CK-MB) (on admission, 12 h later, then daily for 7 days), clinical data and repeated electrocardiographic (ECG) and transesophageal echocardiographic (TEE) recordings. RESULTS: Rhabdomyolysis was observed in all the patients with a significant relationship between CK-MB and CKtot. Despite the fact that no patient demonstrated ECG or TEE signs of myocardial contusion, elevated serum levels of cTnI were observed in six patients (35%) without obvious dilutional interference. As compared with the others, these patients exhibited a more frequent arterial hypotension (83% vs 18%, p = 0.035), required greater volume expansion on day 1 (22,000 vs 8,500 ml, p = 0.027) and usually demonstrated early (83% vs 9%, p = 0.005) and late (66% vs 9%, p = 0.028) multiple organ dysfunction syndrome. CONCLUSIONS: Taking into account the high reported sensitivity and specificity of cTnI dosage, the present results suggest cTnI can play a role in the evaluation of indirect myocardial injury following traumatic shock.

Adult↗
PubMed2001

Sudden death from myocardial contusion following an isolated blunt force trauma to the chest.

Cardiac contusion is a common concomitant injury in blunt, non-penetrating chest trauma and is mostly a benign disorder which remains undiagnosed. In the case presented, a young man sustained a single blunt trauma to the chest from falling pieces of a wooden wheel and died at the scene. Among other findings, the autopsy revealed a circumscribed detachment of the coronary arteries on the anterior side of the heart. The most unusual findings were lacerations of the vessel wall layers in these areas which could already be seen at the autopsy and were proven by histological examination.

Adult↗
PubMed1999

Behavioural and morphological outcome of mild cortical contusion trauma of the rat brain: influence of NMDA-receptor blockade.

The authors studied the effect of a mild cortical contusion to the rat brain on behavioural and morphological outcome and the influence of NMDA-receptor blockade (MK-801, 0.5 mg/kg i.v. 30 min prior to trauma). Spontaneous motor activity was assessed 16-18 days post trauma. Saline treated traumatised rats showed a significant (p < 0.01) hyperactive behaviour compared to animals without injury. MK-801 treated rats performed significantly better than the saline treated animals (p < 0.05). For histopathological evaluation hippocampal hilar neurons were counted, cortical thickness under the impact was measured and microtubule-associated protein 2 (MAP2) immunoreactivity in the dentate hilus was quantified 1, 3 and 21 days post trauma. In traumatised rats scattered loss of nerve cells, oedema and minute haemorrhages were present at the site of the impact one and three days after injury. At day 21 there was a significant reduction of cortical thickness at the site of impact. One day after trauma there was a bilateral, significant loss of neurons and MAP2 immunostaining in the dentate hilus of the hippocampus. MK-801 pretreated rats showed similar morphological changes. The disturbed spontaneous motor behaviour may be caused by hippocampal damage and a reduction of somatosensory cortical neurons. NMDA-receptor blockade improved the outcome assessed by the functional tests but failed to influence the morphological changes, suggesting that this behavioural test is a more sensitive indicator of outcome after mild traumatic brain injury (TBI).

Animals↗
PubMed2001

alpha-Phenyl-tert-N-butyl nitrone (PBN) improves functional and morphological outcome after cortical contusion injury in the rat.

alpha-Phenyl-tert-N-butyl nitrone (PBN), a potent reactive oxygen species (ROS) scavenger, has shown robust neuroprotective properties in several models of acute brain injury, although not previously evaluated in traumatic brain injury (TBI). In this study, we assessed the potential efficacy of PBN in a weight drop model producing a controlled cortical contusion. Sham operation, mild or severe injury was induced in intubated and ventilated rats and functional and morphological outcome was used as end-points at two weeks post-injury. In the trauma groups, saline or PBN (30 mg/kg) was injected as an intravenous bolus 30 minutes prior to injury. At day 11-15 post-injury, cognitive disturbance was assessed using the Morris Water Maze (MWM) and estimation of lesion volume and hemispheric loss of tissue was made. No change in MWM performance were found in either of the mildly traumatized groups as compared to uninjured controls. In contrast, a significant decrease in total mean latency and increase in path length in the severely traumatized rats were found. PBN-treatment significantly improved MWM performance as compared to saline treatment at the severe injury level (p < 0.05). The mild injury level caused a discrete atrophy of the ipsilateral cortex with no effect of PBN treatment. The severe injury caused a substantial loss of ipsilateral hemispheric tissue and a large cortical cavitation. PBN pre-treatment significantly reduced the lesion volume and reduced hemispheric loss of tissue at this injury level (p < 0.05). Our results support the involvement of ROS in the injury process contributing to the tissue loss and cognitive disturbance after TBI. The potential clinical utility of PBN will have to be assessed using a post-injury dosing regime.

Animals↗
PubMed1989

Distribution and time course of protein extravasation in the rat spinal cord after contusive injury.

We have previously characterized a graded, spinal cord contusive injury in the rat. We have now used this reproducible model to examine vascular permeability to horseradish peroxidase (HRP) after injury. The relationship between severity of injury and distribution of protein extravasation was evaluated at 3 h after injury. After mild injury, tracer was primarily confined to central gray matter and the ventral part of the dorsal columns. After moderate injury, protein extravasation was similar to that observed after mild injury, with the exception that the central hemorrhage included pericentral while matter and occasionally extended to the pial surface. After severe injury, reaction product (RP) was more densely distributed within the central cord and peripheral white matter. The axial extent of tracer at sites proximal and distal to the impact site increased with severity of injury. At 2.0 cm from the injury, no leakage of tracer was noted after mild injury. In contrast, after moderate and severe injury limited microvascular leakage of HRP was noted. Furthermore, after severe injury, in addition to local sites of microvascular leakage, intense RP was present in the dorsal columns up to at least 2.0 cm from the injury. The time course for re-establishment of the blood-spinal cord barrier to protein was evaluated from 3 h to 14 days after moderate injury. At 3 h to 1 day, protein leakage was maximal and coincided with sites of extravasated blood components, although was consistently more extensive. By 7 days, despite resolution of the initial hemorrhage, there remained scattered evidence for protein extravasation at the injured site and at sites along the axis of the cord. The blood-spinal cord barrier to HRP was reestablished by 14 days after injury.

Animals↗
PubMed1991

Localization of nerve growth factor receptor mRNA in contused rat spinal cord by in situ hybridization.

Northern blot analysis using a probe for the low-affinity nerve growth factor receptor (NGFR) revealed that a mild contusive injury induces the expression of NGFR mRNA in rat spinal cord with a maximal expression at 7 days post-injury. We have now localized this induction using in situ hybridization and found the highest concentration of NGFR mRNA at the lesion epicenter. The location and pattern of autoradiographic grains were compared with that of various cell types at the injury site as determined by immunocytochemical studies. The results suggest that cells associated with blood vessels at the epicenter are induced to express NGFR mRNA at 7 days post-injury.

Animals↗
PubMed1982

Denervation due to lesions of the central nervous system. An EMG study in cases of cerebral contusion and cerebrovascular accidents.

Electromyographic examination of 10 patients with severe cerebral contusion revealed profuse fibrillation potentials and positive sharp waves in many muscles, proximal as well as distal, sometimes also in the paraspinal musculature. In some cases complete denervation of a muscle was found. It appeared that these findings were not due to plexus lesions or spinal root avulsions, but that they were caused by the lesion of the central nervous system. In 10 patients with slight concussion no spontaneous activity was found. Fibrillation potentials and positive sharp waves occurred in the paretic limbs in 20 out of 21 patients with hemisyndromes due to cerebrovascular accidents. The spontaneous activity appeared after 2-3 weeks (as in peripheral nerve lesions) and disappeared or diminished considerably within 6 months. The denervation caused by the central lesion was attended by normal motor and sensory nerve conduction (apart from disturbed motor conduction to totally denervated and subsequently reinnervated muscles). It is concluded that lesions of the central nervous system may cause a dysfunction of anterior horn cells which leads to axonal degeneration, probably in the form of a dying-back process. Apparently in the majority of the anterior horn cells this dysfunction is temporary, so that axonal regeneration and reinnervation soon take place.

Adolescent↗
PubMed1985

Cerebral blood flow in minor cerebral contusion.

Seventeen patients with minor cerebral contusion were selected from a series of patients with head injuries of various severity, who had undergone repeat evaluations of the regional cerebral blood flow. The mean global flow (expressed as mean global initial slope index) on early examination was found to be significantly lower, compared with that recorded in healthy volunteers. A tendency towards the recovery of higher flow values was apparent in repeat evaluations that were performed several weeks after the injury. Interhemispheric asymmetries of flow were a common occurrence, with lower perfusion and reduced attenuation values on computed tomography scans being, however, in good agreement only in approximately half of the cases.

Adolescent↗
PubMed1994

Development of post-traumatic cysts in the spinal cord of rats-subjected to severe spinal cord contusion.

To study the development of post-traumatic spinal cord (SC) cysts, and their fine anatomic characteristics, rats were subjected to severe SC contusion. Specimens were analyzed from day 1 to 1 year post-injury. Using conventional light, and transmission and scanning electron microscopy, three stages were typified, namely: necrosis, repair, and stability. The final cell composition and thickness of the cyst walls were not uniform. Astrocytes, fibroblasts, ependymal cells, and collagen fibers were the main constituents. Chronic inflammatory cells were also observed. The neuropathologic characterization of posttraumatic SC cysts could be useful in planning strategies for SC reconstruction at different times post-injury.

Animals↗
PubMed1986

Brain macrophages in human cortical contusions as indicator of survival period.

The aim of this study was to establish a morphologic time scheme with which cases of cerebral contusion with unknown survival periods can be dated. Our study of 275 cases was limited to qualitative and quantitative changes in macrophages. The appearance of macrophages and their distribution as well as their content of neutral fat, esterified cholesterol, erythrocytes, siderin, hematoidin, and ceroid were correlated with the survival period. For each cytologic criterium, the observation period, distribution-free limits of tolerance, and relative frequency of identification in different survival periods were determined, and the limits of confidence calculated. The findings permit the dating of trauma in cases with unknown survival periods. Moreover, the probability of this dating was calculated.

Adolescent↗
PubMed2004

The effects of ciliary neurotrophic factor on neurological function and glial activity following contusive spinal cord injury in the rats.

Ciliary neurotrophic factor (CNTF) has been implicated in the pathophysiology of injury to the central nervous system. The rapid increase in CNTF production following spinal cord injury (SCI) in rats is thought to serve a role in the neuronal survival and functional recovery. In this study, 40 SD rats were divided into four groups: sham-operated group, saline-treated group, 5- and 10-microg CNTF group. Saline and CNTF were given through lumbar intrathecal catheter for 10 days after T10 segment of spinal cord were injured by modified Allen contusion method. Animals were behaviorally tested for 6 weeks using the Basso, Beattie, Bresnahan locomotor rating scale and inclined plane test. At the end of 6 week, rubrospinal neurons of five rats in each group were labeled by retrograde transport of the horseradish peroxidase (HRP) from the lesion site, and then the labeled red nucleus neuron (RN) numbers were counted. Additional rats were histologically assessed for tissue sparing and neuronal loss and reactive gliosis at the injury site and adjacent areas. Rats treated with CNTF regained greater improvements in hindlimb function than controls. The amount of spared tissue was significantly higher in CNTF-treated animals than in controls. After CNTF treatment, the number of HRP-labeled RN neurons were significantly increased. Astrocytes and microglia reactivity was more pronounced in CNTF-treated animals than in controls. These results indicate that intrathecal infusion of exogenous CNTF following SCI may significantly reduce tissue damage and protect the rubrospinal descending tracks and enhances functional recovery, and may also induce more gliosis.

Animals↗