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Sample records for experimental head injury

  1. Head Injuries

    MedlinePlus

    ... of head injuries include bicycle or motorcycle wrecks, sports injuries, falls from windows (especially among children who live ... to watch for? When can I start playing sports again after a head injury? How can brain damage from a head injury ...

  2. Head Injuries

    MedlinePlus

    ... injuries internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain Fortunately, most childhood falls or ... knock the brain into the side of the skull or tear blood vessels. Some internal head injuries ...

  3. Head Injuries

    MedlinePlus

    ... before. Often, the injury is minor because your skull is hard and it protects your brain. But ... injuries can be more severe, such as a skull fracture, concussion, or traumatic brain injury. Head injuries ...

  4. Head Injuries

    MedlinePlus

    ... before. Usually, the injury is minor because your skull is hard and it protects your brain. But ... injuries can be more severe, such as a skull fracture, concussion, or traumatic brain injury. Head injuries ...

  5. Head injury.

    PubMed

    Hureibi, K A; McLatchie, G R

    2010-05-01

    Head injury is one of the commonest injuries in sport. Most are mild but some can have serious outcomes. Sports medicine doctors should be able to recognise the clinical features and evaluate athletes with head injury. It is necessary during field assessment to recognise signs and symptoms that help in assessing the severity of injury and making a decision to return-to-play. Prevention of primary head injury should be the aim. This includes protective equipment like helmets and possible rule changes. PMID:20533694

  6. Experimental Injury Biomechanics of the Pediatric Head and Brain

    NASA Astrophysics Data System (ADS)

    Margulies, Susan; Coats, Brittany

    Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults in the United States and results in over 2,500 childhood deaths, 37,000 hospitalizations, and 435,000 emergency department visits each year (Langlois et al. 2004). Computational models of the head have proven to be powerful tools to help us understand mechanisms of adult TBI and to determine load thresholds for injuries specific to adult TBI. Similar models need to be developed for children and young adults to identify age-specific mechanisms and injury tolerances appropriate for children and young adults. The reliability of these tools, however, depends heavily on the availability of pediatric tissue material property data. To date the majority of material and structural properties used in pediatric computer models have been scaled from adult human data. Studies have shown significant age-related differences in brain and skull properties (Prange and Margulies 2002; Coats and Margulies 2006a, b), indicating that the pediatric head cannot be modeled as a miniature adult head, and pediatric computer models incorporating age-specific data are necessary to accurately mimic the pediatric head response to impact or rotation. This chapter details the developmental changes of the pediatric head and summarizes human pediatric properties currently available in the literature. Because there is a paucity of human pediatric data, material properties derived from animal tissue are also presented to demonstrate possible age-related differences in the heterogeneity and rate dependence of tissue properties. The chapter is divided into three main sections: (1) brain, meninges, and cerebral spinal fluid (CSF); (2) skull; and (3) scalp.

  7. Head injury - first aid

    MedlinePlus

    ... is shaken, is the most common type of traumatic brain injury. Scalp wounds. Skull fractures. Head injuries may cause ... of people who suffer head injuries are children. Traumatic brain injury (TBI) accounts for over 1 in 6 injury- ...

  8. Head Injury Prevention Tips

    MedlinePlus

    Head Injury Prevention Tips American Association of Neurological Surgeons 5550 Meadowbrook Drive, Rolling Meadows, IL 60008-3852 ... defined as a blow or jolt to the head or a penetrating head injury that disrupts the ...

  9. Head injury. Second edition

    SciTech Connect

    Cooper, P.R.

    1987-01-01

    This book contains 22 chapters. Some of the chapter titles are: Radiographic Evaluation; Epidemiology of Head Injury; Emergency Care and Initial Evaluation; Skull Fracture and Traumatic Cerebrospinal Fluid Fistulas; Mild Head Injury; and Injuries of the Cranial Nerves.

  10. Head injury - first aid

    MedlinePlus

    ... medlineplus.gov/ency/article/000028.htm Head injury - first aid To use the sharing features on this page, ... a concussion can range from mild to severe. First Aid Learning to recognize a serious head injury and ...

  11. Head Injuries in Children

    ERIC Educational Resources Information Center

    Pennington, Nicole

    2010-01-01

    School nurses play a crucial role in injury prevention and initial treatment when injuries occur at school. The role of school nurses includes being knowledgeable about the management of head injuries, including assessment and initial treatment. The school nurse must be familiar with the outcomes of a head injury and know when further evaluation…

  12. Head Injuries in Soccer.

    ERIC Educational Resources Information Center

    Fields, Karl B.

    1989-01-01

    This article reviews the medical literature on head injuries in soccer and concludes that protective headgear to reduce these injuries may not be as effective as rule changes and other measures, such as padding goal posts. (IAH)

  13. Experimental study of blast-induced traumatic brain injury using a physical head model.

    PubMed

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

    2009-11-01

    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

  14. Mechanics of blast loading on the head models in the study of traumatic brain injury using experimental and computational approaches.

    PubMed

    Ganpule, S; Alai, A; Plougonven, E; Chandra, N

    2013-06-01

    Blast waves generated by improvised explosive devices can cause mild, moderate to severe traumatic brain injury in soldiers and civilians. To understand the interactions of blast waves on the head and brain and to identify the mechanisms of injury, compression-driven air shock tubes are extensively used in laboratory settings to simulate the field conditions. The overall goal of this effort is to understand the mechanics of blast wave-head interactions as the blast wave traverses the head/brain continuum. Toward this goal, surrogate head model is subjected to well-controlled blast wave profile in the shock tube environment, and the results are analyzed using combined experimental and numerical approaches. The validated numerical models are then used to investigate the spatiotemporal distribution of stresses and pressure in the human skull and brain. By detailing the results from a series of careful experiments and numerical simulations, this paper demonstrates that: (1) Geometry of the head governs the flow dynamics around the head which in turn determines the net mechanical load on the head. (2) Biomechanical loading of the brain is governed by direct wave transmission, structural deformations, and wave reflections from tissue-material interfaces. (3) Deformation and stress analysis of the skull and brain show that skull flexure and tissue cavitation are possible mechanisms of blast-induced traumatic brain injury. PMID:22832705

  15. Heading and head injuries in soccer.

    PubMed

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

    2001-01-01

    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

  16. Anaphylaxis Due to Head Injury

    PubMed Central

    Bruner, Heather C.; Bruner, David I.

    2015-01-01

    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. PMID:25987924

  17. Overview of Head Injuries

    MedlinePlus

    ... to Baby Health Highlights: Sept. 13, 2016 Smokers' Perceptions May Play Role in Addiction Sugar Companies Shifted ... amount of oxygen given and the rate and depth of breaths given by the ventilator. The head ...

  18. Dimensions of Family Coping with Head Injury.

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    1994-01-01

    Examined dimensions underlying family coping with head injury. Data from 150 families with a member with a head injury identified 3 dimensions of coping: individual-to-family versus family-to-community coping; family-respite versus head-injury-focused coping; and cognitive versus behavioral coping. Findings have implications for family stress and…

  19. Bilateral internuclear ophthalmoplegia following mild head injury.

    PubMed

    Muthukumar, N; Veerarajkumar, N; Madeswaran, K

    2001-05-01

    A 7-year-old child presented with bilateral internuclear ophthalmoplegia (INO) following a trivial head injury. CT was normal. MRI revealed a pontine lesion. Two months after the injury the patient was neurologically normal. INO following head injury is rare. Rarer still is INO following mild head injury. To date, only four cases of INO had been reported following mild head injury; the present case is the fifth and the first in which the lesion was documented using MRI. The relevant literature is reviewed. PMID:11417420

  20. Head Injury in Partner-Abusive Men.

    ERIC Educational Resources Information Center

    Rosenbaum, Alan; And Others

    1994-01-01

    Fifty-three partner-abusive men, 45 maritally satisfied, and 32 maritally discordant, nonviolent men were evaluated for past history of head injury. Logistic regressions confirmed head injury was significant predictor of being a batterer. Implications of findings for both marital aggression and posthead injury rehabilitation are discussed. (Author)

  1. Clinical Trials in Head Injury

    PubMed Central

    NARAYAN, RAJ K.; MICHEL, MARY ELLEN; Ansell, Beth; Baethmann, Alex; Biegon, Anat; Bracken, Michael B.; Bullock, M. Ross; Choi, Sung C.; Clifton, Guy L.; Contant, Charles F.; Coplin, William M.; Dietrich, W. Dalton; Ghajar, Jamshid; Grady, Sean M.; Grossman, Robert G.; Hall, Edward D.; Heetderks, William; Hovda, David A.; Jallo, Jack; Katz, Russell L.; Knoller, Nachshon; Kochanek, Patrick M.; Maas, Andrew I.; Majde, Jeannine; Marion, Donald W.; Marmarou, Anthony; Marshall, Lawrence F.; McIntosh, Tracy K.; Miller, Emmy; Mohberg, Noel; Muizelaar, J. Paul; Pitts, Lawrence H.; Quinn, Peter; Riesenfeld, Gad; Robertson, Claudia S.; Strauss, Kenneth I.; Teasdale, Graham; Temkin, Nancy; Tuma, Ronald; Wade, Charles; Walker, Michael D.; Weinrich, Michael; Whyte, John; Wilberger, Jack; Young, A. Byron; Yurkewicz, Lorraine

    2006-01-01

    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, the highest of any developed country in the world. This yields an approximate number of 500,000 new cases each year, a sizeable proportion of which demonstrate signficant long-term disabilities. Unfortunately, there is a paucity of proven therapies for this disease. For a variety of reasons, clinical trials for this condition have been difficult to design and perform. Despite promising pre-clinical data, most of the trials that have been performed in recent years have failed to demonstrate any significant improvement in outcomes. The reasons for these failures have not always been apparent and any insights gained were not always shared. It was therefore feared that we were running the risk of repeating our mistakes. Recognizing the importance of TBI, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a workshop that brought together experts from clinical, research, and pharmaceutical backgrounds. This workshop proved to be very informative and yielded many insights into previous and future TBI trials. This paper is an attempt to summarize the key points made at the workshop. It is hoped that these lessons will enhance the planning and design of future efforts in this important field of research. PMID:12042091

  2. Experimental traumatic brain injury

    PubMed Central

    2010-01-01

    Traumatic brain injury, a leading cause of death and disability, is a result of an outside force causing mechanical disruption of brain tissue and delayed pathogenic events which collectively exacerbate the injury. These pathogenic injury processes are poorly understood and accordingly no effective neuroprotective treatment is available so far. Experimental models are essential for further clarification of the highly complex pathology of traumatic brain injury towards the development of novel treatments. Among the rodent models of traumatic brain injury the most commonly used are the weight-drop, the fluid percussion, and the cortical contusion injury models. As the entire spectrum of events that might occur in traumatic brain injury cannot be covered by one single rodent model, the design and choice of a specific model represents a major challenge for neuroscientists. This review summarizes and evaluates the strengths and weaknesses of the currently available rodent models for traumatic brain injury. PMID:20707892

  3. Management of head injuries in children.

    PubMed

    Conchie, Henry; Palmer, Sarah; Fernando, Katalin; Paul, Siba Prosad

    2016-07-01

    Head injury is the most common cause of injury-related death and permanent disability in children. Minor head trauma is common in childhood and does not require any medical treatment. Although deficits can occur even after mild to moderate head injury, they are markedly greater and become clinically evident following severe head injury. It is important that emergency department clinicians are aware of the signs and symptoms that indicate severe traumatic brain injury and triage for urgent intervention in those children who present with these signs and symptoms. Clinicians also need to know when children can be sent home with reassurance and information, and when they require admission or transfer to a neurosurgical unit. This article examines the literature on head injuries in children, describes assessment, management and treatment, and provides a simple management algorithm. PMID:27384805

  4. Head Injury- A Maxillofacial Surgeon's Perspective.

    PubMed

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

    2016-01-01

    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. Head Injury and Aging: The Importance of Bleeding Injuries

    PubMed Central

    Mallory, Ann

    The current study analyzed 1993–2007 data from NASS/CDS (National Automotive Sampling System / Crashworthiness Data System) to explore the types of serious head injuries sustained by adult motor vehicle crash occupants and how the types of head injuries sustained shifted with age. The purpose was to determine which head injuries are most important for older occupants by identifying specific injuries that become more likely for aging occupants and taking into consideration previous reports on the potential outcome of those injuries for an older population. Results confirmed previous reports that older head injury victims in motor vehicle collisions were more likely to sustain bleeding injuries than younger head injury victims. The current study showed that, in particular, the rate of extra-axial bleeding injury (which includes epidural, subdural, and subarachnoid bleeding) increased with age. The increase in extra-axial bleeding injury rate was especially prominent in relatively low Delta-V crashes. Among the extra-axial bleeding injuries that had increased odds of injury for older occupants, subdural hematoma and subarachnoid hemorrhage were notable, with increased odds of injury for occupants age 50 to 69 as well as for occupants age 70 and older. The importance of subdural hematoma for aging occupants is emphasized by previous studies showing its high mortality rate, while the impact of subarachnoid hemorrhage is linked in previous studies to its aggravating effect on other injuries. The results highlight a need to further explore the injury mechanisms of subdural hematoma and subarachnoid hemorrhage in older occupants in order to define age-adjusted injury tolerance and develop countermeasures. PMID:21050591

  6. Experimental Glaucoma Causes Optic Nerve Head Neural Rim Tissue Compression: A Potentially Important Mechanism of Axon Injury

    PubMed Central

    Fortune, Brad; Reynaud, Juan; Hardin, Christy; Wang, Lin; Sigal, Ian A.; Burgoyne, Claude F.

    2016-01-01

    Purpose We tested the hypothesis that experimental glaucoma (EG) results in greater thinning of the optic nerve head (ONH) neural rim tissue than the peripapillary retinal nerve fiber layer (RNFL) tissue. Methods Longitudinal spectral-domain optical coherence tomography (SDOCT) imaging of the ONH and peripapillary RNFL was performed every other week under manometric IOP control (10 mm Hg) in 51 nonhuman primates (NHP) during baseline and after induction of unilateral EG. The ONH parameter minimum rim area (MRA) was derived from 80 radial B-scans centered on the ONH; RNFL cross-sectional area (RNFLA) from a peripapillary circular B-scan with 12° diameter. Results In control eyes, MRA was 1.00 ± 0.19 mm2 at baseline and 1.00 ± 0.19 mm2 at the final session (P = 0.77), while RNFLA was 0.95 ± 0.09 and 0.95 ± 0.10 mm2, respectively (P = 0.96). In EG eyes, MRA decreased from 1.00 ± 0.19 mm2 at baseline to 0.63 ± 0.21 mm2 at the final session (P < 0.0001), while RNFLA decreased from 0.95 ± 0.09 to 0.74 ± 0.19 mm2, respectively (P < 0.0001). Thus, MRA decreased by 36.4 ± 20.6% in EG eyes, significantly more than the decrease in RNFLA (21.7 ± 19.4%, P < 0.0001). Other significant changes in EG eyes included increased Bruch's membrane opening (BMO) nonplanarity (P < 0.05), decreased BMO aspect ratio (P < 0.0001), and decreased MRA angle (P < 0.001). Bruch's membrane opening area did not change from baseline in either control or EG eyes (P = 0.27, P = 0.15, respectively). Conclusions Optic nerve head neural rim tissue thinning exceeded peripapillary RNFL thinning in NHP EG. These results support the hypothesis that axon bundles are compressed transversely within the ONH rim along with glaucomatous deformation of connective tissues. PMID:27564522

  7. [Minor Head Injury – a Silent Epidemic].

    PubMed

    Stocker, Reto; Letta, Claudio

    2016-05-11

    The vast majority out of the 20 000 patients annually hospitalized after sustaining a head injury belong to the minor head injury/cerebral concussion continuum. Fortunately, most of the patients show full recovery after days to weeks. However, about 15 % of these patients suffer from prolonged up to permanent sequels potentially impairing their quality of life to a considerable extent. This especially holds true for those who suffer from recurrent minor head injuries (i.e. victims from contact sport accidents). Unfortunately, many of these patients are never diagnosed in an appropriate way and therefore looked at as hypochondriacs or simulants. This prevents adequate rehabilitation and support. This review aims to present current knowledge about pathophysiology and clinical features of minor head injuries and to give some information about diagnostics and treatment according to current guidelines. PMID:27167479

  8. Treatment Alternatives Following Mild Head Injury.

    ERIC Educational Resources Information Center

    Novack, Thomas A.; And Others

    1988-01-01

    Discusses treatment alternatives which may alleviate problems in recovery following mild head injury, including providing education, cognitive stimulation, stress management training, individual counseling, group discussion, and physical activity in a day treatment setting. (Author/ABL)

  9. Intellectual Changes after Closed Head Injury

    ERIC Educational Resources Information Center

    Becker, Bruce

    1975-01-01

    This study provided more details on the nature of the intellectual deficit suffered by persons having closed head injuries and the recovery process as measured on the Wechsler Adult Intelligence Scale (WAIS). (Author/RK)

  10. On Impact: Students with Head Injuries

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  11. Car Accident Reconstruction and Head Injury Correlation

    NASA Astrophysics Data System (ADS)

    Chawla, A.; Grover, V.; Mukherjee, S.; Hassan, A. M.

    2013-04-01

    Estimation of brain damage remains an elusive issue and controlled tests leading to brain damage cannot be carried out on volunteers. This study reconstructs real-world car accidents to estimate the kinematics of the head impact. This data is to be used to estimate the head injury measures through computer simulations and then correlate reported skull as well as brain damage to impact measures; whence validating the head FE model (Willinger, IJCrash 8:605-617, 2003). In this study, two crash cases were reconstructed. Injury correlation was successful in one of these cases in that the injuries to the brain of one of the car drivers could be correlated in terms of type, location and severity when compared with the tolerance limits of relevant injury parameters (Willinger, IJCrash 8:605-617, 2003).

  12. Public Bicycle Share Programs and Head Injuries

    PubMed Central

    Pless, Barry; Moore, Lynne; Nathens, Avery B.; Hunte, Garth; Rivara, Frederick P.

    2014-01-01

    Objectives. We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries. Methods. We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward. Results. In PBSP cities, the proportion of head injuries among bicycle-related injuries increased from 42.3% before PBSP implementation to 50.1% after (P < .01). This proportion in comparison cities remained similar before (38.2%) and after (35.9%) implementation (P = .23). Odds ratios for head injury were 1.30 (95% confidence interval = 1.13, 1.67) in PBSP cities and 0.94 (95% confidence interval = 0.79, 1.11) in control cities (adjusted for age and city) when we compared the period after implementation to the period before. Conclusions. Results suggest that steps should be taken to make helmets available with PBSPs. Helmet availability should be incorporated into PBSP planning and funding, not considered an afterthought following implementation. PMID:24922150

  13. Restricting the Time of Injury in Fatal Inflicted Head Injuries.

    ERIC Educational Resources Information Center

    Willman, Kristal Y.; Bank, David E.; Scenic, Melvin; Catwalk, David L.

    1997-01-01

    Review of the cases of 95 fatal head injuries in children found that brain swelling could be detected as early as 1 hour 17 minutes postinjury using computerized topography scans. Results also suggested that a reported history of a lucid interval in a case not involving an epidural hematoma is likely to be false and the injury probably inflicted.…

  14. Neck injury response to direct head impact.

    PubMed

    Ivancic, Paul C

    2013-01-01

    Previous in vivo studies have observed flexion of the upper or upper/middle cervical spine and extension at inferior spinal levels due to direct head impacts. These studies hypothesized that hyperflexion may contribute to injury of the upper or middle cervical spine during real-life head impact. Our objectives were to determine the cervical spine injury response to direct head impact, document injuries, and compare our results with previously reported in vivo data. Our model consisted of a human cadaver neck (n=6) mounted to the torso of a rear impact dummy and carrying a surrogate head. Rearward force was applied to the model's forehead using a cable and pulley system and free-falling mass of 3.6kg followed by 16.7kg. High-speed digital cameras tracked head, vertebral, and pelvic motions. Average peak spinal rotations observed during impact were statistically compared (P<0.05) to physiological ranges obtained from intact flexibility tests. Peak head impact force was 249 and 504N for the 3.6 and 16.7kg free-falling masses, respectively. Occipital condyle loads reached 205.3N posterior shear, 331.4N compression, and 7.4Nm extension moment. We observed significant increases in intervertebral extension peaks above physiologic at C6/7 (26.3° vs. 5.7°) and C7/T1 (29.7° vs. 4.6°) and macroscopic ligamentous and osseous injuries at C6 through T1 due to the 504N impacts. Our results indicate that a rearward head shear force causes complex neck loads of posterior shear, compression, and extension moment sufficient to injure the lower cervical spine. Real-life neck injuries due to motor vehicle crashes, sports impacts, or falls are likely due to combined loads transferred to the neck by direct head impact and torso inertial loads. PMID:22613632

  15. Preventing head injuries in children

    MedlinePlus

    ... strapped in with the safety harness. Store all firearms and bullets in a locked cabinet. ... of Health and Human Services. Centers for Disease Control and Prevention. Heads up. Facts for physicians about ...

  16. Family Systems Issues Associated with Closed Head Injuries.

    ERIC Educational Resources Information Center

    Braciszeski, Terry L.

    This report begins by providing two case examples of closed head injuries in families. Closed head injuries or traumatic brain injuries are briefly defined and it is noted that brain injury can cause socialization problems, personality changes, and confusion. It is suggested that families that have an individual member with a closed head injury…

  17. Analysis of finite element models for head injury investigation: reconstruction of four real-world impacts.

    PubMed

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

    2005-11-01

    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. PMID:17096266

  18. Head injuries: a study evaluating the impact of the NICE head injury guidelines

    PubMed Central

    Hassan, Z; Smith, M; Littlewood, S; Bouamra, O; Hughes, D; Biggin, C; Amos, K; Mendelow, A; Lecky, F

    2005-01-01

    Background: The NICE head injury guidelines recommend a different approach in the management of head injury patients. It suggests that CT head scan should replace skull x ray (SXR) and observation/admission as the first investigation. We wished to determine the impact of NICE on SXR, CT scan, and admission on all patients with head injury presenting to the ED setting and estimate the cost effectiveness of these guidelines, which has not been quantified to date. Design: Study of head injury patients presenting to two EDs before and after implementation of NICE guidelines Methods: The rate of SXR, CT scan, and admission were determined six months before and one month after NICE implementation in both centres. The before study also looked at predicted rates had NICE been applied. This enabled predicted and actual cost effectiveness to be determined. Result: 1130 patients with head injury were studied in four 1 month periods (two in each centre). At the teaching hospital, the CT head scan rate more than doubled (3% to 7%), the SXR declined (37% to 4%), while the admission rate more than halved (9% to 4%). This represented a saving of £3381 per 100 head injury patients: greater than predicted with no adverse events. At the District General Hospital, the CT head scan rate more than quadrupled (1.4% to 9%), the SXR dropped (19 to 0.57%), while the admission rate declined (7% to 5%). This represented a saving of £290 per 100 head injury patients: less than predicted. Conclusion: The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes. PMID:16299190

  19. Accidental Head Injury: A Real Life Experience.

    ERIC Educational Resources Information Center

    Blakely, Jim

    1988-01-01

    The adult victim of accidental head injury as a result of an automobile accident recounts his experiences as a brain injured adult with such problems as poor balance, poor speech, spasticity, and lack of fine motor movement. He emphasizes his determination to get on with his life. (DB)

  20. Prevalence of apathy following head injury.

    PubMed

    Kant, R; Duffy, J D; Pivovarnik, A

    1998-01-01

    Although several studies have examined the demographics of mood disorders and personality changes following closed head injury (CHI), there are no studies that address the prevalence of apathy after CHI. Utilizing standardized evaluation tools, this study examines the prevalence of apathy in 83 consecutive patients seen in a neuropsychiatric clinic. A total of 10.84% had apathy without depression while an equal number were depressed without apathy; another 60% of patients exhibited both apathy and depression. Younger patients were more likely to be apathetic than older patients who were more likely to be depressed and apathetic. Patients with severe injury were more likely to exhibit apathy alone. Family members rated the patients higher on apathy scale. These findings suggest that apathy is a frequent symptom after head injury and may occur either alone or in association with depression. PMID:9483342

  1. [Severe head injuries during Judo practice].

    PubMed

    Nagahiro, Shinji; Mizobuchi, Yoshifumi; Hondo, Hideki; Kasuya, Hidetoshi; Kamitani, Takeshi; Shinbara, Yuzo; Nimura, Yuji; Tomatsu, Taisuke

    2011-12-01

    The goal of this study is to elucidate the characteristic features of Judo head injuries and to propose safety measures and a reaction manual on how to prevent and to deal with such accidents in Japan. Thirty cases of severe head injuries suffered during Judo practice were enrolled in this study. They have made insurance claims for damage compensation and inquiries about Judo accidents attributed to the All Japan Judo Federation, from 2003 to 2010. The average age of the patients was 16.5 year old. The incidence of injury showed 2 peaks in different academic grade levels; one is in the first year of junior high-school (30.0%, n=9) and the other is in senior high school (26.7%, n=8). Around half of them were beginners. Four cases (13.3%) had past history of head trauma or headache and dizziness before a catastrophic accident, suggesting the presence of a second impact. Lucid interval was observed in 25 cases (83.3%). Most patients (93.3%) suffered acute subdural hematoma associated with avulsion of a cerebral bridging vein. Of patients who underwent emergency removal of the hematoma, 15 patients (50%) died and 7 patients (23.3%) entered a persistent vegetative state. Based on these findings, we propose an emergency manual with safety measures for effectively preventing and treating Judo head injuries in an appropriate manner. To reduce the disastrous head injuries in Judo, the safety measures and an optimal action manual should be reconsidered and widely spread and accepted by society. PMID:22128268

  2. Occult head injury: its incidence in spinal cord injury.

    PubMed

    Wilmot, C B; Cope, D N; Hall, K M; Acker, M

    1985-04-01

    This study investigated the suspicion that a significant proportion of individuals having spinal cord injury (SCI) also sustain a concomitant undiagnosed occult head injury during the trauma accident. The criteria for high risk of head injury included the following: (1) quadriplegia with high energy deceleration accident, (2) loss of consciousness at time of injury, (3) brainstem or cortical neurologic indicators, or (4) respiratory support required at time of injury. In this study, 67 patients admitted to the rehabilitation unit were given a neuropsychologic evaluation a median of 48 days after injury. Motor free scales used were the Galveston Orientation and Amnesia Test (GOAT), Quick Test, Raven Progressive matrices, serial 7s, Shipley Hartford, Stroop Color/Word Interference, and the Wechsler Memory Scale Associate Learning Tests. Forty-three of the 67 patients (64%) scored mildly to profoundly impaired on the test battery. Evidence of poor premorbid academic history was present in 19 (44%) of those with impaired performance on the neurologic evaluation and in only three (13%) of those scoring unimpaired. Consequently, 56% (24/43) of the impaired had no previous record of scholastic difficulties, presumably acquiring cognitive impairment at the time of injury. The implications of this high incidence of impaired cognitive functioning for treatment of individuals with SCI are significant. PMID:3985774

  3. Finite Element Analysis of Brain Injury due to Head Impact

    NASA Astrophysics Data System (ADS)

    Suh, Chang Min; Kim, Sung Ho; Goldsmith, Werner

    Traumatic Brain Injury (TBI) due to head impact by external impactor was analyzed using Finite Element Method (FEM). Two-dimensiona modeling was performed according to Magnetic Resonance Imaging (MRI) data of Mongolian subject. Pressure variation in a cranium due to external impact was analyzed in order to simulate Nahum et al.'s cadaver test.6 And, analyzed results were compared with Nahum et al.'s experimental data.6 As results, stress and strain behaviors of the brain during impact were accorded with experimental data qualitatively even though there were some differences in quantitative values. In addition, they were accorded with other references about brain injury as well.

  4. Catastrophic Head Injuries in High School and Collegiate Sports.

    ERIC Educational Resources Information Center

    Mueller, Frederick O.

    2001-01-01

    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…

  5. Reported Head Injury and Disciplinary Rule Infractions in Prison.

    ERIC Educational Resources Information Center

    Merbitz, Charles; And Others

    1995-01-01

    Discusses results of a study in which felons at a Midwestern prison were tested for brain injury by a simple structured interview. To assess prison rule following, disciplinary tickets accrued per day were counted for "reported head injury" (n=41) and reported "no head injury" (n=41). Head injured residents were involved in disciplinary infraction…

  6. Head injury prediction capability of the HIC, HIP, SIMon and ULP criteria.

    PubMed

    Marjoux, Daniel; Baumgartner, Daniel; Deck, Caroline; Willinger, Rémy

    2008-05-01

    The objective of the present study is to synthesize and investigate using the same set of sixty-one real-world accidents the human head injury prediction capability of the head injury criterion (HIC) and the head impact power (HIP) based criterion as well as the injury mechanisms related criteria provided by the simulated injury monitor (SIMon) and the Louis Pasteur University (ULP) finite element head models. Each accident has been classified according to whether neurological injuries, subdural haematoma and skull fractures were reported. Furthermore, the accidents were reconstructed experimentally or numerically in order to provide loading conditions such as acceleration fields of the head or initial head impact conditions. Finally, thanks to this large statistical population of head trauma cases, injury risk curves were computed and the corresponding regression quality estimators permitted to check the correlation of the injury criteria with the injury occurrences. As different kinds of accidents were used, i.e. footballer, motorcyclist and pedestrian cases, the case-independency could also be checked. As a result, FE head modeling provides essential information on the intracranial mechanical behavior and, therefore, better injury criteria can be computed. It is clearly shown that moderate and severe neurological injuries can only be distinguished with a criterion that is computed using intracranial variables and not with the sole global head acceleration. PMID:18460382

  7. Behavioral Changes after Closed Head Injury in Children.

    ERIC Educational Resources Information Center

    Fletcher, Jack M.; And Others

    1990-01-01

    Investigated behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Behavior scales were completed by parent at time of injury and again 6 and 12 months postinjury. Severe head injury was associated with declines in adaptive functioning; scores for children with mild and moderate injuries neither differed nor…

  8. The epidemiology of head injury in Cantabria.

    PubMed

    Vázquez-Barquero, A; Vázquez-Barquero, J L; Austin, O; Pascual, J; Gaite, L; Herrera, S

    1992-11-01

    The epidemiology of head injury was studied in Cantabria, Spain, using a methodological design consisting of a cross-selectional analysis of one year of duration and an additional one year follow-up of all the patients included in the initial sample. The 477 cases identified represent a rate of 91/100,000, with males showing a head injury rate 2.7 times higher that than for females. Sixty per cent of all cases involved traffic accidents, falls accounted for 24% and industrial accidents were the cause in 8%. The annual age-adjusted mortality rate was 19.7/100,000. Over 92% of all deaths occurred prior to hospital admission. The presence of alcohol intoxication was evaluated in 211 cases by determining the osmolar gap. It was found that 51% of all the cases examined presented clear evidence of acute alcohol intoxication. PMID:1294388

  9. Does Promoting Bicycle-Helmet Wearing Reduce Childhood Head Injuries?

    ERIC Educational Resources Information Center

    Farley, Celine; Vaez, Marjan; Laflamme, Lucie

    2004-01-01

    The objectives of the study are to assess the impact of a community-based bicycle-helmet program aimed at children aged 5-12 years (about 140,000). A quasi-experimental design, including a control group, was used. Sex- and age-group-based changes in the risk of bicycle-related head injury leading to hospitalisation were measured, using rate…

  10. Biomechanics and neuropathology of adult and paediatric head injury.

    PubMed

    Ommaya, A K; Goldsmith, W; Thibault, L

    2002-06-01

    The objective of this study was to understand the biomechanics in age-related primary traumatic brain injuries (TBI) causing initial severity and secondary progressive damage and to develop strategy reducing TBI outcome variability using biomechanical reconstruction to identify types of causal mechanisms prior to clinical trials of neuro-protective treatment. The methods included the explanation of TBI biomechanics and physiopathological mechanisms from dual perspectives of neurosurgery and biomechanical engineering. Scaling of tolerances for skull failure and brain injuries in infants, children and adults are developed. Diagnostic assumptions without biomechanical considerations are critiqued. Methods for retrospective TBI reconstruction for prevention are summarized. Mechanisms of TBI are based on the differences between the mechanical properties of the head and neck related to age. Skull fracture levels correlate with increasing cranial bone thickness and in the development of the cranial sutures in infants and in adults. Head injury tolerance levels at three age categories for cerebral concussion, skull fracture and three grades of diffuse axonal injuries (DAI) are presented. Brain mass correlates inversely for TBI caused by angular head motions and locations of injurious stresses are predictable by centripetal theory. Improved quantitative diagnosis of TBI type and severity levels depend primarily on age and biomechanical mechanisms. Reconstruction of the biomechanics is feasible and enables quantitative stratification of TBI severity. Experimental treatment has succeeded in preventing progressive damage in animal TBI models. In humans this has failed, because the animal model received biomechanically controlled TBI and humans did not. Clinical similarities of human TBI patients do not necessarily predict equivalent biomechanics because such trauma can be produced in various ways. We recommend 'reverse engineering' for in-depth reconstruction of the TBI injury

  11. [Repeated head injury during judo practice].

    PubMed

    Fujiwara, Kazue

    2014-01-01

    Mild traumatic brain injuries, if repeated, can cause permanent brain damage, or even death. I examined five published documents(three judicial decisions, one official injury report, and one book)to analyze incidents in which high school students who, while practicing judo, experienced acute subdural hematoma(ASDH)with grave outcomes, despite the fact that they had been examined by neurosurgeons. The five students, first-grade boy and girl of junior high school and two first-grade boys and one second-grade girl of senior high school, were hit on the head during extracurricular judo practice and were taken to the neurosurgery department of different hospitals. They were all novices or unskilled players. The initial diagnoses were ASDH in three cases, concussion in one, and headache in one. Although the surgeons, except in one case, prohibited the students from returning to play, the juveniles resumed judo practice soon. Some of them complained of continued headaches, but they kept practicing. Between 17 and 82 days after the first injury, they received the fateful hits to their heads, and they were brought to the emergency rooms. MRI and CT revealed ASDH in all;two of them died, and the other three remain in persistent vegetative state. Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians. They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first. PMID:24388944

  12. Study Links Severe Head Injury to Parkinson's Risk

    MedlinePlus

    ... News) -- A traumatic brain injury with loss of consciousness may increase the risk of developing Parkinson's disease, ... 865 had suffered a head injury and lost consciousness at some point in their lives -- some fairly ...

  13. Thalamic nuclei after human blunt head injury.

    PubMed

    Maxwell, William L; MacKinnon, Mary Anne; Smith, Douglas H; McIntosh, Tracy K; Graham, David I

    2006-05-01

    Paraffin-embedded blocks from the thalamus of 9 control patients, 9 moderately disabled, 12 severely disabled, and 10 vegetative head-injured patients assessed using the Glasgow Outcome Scale and identified from the Department of Neuropathology archive. Neurons, astrocytes, macrophages, and activated microglia were differentiated by Luxol fast blue/cresyl violet, GFAP, CD68, and CR3/43 staining and stereological techniques used to estimate cell number in a 28-microm-thick coronal section. Counts were made in subnuclei of the mediodorsal, lateral posterior, and ventral posterior nuclei, the intralaminar nuclei, and the related internal lamina. Neuronal loss occurred from mediodorsal parvocellularis, rostral center medial, central lateral and paracentral nuclei in moderately disabled patients; and from mediodorsal magnocellularis, caudal center medial, rhomboid, and parafascicular nuclei in severely disabled patients; and all of the above and the centre median nucleus in vegetative patients. Neuronal loss occurred primarily from cognitive and executive function nuclei, a lesser loss from somatosensory nuclei and the least loss from limbic motor nuclei. There was an increase in the number of reactive astrocytes, activated microglia, and macrophages with increasing severity of injury. The study provides novel quantitative evidence for differential neuronal loss, with survival after human head injury, from thalamic nuclei associated with different aspects of cortical activation. PMID:16772871

  14. Advances in the Understanding and Treatment of Head Injury

    PubMed Central

    Evans, Joseph P.

    1966-01-01

    The author describes his personal involvement in head injury prevention and management over the past 40 years. He reviews the evolution of knowledge concerning the role of increased intracranial pressure, and considers the importance of cerebral vasoparalysis in the production of signs and symptoms following head injury, and the development of methods of recording intracranial pressure continuously, over hours and days. The development of an experimental compression model has led to a fuller understanding of edema of the brain and has provided a means of studying, by light and electron microscopy, the histological changes that result from edema. More recently, analyses of biochemical changes and disturbed membrane function have opened up a new avenue of potential treatment. Moreover, it is now clear that cerebral vascular dilatation and abrupt pressure increase can be produced in the monkey, in over 50% of cases, by lesions in the dorsomedial nucleus of the hypothalamus. Similar lesions may occur in the human and this suggests other therapeutic approaches. There is, then, a genuine hope of a breakthrough in the management of head injuries. ImagesFig. 1Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 16Fig. 21 PMID:5928533

  15. Characterizing Discourse Deficits Following Penetrating Head Injury: A Preliminary Model

    ERIC Educational Resources Information Center

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

    2013-01-01

    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…

  16. Subtle Symptoms Associated with Self-Reported Mild Head Injury.

    ERIC Educational Resources Information Center

    Segalowitz, Sidney J.; Lawson, Sheila

    1995-01-01

    A survey of 1,345 high school students and 2,321 university students found that 30-37% reported having experienced a head injury, with 12-15% reporting loss of consciousness. Significant relationships were found between mild head injury incidence and gender; sleep difficulties; social difficulties; handedness pattern; and diagnoses of attention…

  17. School Psychologists' Knowledge of Traumatic Head Injury: Implications for Training.

    ERIC Educational Resources Information Center

    Mira, Mary P.; And Others

    1988-01-01

    Seventy-one school psychologists were surveyed concerning their knowledge base, training, and experience in the area of traumatic head injury. Results indicated that school psychologists have received little systematic training in the area of traumatic head injury and do not have broad-based information about this group of children. (Author/JDD)

  18. Mild Head Injury as a Source of Developmental Disabilities.

    ERIC Educational Resources Information Center

    Segalowitz, Sidney J.; Brown, Deborah

    1991-01-01

    This survey of 616 Canadian high-school adolescents suggests that light and mild head injury is almost 10 times as common as hospital-reported incidence. The study found significant relationships between reported head injury and hyperactivity, stuttering, mixed handedness, and dislike of mathematics. (Author/JDD)

  19. Alcohol, head injury, and pulmonary complications.

    PubMed

    Christensen, M A; Janson, S; Seago, J A

    2001-08-01

    The purpose of this study was to determine the difference in rates of pulmonary complications (e.g., aspiration, pneumonia) in head-injured patients with and without concomitant alcohol intoxication. The records of 98 consecutive patients admitted over a 1-year period to a Level I Trauma Center were reviewed. The patients were grouped into three subsets: acutely intoxicated (n = 26), acutely intoxicated with a diagnosis of chronic alcoholism (n = 14), and non-intoxicated (n = 58). Alcohol intoxication was defined as a blood alcohol level (BAL) > or = 0.08 mg/dl. Admission BALs and Glasgow Coma Scale (GCS) scores were tabulated at admission. Frequency of arterial blood gas (ABG) measurements, need for an artificial airway/mechanical ventilation, and length of stay (LOS) were analyzed by using one-way analysis of variance. Intergroup differences in breath sounds were compared by using the nonparametric Kruskall-Wallis technique. We found no statistical difference between groups in terms of pulmonary sequelae despite the remarkably high BALs observed in the study groups. Similarly, there was no statistically greater LOS in the groups with alcohol intoxication than in alcohol-free cohorts. Despite a great deal of BAL science research to support our hypothesis, we failed to demonstrate a significantly higher rate of pulmonary problems in inebriated individuals with head injuries. We found that our strict exclusion criteria (no concomitant chest, abdominal, or pelvic trauma) limited the sample to only those patients without significant intracranial bleeding, whereas most complications in blood alcohol neuroscience research have been associated with much larger mass lesions (e.g., epidural or subdural hematomas). In addition, we found the characterizations of patients as chronically alcoholic were cumbersome and inaccurate in many cases. Future research should allow for a greater range of concomitant injuries that might suggest a positive or negative relationship to acute

  20. [Retinal haemorrhages in non-accidental head injury in childhood].

    PubMed

    Oberacher-Velten, I M; Helbig, H

    2014-09-01

    Retinal haemorrhages are one of the three cardinal manifestations of the "shaken baby syndrome" or "non-accidental head injury" in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper. PMID:25181505

  1. The state of head injury biomechanics: past, present, and future: part 1.

    PubMed

    Goldsmith, W

    2001-01-01

    This article is the first of two parts of a comprehensive survey of the biomechanics of head injury since its inception in 1939 in the United States, the separation being made for temporal and spatial reasons. The second portion of this material will be published at a later time in this journal. The discussion will be almost exclusively limited to nonpenetrating events. The topics presented in the following sections include an introduction that discusses the magnitude of the problem, the basic tools of biomechanics, and significant major reference sources covering this subject. This is succeeded by a brief description of the components of the head, classification of head injuries, early experimental investigations and human tolerance considerations, measurement techniques of kinetic parameters, and head motion and head injury investigations prior to 1966. A Head Injury Conference sponsored by the National Institutes of Neurological Diseases and Stroke in 1966 changed the landscape of investigations in this area. While informal collaboration between neurosurgeons and engineers had existed prior to this time, the conference established a permanent mechanism of synergism between these disciplines, produced the first zero-order realistic model of biomechanical head injury investigation, and established a 4-year program of federally funded research into the mechanical properties of the tissues of the cranium. While a recession precluded a continuation of the national sponsorship of such work, this 4-year period of intensive research resulted in a nationwide individual effort to develop further knowledge in this area. The current presentation, then, covers the mechanical and structural properties of solid and fluid tissues of the head, emphasizing progress during the past 3 decades; fetal cranial properties; analytical and numerical head injury models; experimental cranial loads applied to human volunteers and cadaver heads, dynamic loading of surrogate heads; and

  2. [Epileptic manifestations following head injury (author's transl)].

    PubMed

    Wessely, P

    1977-01-01

    An analysis is presented of the findings in a group of 300 patients with head injury, aged 15 years or over at the time of the accident, who subsequently developed epileptic manifestations. Early fits (including one case of immediate onset) were found in 33% of the cases (99 patients). In contrast to post-traumatic late epilepsy (PTE), which is a manifestation of a static process, early fits are triggered off by a dynamic process (brain oedema, haemorrhage) and are a sign of cerebral irritation, but do not represent a true form of epilepsy. Early fits are related to the acute traumatic state; the time limit is flexible, but lies in the region of 4 weeks following injury. Conversion of early fits to PTE (with or without a latent interval) occurred in 72% of the cases. This percentage is higher than the average incidence quoted in the literature and presumably arises partly from the selection criteria applied in this study. The time of appearance of early fits following injury is one factor which determines the prognosis. Fits appearing on the first day carry a relatively favourable prognosis and do not proceed to PTE in 41% of the cases, whereas this percentage shrinks to 15% in the case of fits appearing from the second week onwards. Early fits are an isolated occurrence in one third of the cases; progression to PTE is less frequent in these patients than following frequent, repeated convulsions. Furthermore, the incidence of early fits is dependent, to a large extent, on traumatological and clinical factors: the combination of unconsciousness of over three hours' duration, neurological signs referable to the central nervous system, persistent organic psychotic syndrome and intracranial bleeding leads to a significantly higher incidence of early fits than unconsciousness of less than three hours' duration and absence of neurological signs in patients who, moreover, do not display features of the psychotic syndrome, and shows a greater tendency to early fits even

  3. Neuropsychiatric changes following penetrating head injury in children

    PubMed Central

    Badhiwala, Jetan H.; Blackham, Janet R.; Bhardwaj, Ratan D.

    2014-01-01

    Background: Penetrating head injuries demand the prompt attention of a neurosurgeon. While most neurosurgical centers are experienced in the acute management of these injuries, less is known about the long-term neuropsychiatric sequelae of penetrating head trauma. In adults, direct injury to the frontal lobe classically has been associated with mental status changes. However, there is less published data in children. Case Description: We report the case of a 12-year-old boy who suffered a penetrating head injury to the frontal lobes secondary to a self-inflicted gunshot wound, and experienced subsequent resolution of pre-existing bipolar disorder and new onset of attention deficit hyperactivity disorder. Conclusion: Children with penetrating head injury require close multidisciplinary follow-up in order to monitor, and accordingly implement management strategies, for associated sequelae, including behavioral and neuropsychiatric changes. PMID:25422782

  4. Head Injury- A Maxillofacial Surgeon’s Perspective

    PubMed Central

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

    2016-01-01

    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. Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass

    PubMed Central

    Patton, Declan

    2008-01-01

    Objective To investigate the risks of mild traumatic brain injury and neck injury associated with head banging, a popular dance form accompanying heavy metal music. Design Observational studies, focus group, and biomechanical analysis. Participants Head bangers. Main outcome measures Head Injury Criterion and Neck Injury Criterion were derived for head banging styles and both popular heavy metal songs and easy listening music controls. Results An average head banging song has a tempo of about 146 beats per minute, which is predicted to cause mild head injury when the range of motion is greater than 75°. At higher tempos and greater ranges of motion there is a risk of neck injury. Conclusion To minimise the risk of head and neck injury, head bangers should decrease their range of head and neck motion, head bang to slower tempo songs by replacing heavy metal with adult oriented rock, only head bang to every second beat, or use personal protective equipment. PMID:19091761

  6. Injuries to the head and neck in Homer's Odyssey.

    PubMed

    Stathopoulos, Panagiotis; Ghaly, Ghaly Adly; Azari, Afroditi

    2016-07-01

    The Odyssey and the Iliad are the most prominent works of ancient Greek epic poetry, and we have retrieved injuries to the head and neck mentioned in the Odyssey. We studied the texts both in ancient Greek and the translations in modern Greek and English and searched for references to trauma to the head and neck. We recorded the injuries, the attacker and defender, the weapons used, the site, and the result. There were 11 injuries of the head and neck, nine of which were fatal. PMID:26586491

  7. Reactivation of posttraumatic stress disorder after minor head injury.

    PubMed

    Berthier, M L; Kulisevsky, J; Fernández Benitez, J A; Gironell, A

    1998-01-01

    This report describes the reactivation of a posttraumatic stress disorder (PTSD) after a minor head injury in two young women who had recovered from extreme stress caused by sexual abuse during adolescence. Intrusive thoughts, images, dreams, and phobic avoidance bear a direct relationship to the specific circumstances of both head injury and sexual abuse, and were associated with obsessive-compulsive symptoms, generalized anxiety with panic, and depression. These findings suggest that in some individuals minor head injuries may induce not only extreme stress reactions, but also cause the reactivation of symptoms related to previous traumatic experiences. PMID:9750980

  8. Fatal pediatric head injury due to toppled television: does the injury pattern overlap with abusive head trauma?

    PubMed

    Kodikara, Sarathchandra; Pollanen, Michael

    2012-07-01

    Pediatric head injuries can occur from abusive head trauma (AHT) or accidents. Accidental pediatric head injuries caused by cathode-ray tube televisions (CRTT) toppling have become a 'silent epidemic'. Differentiation between a fatal case of AHT and CRTT toppling could be vexing when the historical and scene evidence are subtle. A 2-year-old girl was found unresponsive in her house and could not be resuscitated. A 27" CRTT was found fallen from its stand onto the floor at the scene. The siblings report that the deceased was climbing on the television stand when it toppled. Autopsy revealed a spectrum of head injuries including, contusions, fractures, bilateral acute subdural hemorrhages, subarachnoid hemorrhages, brain contusion-lacerations and corpus callosal hemorrhages. Microscopy of the eyes revealed bilateral acute retinal hemorrhages. The cause of death was given as crushing injuries of head and brain. The skull fracture pattern is compatible with an accident causing crush injury due to the toppled CRTT rather than AHT. The injury pattern reconfirms that the head is the most vulnerable site in case of CRTT tipover. Although there may be an overlap between the injury pattern in AHT and in CRTT tipover cases, a careful evaluation of the history and scene and autopsy findings such as the crushing nature of the skull fractures and distribution of injury, can solve this problem. PMID:22498234

  9. Why do woodpeckers resist head impact injury: a biomechanical investigation.

    PubMed

    Wang, Lizhen; Cheung, Jason Tak-Man; Pu, Fang; Li, Deyu; Zhang, Ming; Fan, Yubo

    2011-01-01

    Head injury is a leading cause of morbidity and death in both industrialized and developing countries. It is estimated that brain injuries account for 15% of the burden of fatalities and disabilities, and represent the leading cause of death in young adults. Brain injury may be caused by an impact or a sudden change in the linear and/or angular velocity of the head. However, the woodpecker does not experience any head injury at the high speed of 6-7 m/s with a deceleration of 1000 g when it drums a tree trunk. It is still not known how woodpeckers protect their brain from impact injury. In order to investigate this, two synchronous high-speed video systems were used to observe the pecking process, and the force sensor was used to measure the peck force. The mechanical properties and macro/micro morphological structure in woodpecker's head were investigated using a mechanical testing system and micro-CT scanning. Finite element (FE) models of the woodpecker's head were established to study the dynamic intracranial responses. The result showed that macro/micro morphology of cranial bone and beak can be recognized as a major contributor to non-impact-injuries. This biomechanical analysis makes it possible to visualize events during woodpecker pecking and may inspire new approaches to prevention and treatment of human head injury. PMID:22046293

  10. Avoidable factors contributing to death of children with head injury.

    PubMed Central

    Sharples, P M; Storey, A; Aynsley-Green, A; Eyre, J A

    1990-01-01

    OBJECTIVE--To assess the incidence of potentially avoidable complications contributing to death of children with head injuries. DESIGN--Retrospective review of children who died with head injuries from 1979 to 1986 from data of the Office of Population Censuses and Surveys, Hospital Activity Analyses, case notes, coroners' records, and necropsy reports. SETTING--District general hospitals and two regional neurosurgical centres in Northern region. RESULTS--255 Children died from head injury in the region, the mortality being 5.3 per 100,000 children per year. Head injury was the single most important cause of death in children aged greater than 1 year, accounting for 15% of deaths in children aged 1-15 years and a quarter for those aged 5-15 years. 121 Potentially avoidable factors possibly or probably contributing to death occurred in 81 children (32%). Half the children (125) died before admission, 27 of whom (22%) had potentially avoidable factors possibly or probably contributing to death, and 130 died after admission, 54 of whom (42%) had 93 such factors, which included failure of diagnosis or delayed recognition of intracranial haemorrhage or associated injury, inadequate management of the airways, and poor management of the transfer between hospitals. IMPLICATIONS--Regions should revise urgently their guidelines for optimal management and indications for neurosurgical referral to include children with severe head injuries and audit their systems of care for all patients with head injuries. PMID:2105782

  11. Why Do Woodpeckers Resist Head Impact Injury: A Biomechanical Investigation

    PubMed Central

    Wang, Lizhen; Cheung, Jason Tak-Man; Pu, Fang; Li, Deyu; Zhang, Ming; Fan, Yubo

    2011-01-01

    Head injury is a leading cause of morbidity and death in both industrialized and developing countries. It is estimated that brain injuries account for 15% of the burden of fatalities and disabilities, and represent the leading cause of death in young adults. Brain injury may be caused by an impact or a sudden change in the linear and/or angular velocity of the head. However, the woodpecker does not experience any head injury at the high speed of 6–7 m/s with a deceleration of 1000 g when it drums a tree trunk. It is still not known how woodpeckers protect their brain from impact injury. In order to investigate this, two synchronous high-speed video systems were used to observe the pecking process, and the force sensor was used to measure the peck force. The mechanical properties and macro/micro morphological structure in woodpecker's head were investigated using a mechanical testing system and micro-CT scanning. Finite element (FE) models of the woodpecker's head were established to study the dynamic intracranial responses. The result showed that macro/micro morphology of cranial bone and beak can be recognized as a major contributor to non-impact-injuries. This biomechanical analysis makes it possible to visualize events during woodpecker pecking and may inspire new approaches to prevention and treatment of human head injury. PMID:22046293

  12. Career Opportunitities and Professional Preparation in Head Injury Rehabilitation.

    ERIC Educational Resources Information Center

    McMahon, Brian T.; And Others

    1988-01-01

    Outlines career opportunities and delineates appropriate personal characteristics for prospective head injury rehabilitation counselors. Provides preservice training requirements in terms of program of study emphases, and recommended electives and readings. (Author)

  13. Characterization of Closed Head Impact Injury in Rat

    PubMed Central

    Hua, Yi; Akula, Praveen; Kelso, Matthew; Gu, Linxia

    2015-01-01

    The closed head impact (CHI) rat models are commonly used for studying the traumatic brain injury. The impact parameters vary considerably among different laboratories, making the comparison of research findings difficult. In this work, numerical CHI experiments were conducted to investigate the sensitivities of intracranial responses to various impact parameters (e.g., impact depth, velocity, and position; impactor diameter, material, and shape). A three-dimensional finite element rat head model with anatomical details was subjected to impact loadings. Results revealed that impact depth and impactor shape were the two leading factors affecting intracranial responses. The influence of impactor diameter was region-specific and an increase in impactor diameter could substantially increase tissue strains in the region which located directly beneath the impactor. The lateral impact could induce higher strains in the brain than the central impact. An indentation depth instead of impact depth would be appropriate to characterize the influence of a large deformed rubber impactor. The experimentally observed velocity-dependent injury severity could be attributed to the “overshoot” phenomenon. This work could be used to better design or compare CHI experiments. PMID:26451365

  14. Head Injury With Subsequent, Intermittent, Nonschizophrenic, Psychotic Symptoms and Violence

    PubMed Central

    Bell, Carl C.; Kelly, Ruby P.

    1987-01-01

    A young, black, adult woman presented to an outpatient clinic for treatment with a history of intermittent, nonschizophrenic, psychotic symptoms. Blacks, because of their situational sociology, may be more predisposed to severe head injuries, and this acquired biologic factor may be, in part, responsible for the high rates of black-on-black murder. The use of beta blockers is discussed as an adjunct in the treatment of violence occurring in patients with a past history of severe head injury. PMID:3694693

  15. Can we abolish skull x rays for head injury?

    PubMed Central

    Reed, M; Browning, J; Wilkinson, A; Beattie, T

    2005-01-01

    Objectives: To assess the effect of a change in skull x ray policy on the rate of admission, use of computed tomography (CT), radiation dose per head injury, and detection of intracranial injuries; and to compare the characteristics of patients with normal and abnormal head CT. Design: Retrospective cohort study. Setting: UK paediatric teaching hospital emergency department. Patients: 1535 patients aged between 1 and 14 years with a head injury presenting to the emergency department between 1 August 1998 and 31 July 1999 (control period), and 1867 presenting between 1 August 2002 and 31 July 2003 (first year of new skull x ray policy). Intervention: Hospital notes and computer systems were analysed and data were collected on all patients presenting with a head injury. Results: The abolition of skull x rays in children aged over 1 year prevented about 400 normal skull x rays being undertaken in period 2. The percentage of children undergoing CT rose from 1.0% to 2.1% with no change in the positive CT pick up rate (25.6% v 25.0%). There was no significant change in admission rate (10.9% v 10.1%), and a slight decrease in the radiation dose per head injury (0.042 mSv compared to 0.045 mSv). Conclusions: Skull x rays can be abandoned in children aged 1 to 14 without a significant increase in admission rate, radiation dose per head injury, or missed intracranial injury. The mechanism and history of the injury and a reduced Glasgow coma scale are probably the most important indicators of significant head injury in children. PMID:15851418

  16. The History and Evolution of Experimental Traumatic Brain Injury Models.

    PubMed

    Povlishock, John

    2016-01-01

    This narrative provides a brief history of experimental animal model development for the study of traumatic brain injury. It draws upon a relatively rich history of early animal modeling that employed higher order animals to assess concussive brain injury while exploring the importance of head movement versus stabilization in evaluating the animal's response to injury. These themes are extended to the development of angular/rotational acceleration/deceleration models that also exploited brain movement to generate both the morbidity and pathology typically associated with human traumatic brain injury. Despite the significance of these early model systems, their limitations and overall practicality are discussed. Consideration is given to more contemporary rodent animal models that replicate individual/specific features of human injury, while via various transgenic technologies permitting the evaluation of injury-mediated pathways. The narrative closes on a reconsideration of higher order, porcine animal models of injury and their implication for preclinical/translational research. PMID:27604709

  17. Preschool children with head injury: comparing injury severity measures and clinical care.

    PubMed

    Youngblut, JoAnne M; Caicedo, Carmen; Brooten, Dorothy

    2013-01-01

    The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care. PMID:24640315

  18. Preschool Children with Head Injury: Comparing Injury Severity Measures And Clinical Care

    PubMed Central

    Youngblut, JoAnne M.; Caicedo, Carmen; Brooten, Dorothy

    2014-01-01

    The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care. PMID:24640315

  19. Head motions while riding roller coasters: Implications for brain injury

    PubMed Central

    Chickola, Larry; Smith, Douglas H.

    2009-01-01

    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 three different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared to published data using similar analyses of head motions. An 8.05m/s car crash lead to the largest head injury criterion measure (HIC15) of 28.1 and head impact factor (HIP) of 3.41, over six 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. PMID:19901817

  20. Head motions while riding roller coasters: implications for brain injury.

    PubMed

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

    2009-12-01

    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. PMID:19901817

  1. On Impact: A Case of a Student with Head Injuries

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  2. A Drosophila model of closed head traumatic brain injury

    PubMed Central

    Katzenberger, Rebeccah J.; Loewen, Carin A.; Wassarman, Douglas R.; Petersen, Andrew J.; Ganetzky, Barry; Wassarman, David A.

    2013-01-01

    Traumatic brain injury (TBI) is a substantial health issue worldwide, yet the mechanisms responsible for its complex spectrum of pathologies remains largely unknown. To investigate the mechanisms underlying TBI pathologies, we developed a model of TBI in Drosophila melanogaster. The model allows us to take advantage of the wealth of experimental tools available in flies. Closed head TBI was inflicted with a mechanical device that subjects flies to rapid acceleration and deceleration. Similar to humans with TBI, flies with TBI exhibited temporary incapacitation, ataxia, activation of the innate immune response, neurodegeneration, and death. Our data indicate that TBI results in death shortly after a primary injury only if the injury exceeds a certain threshold and that age and genetic background, but not sex, substantially affect this threshold. Furthermore, this threshold also appears to be dependent on the same cellular and molecular mechanisms that control normal longevity. This study demonstrates the potential of flies for providing key insights into human TBI that may ultimately provide unique opportunities for therapeutic intervention. PMID:24127584

  3. Nail Gun Induced Open Head Injury: A Case Report.

    PubMed

    Oh, Hyun Ho; Kim, Young; Park, Sung Choon; Ha, Young Soo; Lee, Kyu Chang

    2014-10-01

    Increasing use of the nail gun has led to higher injury rates from the use of tools with sequential actuation. Nail gun injury can occur to various parts of the body. Very deep penetration in the brain can have fatal results. A 46-year-old male fired shots from a nail gun into his brain in a suicide attempt. This case demonstrated successful surgical management of the resultant open head injury. PMID:27169051

  4. Spinal injuries in abusive head trauma: patterns and recommendations.

    PubMed

    Kemp, Alison; Cowley, Laura; Maguire, Sabine

    2014-12-01

    A growing body of scientific evidence suggests that there is an association between occult spinal injury and abusive head trauma (previously known as shaken baby syndrome). Consideration needs to be given to the nature of these injuries, the possible causal mechanisms and what investigations should be undertaken to delineate the full extent of spinal involvement in infants with suspected abusive head trauma. This association has the potential to influence our understanding of the biomechanics and subsequent neuropathology associated with abusive head trauma. PMID:25501732

  5. A different approach to missile induced head injuries.

    PubMed

    Pabuscu, Yüksel; Bulakbasi, Nail; Kocaoglu, Murat; Ustünsöz, Bahri; Tayfun, Cem

    2003-01-01

    Missile induced head injuries can be influenced by the anatomical location of the injury, i.e. type of tissue and by the ballistic properties such as the design of the weapon and the mass, shape and construction of the projectile, as well as its velocity characteristics and trajectory angle. In the diagnostic work up of the patients with missile induced head injuries, every available modality can be used. It is important, however, to recognize that CT scan is the primary and most efficacious diagnostic tool in such patients. In this article we have identified risk factors for both morbidity and mortality in patients with missile induced head injury with excluding the patients who had also extracranial serious trauma and systemic disease. PMID:12821033

  6. Documentation of Associated Injuries Occurring With Radial Head Fracture

    PubMed Central

    van Riet, Roger P.

    2008-01-01

    We believe a better way is needed to accurately describe the spectrum of associated injuries that commonly occur in conjunction with a radial head fracture. A review of our institution’s experience with 333 radial head fractures from 1997 to 2002 documented 88 (26%) associated injuries. Based on this clinical experience, our goal was to develop an accurate and comprehensive description of associated injuries. A shorthand suffix method first recognizes the type of radial head fracture with the traditional Mason classification, followed by abbreviations designating the articular injuries, coronoid (c) and olecranon (o), and the ligamentous injuries, lateral collateral ligament (l), medial collateral ligament (m), and distal radioulnar joint (d). The proposed system offers a logical and reproducible (98%) extension of the current Mason fracture classification to document the presence of additional articular and ligamentous injuries. This provides an opportunity to standardize the communication of fracture type with further details of other injuries that ultimately can help with better understanding of treatment outcome based on the precise injury complex. PMID:18196384

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

    PubMed

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

    2010-01-01

    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. PMID:21799615

  8. Head CT scan in Iranian minor head injury patients: evaluating current decision rules.

    PubMed

    Sadegh, Robab; Karimialavijeh, Ehsan; Shirani, Farzaneh; Payandemehr, Pooya; Bahramimotlagh, Hooman; Ramezani, Mahtab

    2016-02-01

    The objective of this study is to select one of the seven available clinical decision rules for minor head injury, for managing Iranian patients. This was a prospective cohort study evaluating medium- or high-risk minor head injury patients presenting to the Emergency Department. Patients with minor head trauma who were eligible for brain imaging based on seven available clinical decision rules (National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS)-II, Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS), New Orleans, American College of Emergency Physicians (ACEP) Guideline, Scandinavian, and Canadian computed tomography (CT) head rule) were selected. Subjects were underwent a non-contrast axial spiral head CT scan. The outcome was defined as abnormal and normal head CT scan. Univariate analysis and stepwise linear regression were applied to show the best combination of risk factors for detecting CT scan abnormalities. Five hundred patients with minor head trauma were underwent brain CT scan. The following criteria were derived by stepwise linear regression: Glasgow Coma Scale (GCS) less than 15, confusion, signs of basal skull fracture, drug history of warfarin, vomiting more than once, loss of consciousness, focal neurologic deficit, and age over 65 years. This model has 86.15 % (75.33-93.45 %) sensitivity and 46.44 % (46.67-51.25 %) specificity in detecting minor head injury patients with CT scan abnormalities (95 % confidence interval). Of seven decision rules, only the Canadian CT Head Rule possesses seven of the eight high-risk factors associated with abnormal head CT results which were identified by this study. This study underlines the Canadian CT Head Rule's utility in Iranian minor head injury patients. Our study encourages researchers to evaluate available guidelines in different communities. PMID:26407978

  9. Dizziness following head injury: a neuro-otological study.

    PubMed

    Davies, R A; Luxon, L M

    1995-03-01

    Dizziness is a frequent and debilitating complications of head injury and accounts for increasing numbers of medico-legal claims. A detailed neuro-otological study was carried out from the records of 100 patients with post-traumatic dizziness to explore the neuro-otological basis of their symptoms: 50 patients presenting for medico-legal purposes (group I) and 50 presenting for management of their vestibular symptoms (group II). The two groups showed a similar sex distribution, a similar range of causes of head injury and similar severity of head injury (72 minor, 24 moderate and 4 severe). Of the 100, 88 showed at least one audio-vestibular abnormality on testing. Vertigo of the benign positional paroxysmal type was the commonest vestibular diagnosis in both groups (61/100), and only 8 patients showed central vestibular abnormalities. Fifty-three patients had audiometric abnormalities attributable to the head injury, the commonest of which was a high-tone sensorineural hearing loss. There was no significant difference in the incidence of any of the abnormalities in the medico-legal group (group I) when compared with the symptom management group (group II). The results provide strong evidence for an organic basis to recurring dizziness after head injury, whether or not a claim for compensation is pending, and emphasize the need for specialist neuro-otological investigation if abnormalities are to be identified and managed correctly. PMID:7798121

  10. Contribution of traumatic head injury to neuropsychological deficits in alcoholics.

    PubMed Central

    Hillbom, M; Holm, L

    1986-01-01

    The contribution of head injuries to neuropsychological deficits was studied in 157 recently detoxified alcoholics and 400 control subjects consisting of age-stratified randomly selected men and women from the same geographical area as the alcoholics. Head injuries had occurred in 41% and 22% of the male and female alcoholics, but only in 15% and 6% of the male and female control subjects. One third of the injured subjects in both groups had been admitted to hospital for treatment of the acute injury. The neuropsychological test results of alcoholics were significantly inferior to those of control subjects. Unexpectedly, alcoholics with head injuries not identified at hospital were significantly inferior in several Halstead-Reitan subtests when compared with uninjured alcoholics with a similar duration of alcoholism and abstinence. By contrast, control subjects who had sustained a head injury not identified at hospital did not show signs of intellectual impairment when compared with uninjured controls. We conclude that traumatic brain injuries that may cause significant intellectual impairment may easily remain unrecognised in alcoholics. PMID:3806110

  11. The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

    2008-01-01

    The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The…

  12. The postconcussion syndrome and the sequelae of mild head injury.

    PubMed

    Evans, R W

    1992-11-01

    The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. Neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. Risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small

  13. Effects of Head Injury on the Educational and Vocational Potential of American Indians.

    ERIC Educational Resources Information Center

    Horan, Kevin T.

    1986-01-01

    Identifies possible causes of head injury among reservation American Indians. Discusses the range of problems to look for following head trauma and offers some common sense safety precautions for head injury prevention. Describes a plan of action for teachers of American Indian children who have sustained head injuries. (JHZ)

  14. Development of head injury assessment reference values based on NASA injury modeling.

    PubMed

    Somers, Jeffrey T; Granderson, Bradley; Melvin, John W; Tabiei, Ala; Lawrence, Charles; Feiveson, Alan; Gernhardt, Michael; Ploutz-Snyder, Robert; Patalak, John

    2011-11-01

    NASA is developing a new crewed vehicle and desires a lower risk of injury compared to automotive or commercial aviation. Through an agreement with the National Association of Stock Car Auto Racing, Inc. (NASCAR®), an analysis of NASCAR impacts was performed to develop new injury assessment reference values (IARV) that may be more relevant to NASA's context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by analyzing all NASCAR recorded impact data for the 2002-2008 race seasons. From the 4015 impact files, 274 impacts were selected for numerical simulation using a custom NASCAR restraint system and Hybrid III 50th percentile male Finite Element Model (FEM) in LS-DYNA. Head injury occurred in 27 of the 274 selected impacts, and all of the head injuries were mild concussions with or without brief loss of consciousness. The 247 noninjury impacts selected were representative of the range of crash dynamics present in the total set of impacts. The probability of head injury was estimated for each metric using an ordered probit regression analysis. Four metrics had good correlation with the head injury data: head resultant acceleration, head change in velocity, HIC 15, and HIC 36. For a 5% risk of AIS≥1/AIS≥2 head injuries, the following IARVs were found: 121.3/133.2 G (head resultant acceleration), 20.3/22.0 m/s (head change in velocity), 1,156/1,347 (HIC 15), and 1,152/1,342 (HIC 36) respectively. Based on the results of this study, further analysis of additional datasets is recommended before applying these results to future NASA vehicles. PMID:22869304

  15. Monitoring of head injury by myotatic reflex evaluation

    PubMed Central

    Cozens, J; Miller, S.; Chambers, I.; Mendelow, A

    2000-01-01

    OBJECTIVES—(1) To establish the feasibility of myotatic reflex measurement in patients with head injury. (2) To test the hypothesis that cerebral dysfunction after head injury causes myotatic reflex abnormalities through disordered descending control. These objectives arise from a proposal to use reflex measurements in monitoring patients with head injury.
METHODS—The phasic stretch reflex of biceps brachii was elicited by a servo-positioned tendon hammer. Antagonist inhibition was evoked by vibration to the triceps. Using surface EMG, the amplitude of the unconditioned biceps reflex and percentage antagonist inhibition were measured. After standardisation in 16 normal adult subjects, the technique was applied to 36 patients with head injury across the range of severity. Objective (1) was addressed by attempting a measurement on each patient without therapeutic paralysis; three patients were also measured under partial paralysis. Objective (2) was addressed by preceding each of the 36 unparalysed measurements with an assessment of cerebral function using the Glasgow coma scale (GCS); rank correlation was employed to test a null hypothesis that GCS and reflex indices are unrelated.
RESULTS—In normal subjects, unconditioned reflex amplitude exhibited a positive skew requiring logarithmic transformation. Antagonist inhibition had a prolonged time course suggesting presynaptic mechanisms; subsequent measurements were standardised at 80 ms conditioning test interval (index termed "TI80").
 Measurements were obtained on all patients, even under therapeutic paralysis (objective (1)). The unconditioned reflex was absent in most patients with GCS less than 5; otherwise it varied little across the patient group. TI80 fell progressively with lower GCS, although patients' individual GCS could not be inferred from single measurements. Both reflex indices correlated with GCS (p<0.01), thereby dismissing the null hypothesis (objective (2)).

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

    PubMed Central

    Yattoo, GH; Tabish, Amin

    2008-01-01

    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 PMID:18570674

  17. Severe Traumatic Head Injury Affects Systemic Cytokine Expression

    PubMed Central

    LaPar, Damien J; Rosenberger, Laura H; Walters, Dustin M; Hedrick, Traci L; Swenson, Brian R; Young, Jeffrey S; Dossett, Lesly A; May, Addison K; Sawyer, Robert G

    2012-01-01

    Background The neuroimmunologic effect of traumatic head injury remains ill-defined. This study aimed to characterize systemic cytokine profiles among traumatically injured patients to assess the effect of traumatic head injury on the systemic inflammatory response. Study Design Over five years, 1,022 patients were evaluated from a multi-institutional trauma immunomodulatory database (TIMD). Patients were stratified by presence of severe head injury (SHI, Head ISS ≥ 4, n=335) versus non-severe head injury (NHI, Head ISS ≤ 3, n=687). Systemic cytokine expression was quantified by ELISA within 72 hours of admission. Patient factors, outcomes, and cytokine profiles were compared by univariate analyses. Results SHI patients were more severely injured with higher mortality despite similar ICU infection and ventilator associated pneumonia (VAP) rates. Expression of early pro-inflammatory cytokines, IL-6 (p<0.001) and tumor necrosis factor (TNF)-α (p=0.02), were higher among NHI patients, while expression of immunomodulatory cytokines, interferon-γ (p=0.01) and IL-12 (p=0.003), was higher in SHI patients. High TNF-α levels in NHI patients were associated with mortality (p=0.01), increased mechanical ventilation (p=0.02), and development of VAP (p=0.01). Alternatively, among SHI patients, high IL-2 levels were associated with survival, decreased mechanical ventilation, and absence of VAP. Conclusions The presence of severe traumatic head injury significantly alters systemic cytokine expression and exerts an immunomodulatory effect. Early recognition of these profiles may allow for targeted intervention to reduce patient morbidity and mortality. PMID:22342787

  18. An Experimental Device to Record Infant Head Movements.

    ERIC Educational Resources Information Center

    Jouen, Francois

    1981-01-01

    Analyzes methods used to record infant head position and the limits of these methods. An experimental device is proposed which records infant head turning and head righting when the vestibular system is stimulated. (Author/DB)

  19. Development of Head Injury Assessment Reference Values Based on NASA Injury Modeling

    NASA Technical Reports Server (NTRS)

    Somers, Jeffrey T.; Melvin, John W.; Tabiei, Ala; Lawrence, Charles; Ploutz-Snyder, Robert; Granderson, Bradley; Feiveson, Alan; Gernhardt, Michael; Patalak, John

    2011-01-01

    NASA is developing a new capsule-based, crewed vehicle that will land in the ocean, and the space agency desires to reduce the risk of injury from impact during these landings. Because landing impact occurs for each flight and the crew might need to perform egress tasks, current injury assessment reference values (IARV) were deemed insufficient. Because NASCAR occupant restraint systems are more effective than the systems used to determine the current IARVs and are similar to NASA s proposed restraint system, an analysis of NASCAR impacts was performed to develop new IARVs that may be more relevant to NASA s context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by completing a detailed analysis of all of the 2002-2008 NASCAR impact data. Specific inclusion and exclusion criteria were used to select 4071 impacts from the 4015 recorder files provided (each file could contain multiple impact events). Of the 4071 accepted impacts, 274 were selected for numerical simulation using a custom NASCAR restraint system and Humanetics Hybrid-III 50th percentile numerical dummy model in LS-DYNA. Injury had occurred in 32 of the 274 selected impacts, and 27 of those injuries involved the head. A majority of the head injuries were mild concussions with or without brief loss of consciousness. The 242 non-injury impacts were randomly selected and representative of the range of crash dynamics present in the total set of 4071 impacts. Head dynamics data (head translational acceleration, translational change in velocity, rotational acceleration, rotational velocity, HIC-15, HIC-36, and the Head 3ms clip) were filtered according to SAE J211 specifications and then transformed to a log scale. The probability of head injury was estimated using a separate logistic regression analysis for each log-transformed predictor candidate. Using the log transformation constrains the estimated probability of injury to become negligible as IARVs approach

  20. The potential and limitations of utilising head impact injury models to assess the likelihood of significant head injury in infants after a fall.

    PubMed

    Cory, C Z; Jones, M D; James, D S; Leadbeatter, S; Nokes, L D

    2001-12-01

    The use of engineering principles in assessing head injury scenarios is of increasing significance in investigations into suspected child abuse. A fall scenario is often given as the history for a head injury to an infant. This paper addresses the basic engineering principles and factors to be considered when calculating the severity of a head impact after free-fall. The application of head injury models (HIMs) to ascertain the forces involved in childhood head injuries from impact is also discussed. Previous studies including Duhaime et al. [J. Neurosurg. 66 (1987) 409] and Nokes et al. [Forensic Sci. Int. 79 (1995) 85] have utilised HIMs for this purpose: this paper reviews those models most widely documented.The HIM currently considered the 'state-of-the-art' is the head injury criterion (HIC) and it is suggested that this model should be utilised for assessing head impact injury in child abuse cases where appropriate. PMID:11728733

  1. Social Cognition after Head Injury: Sarcasm and Theory of Mind

    ERIC Educational Resources Information Center

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

    2005-01-01

    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…

  2. [Reflection around the return home of a head injury patient].

    PubMed

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

    2016-05-01

    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. PMID:27155279

  3. Discourse Formulation in Children with Closed Head Injury

    ERIC Educational Resources Information Center

    Hay, Emma; Moran, Catherine

    2005-01-01

    In this study, narrative and expository discourse-retelling abilities were compared in 9 children with closed head injury (CHI) age 9;5-15;3 (years;months) and 9 typically developing age-matched peers. Narrative and expository retellings were analyzed according to language variables (i.e., number of words, number of T-units, and sentential…

  4. Development of a computational biomechanical infant model for the investigation of infant head injury by shaking.

    PubMed

    Jones, Michael David; Martin, Philip S; Williams, Jonathan M; Kemp, Alison M; Theobald, Peter

    2015-10-01

    The inertial loading thresholds for infant head injury are of profound medico-legal and safety-engineering significance. Injurious experimentation with infants is impossible, and physical and computational biomechanical modelling has been frustrated by a paucity of paediatric biomechanical data. This study describes the development of a computational infant model (MD Adams®) by combining radiological, kinematic, mechanical modelling and literature-based data. Previous studies have suggested the neck as critical in determining inertial head loading. The biomechanical effects of varying neck stiffness parameters during simulated shakes were investigated, measuring peak translational and rotational accelerations and rotational velocities at the vertex. A neck quasi-static stiffness of 0.6 Nm/deg and lowest rate-dependent stiffness predisposed the model infant head to the highest accelerations. Plotted against scaled infant injury tolerance curves, simulations produced head accelerations commensurate with those produced during simulated physical model shaking reported in the literature. The model provides a computational platform for the exploitation of improvements in head biofidelity for investigating a wider range of injurious scenarios. PMID:25550310

  5. Traumatic Intracranial Aneurysm Formation following Closed Head Injury

    PubMed Central

    Miley, Jefferson T; Rodriguez, Gustavo J; Qureshi, Adnan I

    2008-01-01

    Background: Traumatic intracranial aneurysms are rare conditions that can be a result of non-penetrating head trauma. We report the occurrence of intracranial aneurysms in patients with traumatic brain injury. Methods: All diagnostic cerebral angiograms performed in patients with traumatic brain injury at a level I trauma center from January 2006 to July 2007 were reviewed. Results: Diagnostic cerebral angiography was performed in 74 patients with the diagnosis of closed head injury. A total of 4 traumatic intracranial pseudoaneurysms were found in 4 patients, two in the supraclinoid segment of the internal carotid artery, one in the cavernous segment of the internal carotid artery and one in the paraophthalmic segment of the internal carotid artery. Two patients were treated with coil embolization. One patient had follow up imaging on which there was no change in the size and morphology of the aneurysm. Conclusion: Intracranial aneurysms can develop in patients with closed head injury presumably related to shear or rotational injury. It is unclear whether these aneurysms should be classified as traumatic intracranial aneurysms or pseudoaneurysms, but the pathological findings frequently reveal disruption of the three vascular layers fulfilling the definition of pseudoaneurysm. For these reason we favor the name of post-traumatic intracranial pseudoaneurysms. PMID:22518228

  6. Accidental low velocity atypical missile injury to the head.

    PubMed

    Chattopadhyay, Saurabh

    2008-12-01

    Missile injuries on the head are mostly due to firearms. Atypical missiles may be encountered in case of shrapnel of bomb explosions but rarely because of stones. The present case is a rare case where a stone propelled by the pressure from the rear wheel of a speeding truck on the highway, struck the head of a 7-year-old girl resulting in fatality. Reconstruction of the incident on the basis of history and postmortem findings throws some light on the mechanism. The case is unique as it is the first reported case of an accidental missile injury to the head resulting in fatality without any direct human involvement for propulsion of the projectile. PMID:19259020

  7. Computed tomography in the prediction of outcome in head injury

    SciTech Connect

    Lipper, M.H.; Kishore, P.R.S.; Enas, G.G.; Domingues da Silva, A.A.; Choi, S.C.; Becker, D.P.

    1985-03-01

    To determine the prognostic significance of computed tomographic (CT) findings in head injury, retrospective analysis was performed in 128 randomly selected severe head-injury patients managed with a standardized protocol. The minimal criterion for entry into this study was that the patients were unable to obey simple commands or utter formed words. Serial CT was performed on admission and 3-5 days, 2 weeks, 3 months, and 1 year after injury. A scale of severity of abnormalities was devised taking into account the size of the traumatic lesions on CT. The CT findings using the proposed scale were correlated with the clincial outcome and analyzed using linear logistic regression. The correct prediction rate of outcome using the proposed scale for CT findings alone was found to be 69.7%. When CT findings were combined with the Glasgow Coma Scale score this rate was increased to 75.8%.

  8. BIOMECHANICS OF HEAD INJURY IN OLYMPIC TAEKWONDO AND BOXING

    PubMed Central

    Fife, G.P.; Pieter, W.

    2013-01-01

    Objective The purpose was to examine differences between taekwondo kicks and boxing punches in resultant linear head acceleration (RLA), head injury criterion (HIC15), peak head velocity, and peak foot and fist velocities. Data from two existing publications on boxing punches and taekwondo kicks were compared. Methods For taekwondo head impacts a Hybrid II Crash Dummy (Hybrid II) head was instrumented with a tri-axial accelerometer mounted inside the Hybrid II head. The Hybrid II was fixed to a height-adjustable frame and fitted with a protective taekwondo helmet. For boxing testing, a Hybrid III Crash Dummy head was instrumented with an array of tri-axial accelerometers mounted at the head centre of gravity. Results Differences in RLA between the roundhouse kick (130.11±51.67 g) and hook punch (71.23±32.19 g, d = 1.39) and in HIC15 (clench axe kick: 162.63±104.10; uppercut: 24.10±12.54, d = 2.29) were observed. Conclusions Taekwondo kicks demonstrated significantly larger magnitudes than boxing punches for both RLA and HIC. PMID:24744497

  9. Epidemiology of children with head injury: a national overview

    PubMed Central

    Trefan, L; Houston, R; Pearson, G; Edwards, R; Hyde, P; Maconochie, I; Parslow, RC; Kemp, A

    2016-01-01

    Background The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury. Method Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided. Results Details of 5700 children, median age 4 years (range 0–14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0–14.9 years)). Conclusions The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed

  10. Family Coping Following Traumatic Head Injury: An Exploratory Analysis with Recommendations for Treatment.

    ERIC Educational Resources Information Center

    Brown, Bruce W.; McCormick, Tony

    1988-01-01

    Used intensive interviewing and observation of volunteer sample of six families of victims of head injuries over eight-month period. Results indicated similar experiences and coping responses occurring in families following head injury. Head-injury rehabilitation systems were found to be more client centered than family centered. (Author/NB)

  11. Impact of Head Injury on Families: An Introduction for Family Counselors.

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    1995-01-01

    Coping with the impact of a family member's head injury is one of the most difficult tasks that can confront a family. An overview of head injury etiology, sequelae, and impact on families is presented. Provides guidelines for counseling families of persons with head injuries and suggestions for research. (Author/JBJ)

  12. Bicycle helmets are highly effective at preventing head injury during head impact: head-form accelerations and injury criteria for helmeted and unhelmeted impacts.

    PubMed

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

    2014-09-01

    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

  13. Head and neck injuries in soccer. Impact of minor trauma.

    PubMed

    Tysvaer, A T

    1992-09-01

    Head injuries have been shown to account for between 4 and 22% of soccer injuries. Clinical and neuropsychological investigations of patients with minor head trauma have revealed organic brain damage. 69 active football (soccer) players and 37 former players of the Norwegian national team were included in a neurological and electroencephalographic (EEG) study to investigate the incidence of head injuries mainly caused by heading the ball. 3% of the active and 30% of the former players complained of permanent problems such as headache, dizziness, irritability, impaired memory and neck pain. 35% of the active and 32% of former players had from slightly abnormal to abnormal EEG compared with 13 and 11% of matched controls, respectively. There were fewer definitely abnormal EEG changes among typical 'headers' (10%) than among 'nonheaders' (27%). The former players were also subjected to cerebral computed tomography (CT), a neuropsychological examination and a radiological examination of the cervical spine. One-third of the players were found to have central cerebral atrophy and 81% to have from mild to severe (mostly mild to moderate) neuropsychological impairment. The radiological examination of the cervical spine revealed a significantly higher incidence and degree of degenerative changes than in a matched control group. PMID:1439395

  14. An unusual presentation of head injury: teeth in brain.

    PubMed

    Singh, Deepak; Gupta, Vishnu; Kataria, Rashim; Chopra, Sanjeev; Gupta, Pankaj; Bagaria, H

    2010-01-01

    Penetrating injuries other than gunshot wounds or low-velocity wounds to the head are extremely rare. We report the case of a 19 year old male who sustained a penetrating craniocerebral trauma following a road traffic accident. Noncontrast CT scan revealed three foreign bodies embedded in left frontal lobe, which on surgery turned out to be human teeth. Mechanism of injury seems to share characteristics of low velocity projectiles. The survey of management pattern of these injuries showed a general agreement about CT scan, antibiotics and anticonvulsants. The prompt management resulted in an excellent outcome. We discuss the management of this unusual case reviewing the current literature on craniocerebral injuries caused by similar objects. PMID:20066624

  15. Current Topics in Sports-related Head Injuries: A Review

    PubMed Central

    NAGAHIRO, Shinji; MIZOBUCHI, Yoshifumi

    2014-01-01

    We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), 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 in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries. PMID:25367588

  16. Head injuries in the female football player: incidence, mechanisms, risk factors and management

    PubMed Central

    Dvorak, Jiri; McCrory, Paul; Kirkendall, Donald T

    2007-01-01

    Although all injuries in sports are a concern for participants, head injuries are particularly troublesome because of the potential for long‐term cognitive deficits. To prevent any specific injury, it is important to understand the basic frequency and incidence of injury and then the mechanism of injury. Once these are established, prevention programmes can be tested to see if the rate of injury changes. A primary problem with head injuries is recognising that the injury has occurred. Many athletes are not aware of the seriousness of concussive injury, thus this type of injury is probably under‐reported. Once the diagnosis of a concussion is made, the next difficult decision is when to return a player to the game. These two management issues dominate the continuing development of understanding of concussive head injury. This paper explores the known gender differences between head injuries and highlights the areas that need to be considered in future research. PMID:17496069

  17. [Usefulness of biomarkers in the prognosis of severe head injuries].

    PubMed

    Gordillo-Escobar, E; Egea-Guerrero, J J; Rodríguez-Rodríguez, A; Murillo-Cabezas, F

    2016-03-01

    Severe head injuries have a great socioeconomic and public health impact. Despite progress in diagnosis and treatment, no sufficiently reliable predictive models have been established for developing clinical trials and promoting effective therapeutic strategies capable of improving the prognosis. In the last decades, several brain damage biomarkers have been studied as potential diagnostic and prognostic tools in traumatic brain injury. However, all of them have limitations that preclude their universalized application. The properties of the known biomarkers -both those traditionally shown to correlate with severity and prognosis, and those recently announced as promising options- should be analyzed. New studies are needed to define their properties, both isolatedly and in combined use. PMID:26823158

  18. Sigmoid sinus thrombosis after closed head injury in children.

    PubMed

    Taha, J M; Crone, K R; Berger, T S; Becket, W W; Prenger, E C

    1993-04-01

    In the literature, clinical descriptions of sigmoid sinus thrombosis occurring after closed head injury in children are rare. One to 5 days after trauma to the back of the head, five children (aged 1 to 7 yr) presented with gait ataxia, vomiting, and headache. Trauma was mild in four children. Computed tomography of all the children, performed within 5 days after the injury, showed focal hyperdensity in the region of the left sigmoid sinus. Four children had extra-axial hyperdense collections along the left transverse sinus, and three had skull fractures adjacent to the left sigmoid sinus. Magnetic resonance imaging (MRI) of all the children, performed 2 to 6 days after injury, showed left sigmoid-sinus thrombosis and decreased flow or thrombosis within the lateral third of the left transverse sinus. All the children had MRI scans 4 to 6 weeks after their diagnosis and were followed up for 1 to 12 months. In four children whose symptoms subsided completely within 2 to 10 weeks, MRI showed recanalization of the sigmoid sinus within 4 to 6 weeks after injury. In one child whose symptoms resolved after 6 months, sigmoid-sinus thrombosis persisted with the formation of collateral flow. We conclude that traumatic sigmoid-sinus thrombosis should be suspected when a child has persistent or delayed gait ataxia and vomiting after injury to the back of the head. Computed tomography characteristically demonstrated focal hyperdensity within the sigmoid sinus that we term the dense sigmoid-sinus sign. Because the sinus recanalized and the symptoms subsided in most children within 6 weeks, we conclude that prophylactic medical or surgical intervention is not indicated. PMID:8474644

  19. Wernicke-Korsakoff syndrome in head injury: a missed insult.

    PubMed

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

    2000-01-01

    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. PMID:11304069

  20. A Review of Sport-Related Head Injuries

    PubMed Central

    Nagahiro, Shinji

    2016-01-01

    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. PMID:27182494

  1. A Review of Sport-Related Head Injuries.

    PubMed

    Mizobuchi, Yoshifumi; Nagahiro, Shinji

    2016-04-01

    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. PMID:27182494

  2. Injury risk assessment of non-lethal projectile head impacts.

    PubMed

    Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre

    2014-01-01

    Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as "force wall approach" suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the "force wall approach" and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics. PMID:25400712

  3. Injury Risk Assessment of Non-Lethal Projectile Head Impacts

    PubMed Central

    Oukara, Amar; Nsiampa, Nestor; Robbe, Cyril; Papy, Alexandre

    2014-01-01

    Kinetic energy non-lethal projectiles are used to impart sufficient effect onto a person in order to deter uncivil or hazardous behavior with a low probability of permanent injury. Since their first use, real cases indicate that the injuries inflicted by such projectiles may be irreversible and sometimes lead to death, especially for the head impacts. Given the high velocities and the low masses involved in such impacts, the assessment approaches proposed in automotive crash tests and sports may not be appropriate. Therefore, there is a need of a specific approach to assess the lethality of these projectiles. In this framework, some recent research data referred in this article as “force wall approach” suggest the use of three lesional thresholds (unconsciousness, meningeal damages and bone damages) that depend on the intracranial pressure. Three corresponding critical impact forces are determined for a reference projectile. Based on the principle that equal rigid wall maximal impact forces will produce equal damage on the head, these limits can be determined for any other projectile. In order to validate the consistence of this innovative method, it is necessary to compare the results with other existing assessment methods. This paper proposes a comparison between the “force wall approach” and two different head models. The first one is a numerical model (Strasbourg University Finite Element Head Model-SUFEHM) from Strasbourg University; the second one is a mechanical surrogate (Ballistics Load Sensing Headform-BLSH) from Biokinetics. PMID:25400712

  4. [Severe apathy following head injury: improvement with Selegiline treatment].

    PubMed

    Moutaouakil, F; El Otmani, H; Fadel, H; Slassi, I

    2009-12-01

    Apathy is defined as reduced goal-directed behavior due to lack of motivation. Traumatic brain injury is a frequent cause. Drugs activating the dopaminergic system provide variable benefit. A 30-year-old patient was the victim of a severe head injury with frontal bruise at the age of 15. At the request of his family, he consulted for a 7-year history that included a lack of initiative and the inability to generate behavior spontaneously, contrasting with the ability to execute behaviors on command. He also presented indifference, major emotional disruption without sadness, pessimism, and other depressive signs. The examination found a severe apathetic syndrome confirmed by specific scales with a mild impairment of executive functions and without depressive syndrome. Encephalic MRI showed atrophy of the whole prefrontal cerebral cortex. The patient was treated with bromocriptine, which he did not tolerate, then with Selegiline at 15 mg per day, which dramatically improved his symptoms. Apathy occurs frequently after traumatic brain injury, in 23-71% of patients according to the authors. The pathophysiology of apathy has been described in anatomical terms as related to disruption of frontal-subcortical pathways. The biochemical hypothesis postulates a disruption in dopaminergic activity. The use of dopaminergic agents usually improves cases similar to our patient. Apathy is frequent following head injury, warranting a search for systematic causes. Since it increases dopaminergic activity, Selegiline is well worth trying in these patients. PMID:19084243

  5. Head and neck injuries in college football: an eight-year analysis.

    PubMed

    Albright, J P; McAuley, E; Martin, R K; Crowley, E T; Foster, D T

    1985-01-01

    The present study documented head and neck injuries in a study group of 342 college football players at a single institution for a period of 8 years. All freshmen players were screened for evidence of: (1) past history of head and neck injuries, and (2) abnormalities of the cervical spine on physical examination and x-ray film. By recording all head injuries and those neck injuries with time loss, incidence rates and patterns of injury incurred in college competition were determined. A total of 175 head and neck injuries were sustained by 100 players over the 8 year period. Those players with abnormal findings on screening examination were twice as likely to have a head or neck injury at some point in their college careers as those players with a normal screening examination. The greater the degree of abnormality on freshman screening examination, the more severe the neck injury in college was likely to be. Twenty-nine percent of all players in the study group sustained a head or neck injury during their college careers. The probability of a subsequent head or neck injury escalated sharply following a single incident. The overall incidence of injury was found to have been dramatically reduced over the 8 years. Influential factors such as legislative rule changes, medical status of recruits, and general coaching philosophies are discussed with regard to injury reduction and prevention of head and neck injuries in college football. PMID:4014528

  6. Penetrating head injury from a pedestal fan rotor blade in a child - an unusual case.

    PubMed

    Kumar, Arun; Singh, Hukum; Sharma, Karam Chand

    2006-01-01

    Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in casualty. A number of household articles have been described to cause penetrating injuries, apart from gunshot and pellet injuries. We describe, for the first time, an unusual case of penetrating injury due to the rotor blade of pedestal fan used very commonly in the Indian subcontinent. PMID:17047422

  7. Novel Model of Frontal Impact Closed Head Injury in the Rat

    PubMed Central

    Kilbourne, Michael; Kuehn, Reed; Tosun, Cigdem; Caridi, John; Keledjian, Kaspar; Bochicchio, Grant; Scalea, Thomas; Gerzanich, Volodymyr

    2009-01-01

    Abstract Frontal impact, closed head trauma is a frequent cause of traumatic brain injury (TBI) in motor vehicle and sports accidents. Diffuse axonal injury (DAI) is common in humans and experimental animals, and results from shearing forces that develop within the anisotropic brain. Because the specific anisotropic properties of the brain are axis-dependent, the anatomical site where force is applied as well as the resultant acceleration, be it linear, rotational, or some combination, are important determinants of the resulting pattern of brain injury. Available rodent models of closed head injury do not reproduce the frontal impact commonly encountered in humans. Here we describe a new rat model of closed head injury that is a modification of the impact-acceleration model of Marmarou. In our model (the Maryland model), the impact force is applied to the anterior part of the cranium and produces TBI by causing anterior-posterior plus sagittal rotational acceleration of the brain inside the intact cranium. Skull fractures, prolonged apnea, and mortality were absent. The animals exhibited petechial hemorrhages, DAI marked by a bead-like pattern of β-amyloid precursor protein (β-APP) in damaged axons, and widespread upregulation of β-APP in neurons, with regions affected including the orbitofrontal cortex (coup), corpus callosum, caudate, putamen, thalamus, cerebellum, and brainstem. Activated caspase-3 was prominent in hippocampal neurons and Purkinje cells at the grey-white matter junction of the cerebellum. Neurobehavioral dysfunction, manifesting as reduced spontaneous exploration, lasted more than 1 week. We conclude that the Maryland model produces diffuse injuries that may be relevant to human brain injury. PMID:19929375

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

    PubMed

    Li, Zhigang; Luo, Xiao; Zhang, Jinhuan

    2013-12-01

    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. PMID:24008251

  9. Collateral damage--penetrating head injury and orbital injury: a case report.

    PubMed

    Deyle, Simone; Exadaktylos, Aristomenis K; Kneubuehl, Beat P; Buck, Ursula; Thali, Michael J; Voisard, Matthias X

    2011-09-01

    We report a case of an accidental death or potential suicide by revolver with subsequent injury of another person. A 44-year-old man shot himself in the head while manipulating his .38 caliber special revolver in the kitchen in the presence of his wife, standing approximately 1.5 m next to him. After passing through the husband's head, the lead round-nose bullet entered the region underneath his wife's left eye. When the bullet left the man's head, it retained the energy to penetrate the soft tissue at this distance, including the skin and thin bone plates like the orbital wall. Owing to the low energy of the projectile, the entry wound was of atypical in shape and without loss of tissue. Only a small line--resembling a cut--was externally visible. The man died in the hospital from his injuries; his wife suffered visual loss of her left eye. PMID:21540723

  10. Overreporting of Closed-Head Injury Symptoms on the MMPI-2.

    ERIC Educational Resources Information Center

    Berry, David T. R.; And Others

    1995-01-01

    Minnesota Multiphasic Personality Inventory (MMPI-2) validity scales were compared for 20 nonclinical participants, 18 subjects asked to fake injury, 18 head injury patients not seeking compensation, and 30 compensation-seeking head injury patients. Results suggest that MMPI-2 overreporting scales are sensitive to complaint fabrication and…

  11. Thiamine deficiency in head injury: a missed insult?

    PubMed

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

    1997-01-01

    Practice regarding the use of thiamine in head-injured patients at risk of Wernicke-Korsakoff syndrome in Scottish neurosurgical units was surveyed by questionnaire and revealed no clear policy. A 2 year retrospective study of 218 admissions to one of these units of patients who had taken alcohol shortly before sustaining head injury is also described. The minority (20.6%) of the total had been given thiamine, with just over half (56.1%) of those categorized as alcoholic receiving this treatment. Additional carbohydrate loads, in the form of i.v. dextrose or parenteral nutrition, had been given to 44.5% of patients and only 28.9% of this group had also been given thiamine. The dose and duration of thiamine given was inadequate in most cases. It is suggested that failure to ensure that head injury patients at risk of Wernicke-Korsakoff syndrome receive appropriate thiamine prophylaxis represents a missed and treatable additional insult to the damaged brain. PMID:9269857

  12. [A guide to initial management of minor head injury].

    PubMed

    Shiomi, Naoto; Echigo, Tadashi

    2004-05-01

    We reviewed the records of 1,335 minor head injury patients with initial Glasgow Coma Scale (GCS) scores of 15 treated by our neurosurgery service between January 1998 and December 2000. Skull X-ray was performed in 945 patients (71%), and Computed tomography (CT) was performed in 590 patients (44%). Skull fracture was shown radiographically in 24 patients (2.5%), and abnormalities on the initial CT were seen in 29 patients (4.9%). The most frequent intracranial lesion on CT was acute epidural hematoma with skull fracture. Significantly more intracranial lesions were found in those with a fracture than in those without by chi2 analysis. Post-traumatic vomiting was significantly associated with radiographical abnormalities, but headache and nausea did not increase the risk of skull fracture and intracranial lesions on the CT. Patients required neurosurgical intervention in 4 cases, and all of those were acute epidural hematoma with skull fracture. In this study, the first thing we should do for asymptomatic minor head injury patients with a GCS score of 15 is to investigate the presence of a skull fracture by skull X-ray. Head trauma patients with a skull fracture and post-traumatic vomiting should undergo CT to facilitate detection of intracranial lesions, even when there are no abnormal neurological signs. PMID:15287484

  13. Office management of mild head injury in children and adolescents

    PubMed Central

    Garcia-Rodriguez, Juan Antonio; Thomas, Roger E.

    2014-01-01

    Abstract Objective To provide family physicians with updated, practical, evidence-based information about mild head injury (MHI) and concussion in the pediatric population. Sources of information MEDLINE (1950 to February 2013), the Cochrane Database of Systematic Reviews (2005 to 2013), the Cochrane Central Register of Controlled Trials (2005 to 2013), and DARE (2005 to 2013) were searched using terms relevant to concussion and head trauma. Guidelines, position statements, articles, and original research relevant to MHI were selected. Main message Trauma is the main cause of death in children older than 1 year of age, and within this group head trauma is the leading cause of disability and death. Nine percent of reported athletic injuries in high school students involve MHI. Family physicians need to take a focused history, perform physical and neurologic examinations, use standardized evaluation instruments (Glasgow Coma Scale; the Sport Concussion Assessment Tool, version 3; the child version of the Sport Concussion Assessment Tool; and the Balance Error Scoring System), instruct parents how to monitor their children, decide when caregivers are not an appropriately responsible resource, follow up with patients promptly, guide a safe return to play and to learning, and decide when neuropsychological testing for longer-term follow-up is required. Conclusion A thorough history, physical and neurologic assessment, the use of validated tools to provide an objective framework, and periodic follow-up are the basis of family physician management of pediatric MHI. PMID:24925941

  14. Bicycle accident-related head injuries in India

    PubMed Central

    Munivenkatappa, Ashok; Devi, Bhagavatula Indira; Gregor, Thomas Issac; Bhat, Dhananjay I.; Kumarsamy, Akhil Deepika; Shukla, Dhaval P.

    2013-01-01

    Objectives: To describe the epidemiology of head injuries sustained due to bicycle accidents in India. Materials and Methods: Data were retrospectively collected over a period of six months (15 May 2011 to 15 November 2011). Demography of patients, Glasgow coma scale (GCS), clinical and imaging findings, and mortality and outcome using Glasgow outcome scale (GOS), Rivermead post-concussion symptom questionnaire (RPCSQ) and Rivermead head injury follow-up questionnaire (RHFUQ), were analyzed. Outcome was assessed by telephonic interview. Results: There were 108 patients (100 males) with mean age of 27.7 years. Seventy-four (68.5%) were from rural areas. Accidents due to vehicular collision accounted for 60 (55.6%) cases. None wore a helmet. The admission GCS was 14-15 in 68.5% cases, 13-3 in 31.5%. The risk of moderate to severe injuries was increased among working laborers (OR = 5), and patients with loss of consciousness (OR = 4). Sixty-three (49%) patients had abnormal computed tomography (CT) findings; most common finding was skull fracture 25 (23.1%). Four patients needed surgery. The GOS assessment at three to six months revealed favorable outcome in 66 patients (61.1%) and death in 8 (7.4%). The common post-concussion symptoms were headache, fatigue, and poor concentration. Conclusion: The majority of hospitalized cyclists were from a rural background and of the lower income group. After three months the majority of patients had good recovery with few persistent concussion symptoms. PMID:24250156

  15. [ENT emergency treatment and alcohol related head and neck injuries].

    PubMed

    Teudt, I; Grundmann, T; Pueschel, K; Hogan, B; Leventli, B

    2013-08-01

    The spectrum of ENT-diseases can differ widely among emergency departments (ED) of different geographic regions. Especially in terms of head and neck trauma a higher number of injuries can be expected in large cities due to alcohol related violence.The ED of a large hospital situated in the center of Hamburg Germany was analysed for ENT-emergency treatments in 2011 retrospectively. Beside usual patient statistics, the study focused on alcohol related injuries with an ENT-surgeon involved. All data were compared to reports by other EDs in Germany and alcohol related costs were approximated for initiation of prevention programs in the future.2 339 ENT-patients were admitted to the ED. 19% of all patients used an ambulance whereas 80% reached the ED by private transportation. The majority of patients were between 21 and 30 years of age. For 143 of all trauma cases alcohol involvement was documented. Subanalysis revealed male dominance and a high use of ambulance transportation.The high number of traumata differs considerably from other ENT studies. One reason is the hospital's close proximity to all time party districts like "Reeperbahn" and the "Port of Hamburg". In those areas high amounts of alcohol ingestion takes place leading to more injuries at the head- and neck region. Theoretically financial resources would be plenty after the initiation of those programs as the severe costs for alcohol related medical treatment would decline. PMID:23568584

  16. High-velocity gunshot to the head presenting as initial minor head injury: things are not what they seem.

    PubMed

    Robles, Luis A

    2012-11-01

    Tangential gunshots to the head are a special type of injury in which the bullet or bullet fragments do not penetrate the inner table of the skull. Most of patients experiencing this kind of injuries usually have a benign clinical presentation. We describe the case of a 22-year-old soldier who had a tangential gunshot to the head caused by a high-velocity projectile. Initially, the patient was neurologically intact, progressing to profound coma in the next 2 hours. The characteristics of the wound and initial neurologic condition led to first contact physicians to treat this injury as a case of mild head trauma. This case shows us that gunshots to the head caused by high-velocity missiles must be treated aggressively like a severe head injury, even when the initial neurologic examination is normal. PMID:22386344

  17. Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California.

    PubMed

    Erhardt, Taryn; Rice, Thomas; Troszak, Lara; Zhu, Motao

    2016-01-01

    The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death. PMID:26496484

  18. Ischemic retinopathy and neovascular proliferation secondary to severe head injury.

    PubMed

    Coban-Karatas, Muge; Altan-Yaycioglu, Rana

    2014-01-01

    We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma. PMID:25143848

  19. [The German guideline "legal evaluation after closed head injury"].

    PubMed

    Wallesch, C W; Fries, W; Marx, P; du Mesnil de Rochemont, R; Roschmann, R; Schmidt, R; Schwerdtfeger, K; Tegenthoff, M; Widder, B

    2013-09-01

    In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected. PMID:23986459

  20. Injury predictors for traumatic axonal injury in a rodent head impact acceleration model.

    PubMed

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

    2011-11-01

    A modified Marmarou impact acceleration injury model was developed to study the kinematics of the rat head to quantify traumatic axonal injury (TAI) in the corpus callosum (CC) and brainstem pyramidal tract (Py), to determine injury predictors and to establish injury thresholds for severe TAI. Thirty-one anesthetized male Sprague-Dawley rats (392±13 grams) were impacted using a modified impact acceleration injury device from 2.25 m and 1.25 m heights. Beta-amyloid precursor protein (β-APP) immunocytochemistry was used to assess and quantify axonal changes in CC and Py. Over 600 injury maps in CC and Py were constructed in the 31 impacted rats. TAI distribution along the rostro-caudal direction in CC and Py was determined. Linear and angular responses of the rat head were monitored and measured in vivo with an attached accelerometer and angular rate sensor, and were correlated to TAI data. Logistic regression analysis suggested that the occurrence of severe TAI in CC was best predicted by average linear acceleration, followed by power and time to surface righting. The combination of average linear acceleration and time to surface righting showed an improved predictive result. In Py, severe TAI was best predicted by time to surface righting, followed by peak and average angular velocity. When both CC and Py were combined, power was the best predictor, and the combined average linear acceleration and average angular velocity was also found to have good injury predictive ability. Receiver operator characteristic curves were used to assess the predictive power of individual and paired injury predictors. TAI tolerance curves were also proposed in this study. PMID:22869303

  1. Behavior Disorders after Severe Head Injury: Their Nature and Causes and Strategies for Management.

    ERIC Educational Resources Information Center

    Eames, Peter

    1988-01-01

    The article discusses the multifactorial causation of behavior disorders after head injury, arguing that management strategies must be based on an understanding of their general nature and on specific knowledge of the individual's history and injury. (DB)

  2. Association of Interpersonal Violence With Self-Reported History of Head Injury

    PubMed Central

    Zimmerman, Marc A.

    2011-01-01

    OBJECTIVE: The purpose of this study was to examine differences in interpersonal violence among individuals who reported a head injury compared with those who did not report a head injury. METHODS: We used data from an 8-year longitudinal study of youth selected by their grade point average to study those at-risk for high school dropout in 4 public high schools in a Midwestern city (N = 850). Participants were followed up from mid-adolescence to the transition into young adulthood. One-way analyses of variance were used to test for differences in levels of interpersonal violence, and repeated measures multivariate analyses of variance were used to assess differences in levels of violence over time among participants based on reports of head injury. A series of multivariate regression analyses examined whether head injury was associated with subsequent violent behavior. RESULTS: Participants who had ever experienced a head injury before young adulthood reported more interpersonal violence in young adulthood than participants who had never had a head injury. In multivariate analyses, respondents who had a head injury in the past year reported more subsequent interpersonal violence than respondents who had not had a head injury. CONCLUSION: Our findings support other studies that link history of head injury to later interpersonal violence. PMID:21624875

  3. Head, Neck, Face, and Shoulder Injuries in Female and Male Rugby Players.

    ERIC Educational Resources Information Center

    Havkins, Sabina B.

    1986-01-01

    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)

  4. Neuroprotective effects of tetracyclines on blunt head trauma: An experimental study on rats

    PubMed Central

    Uckun, Ozhan Merzuk; Alagoz, Fatih; Secer, Mehmet; Karakoyun, Oguz; Ocakcioglu, Ayhan; Yildirim, Ali Erdem; Yımaz, Fevzi; Sahinoglu, Mert; Divanlioglu, Denizhan; Dalgic, Ali; Daglioglu, Ergun; Belen, Ahmet Deniz

    2015-01-01

    Background: Prevention of primary damage caused by head trauma may be avoided with protective measures and techniques which is a public health concern. Experimental and clinical studies about treatment of head trauma were all centered to prevent secondary damage caused by physiopathological changes following primary injury. Neuroprotective features of tetracyclines were the focus of several experimental studies in the last decade. In the present study we aimed to investigate the neuroprotective effects of tetracycline in an experimental model of blunt brain injury in rats. Materials and Methods: 32 male Sprague-Dawley rats were divided into four experimental groups (n = 8). Head trauma was not performed in control group (group 1, craniectomy only). In the second group, head trauma and craniectomy were performed. Intraperitoneal saline was used in addition to trauma and craniectomy for treatment in group 3 whereas intraperitoneal tetracycline and saline were used for treatment in group 4. Results: When histological examinations performed by transmission electron microscopy were evaluated, injury at ultrastructural level was demonstrated to be less pronounced in tetracycline group with decreased lipid peroxidation levels. Conclusion: In accordance with these findings, we conclude that systemic tetracycline administration is effective in reduction of secondary brain damage and brain edema and thus it may be considered as a therapeutic option. PMID:25552848

  5. Traumatic Brain Injury by a Closed Head Injury Device Induces Cerebral Blood Flow Changes and Microhemorrhages

    PubMed Central

    Kallakuri, Srinivasu; Bandaru, Sharath; Zakaria, Nisrine; Shen, Yimin; Kou, Zhifeng; Zhang, Liying; Haacke, Ewart Mark; Cavanaugh, John M

    2015-01-01

    Objectives: Traumatic brain injury is a poly-pathology characterized by changes in the cerebral blood flow, inflammation, diffuse axonal, cellular, and vascular injuries. However, studies related to understanding the temporal changes in the cerebral blood flow following traumatic brain injury extending to sub-acute periods are limited. In addition, knowledge related to microhemorrhages, such as their detection, localization, and temporal progression, is important in the evaluation of traumatic brain injury. Materials and Methods: Cerebral blood flow changes and microhemorrhages in male Sprague Dawley rats at 4 h, 24 h, 3 days, and 7 days were assessed following a closed head injury induced by the Marmarou impact acceleration device (2 m height, 450 g brass weight). Cerebral blood flow was measured by arterial spin labeling. Microhemorrhages were assessed by susceptibility-weighted imaging and Prussian blue histology. Results: Traumatic brain injury rats showed reduced regional and global cerebral blood flow at 4 h and 7 days post-injury. Injured rats showed hemorrhagic lesions in the cortex, corpus callosum, hippocampus, and brainstem in susceptibility-weighted imaging. Injured rats also showed Prussian blue reaction products in both the white and gray matter regions up to 7 days after the injury. These lesions were observed in various areas of the cortex, corpus callosum, hippocampus, thalamus, and midbrain. Conclusions: These results suggest that changes in cerebral blood flow and hemorrhagic lesions can persist for sub-acute periods after the initial traumatic insult in an animal model. In addition, microhemorrhages otherwise not seen by susceptibility-weighted imaging are present in diverse regions of the brain. The combination of altered cerebral blood flow and microhemorrhages can potentially be a source of secondary injury changes following traumatic brain injury and may need to be taken into consideration in the long-term care of these cases. PMID:26605126

  6. The neurobehavioural rating scale: assessment of the behavioural sequelae of head injury by the clinician.

    PubMed Central

    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

    1987-01-01

    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

  7. The Relationship of Intimate Partner Aggression to Head Injury, Executive Functioning, and Intelligence

    ERIC Educational Resources Information Center

    Walling, Sherry M.; Meehan, Jeffrey C.; Marshall, Amy D.; Holtzworth-Munroe, Amy; Taft, Casey T.

    2012-01-01

    Measures of head injury, executive functioning, and intelligence were given to a community sample composed of 102 male perpetrators of intimate partner aggression (IPA) and 62 nonaggressive men. A history of head injury and lower mean score on a measure of verbal intelligence were associated with the frequency of male-perpetrated physical IPA as…

  8. Head Injury Secondary to Suspected Child Maltreatment: Results of a Prospective Canadian National Surveillance Program

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  9. Dimensions of Family Coping with Head Injury: A Replication and Extension.

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    1997-01-01

    Studied the dimensions that underlie family coping with head injury by replicating and extending an earlier study. Identified two dimensions: (1) using social support versus cognitive coping; and (2) head injury--focused coping versus family tension management. Results provide additional evidence regarding the structure of family coping across…

  10. Head injury predictors in sports trauma--a state-of-the-art review.

    PubMed

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

    2015-08-01

    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. PMID:26238791

  11. Recovery from mild head injury in pediatric populations.

    PubMed

    Thompson, Matthew D; Irby, James W

    2003-06-01

    This article provides an overview of the diagnosis, classification, and pathophysiology of mild head injury (MHI) in children. The difficulties associated with determination of MHI severity are outlined. Also, recently published research pertaining to pediatric MHI is reviewed. The recent research pertaining to MHI in children is generally consistent with the conclusions reached by the authors of the most recent comprehensive review, which reported that children who have suffered MHI often experience a symptomatic phase that could extend up to a few months, but these symptoms usually resolve. Numerous preinjury variables have been identified, including premorbid learning and behavior problems, disadvantaged socioeconomic status, premorbid neurodevelopmental abnormalities, and adverse family conditions, that appear to explain the persistence of some symptoms experienced by a subset of children with MHI. Directions for future research are provided. PMID:14572149

  12. Paediatric head injuries treated in a children's emergency department from Cluj-Napoca, Romania.

    PubMed

    Rus, Diana; Chereches, Razvan Mircea; Peek-Asa, Corinne; Marton-Vasarhely, Emanuela Oana; Oprescu, Florin; Brinzaniuc, Alexandra; Mocean, Floarea

    2016-06-01

    The aim of the study was to describe paediatric head injuries and identify factors that led to advanced care. Incident cases of head injuries that sought care from December 2008 to October 2010 at Children's Emergency Hospital Cluj-Napoca were evaluated. The main outcome was transfer or admission to advanced care. From a total of 3053 children treated for an injury, 1541 (50.4%) presented with head injury. A total of 960 (62.3%) of the children with a head injury required advanced care treatment. Young children were more likely to suffer a head injury than older children, but a higher proportion of older children required advanced care (70.3%). Children who suffered a head injury as a consequence of road traffic were almost five times more likely to require advanced care (OR: 4.97; 3.09-8.06) than being released. Our results suggest that data on injuries provide evidence-based information on the nature of injuries children are prone to, and what activity, type, and mechanism of injury impact Romanian children. PMID:24479864

  13. Reported head injury and sex differences in color naming, color matching, and digit-string matching.

    PubMed

    Majeres, R L; Demovic, A R; Preston, L A

    1992-04-01

    It was hypothesized that the observed sex differences on three speeded tasks could be accounted for in terms of the greater incidence of head injury in men than in women. In two studies of 64 male and 66 female college students significant sex differences were found on digit-string matching and color-matching tasks. When the data from those 39 subjects with reported histories of head injury were eliminated from the analysis or head-injury reports were statistically controlled, significant sex differences remained. Digit-string matching times were significantly correlated with reported head injury in both studies, suggesting that this test is sensitive to residual effects of head injury. PMID:1594412

  14. Development of a Human Head FE Model and Impact Simulation on the Focal Brain Injury

    NASA Astrophysics Data System (ADS)

    Watanabe, Dai; Yuge, Kohei; Nishimoto, Tetsuya; Murakami, Shigeyuki; Takao, Hiroyuki

    In this paper, a three-dimensional digital human-head model was developed and several dynamic analyses on the head trauma were conducted. This model was built up by the VOXEL approach using 433 slice CT images (512×512 pixels) and made of 1.22 million parallelepiped finite elements with 10 anatomical tissue properties such as scalp, CSF, skull, brain, dura mater and so on. The numerical analyses were conducted using a finite element code the authors have developed. The main features of the code are 1) it is based on the explicit time integration method and 2) it uses the one point integration method to evaluate the equivalent nodal forces with the hourglass control proposed by Flanagan and Belytschko(1) and 3) it utilizes the parallel computation system based on MPI. In order to verify the developed model, the head impact experiment for a cadaver by Nahum et al.(2) was simulated. The calculated results showed good agreement with the experimental ones. A front and rear impact analyses were also performed to discuss on the characteristic measure of the brain injury, in which the von-Mises stress was high in the frontal lobe in both of the analyses because of the large deformations of a frontal cranial base. This result suggests that the von-Mises stress can be a good measure of the brain injury since it is empirically well known that the frontal lobe tends to get injured regardless of the impact positions.

  15. Closed traumatic brain injury model in sheep mimicking high-velocity, closed head trauma in humans.

    PubMed

    Grimmelt, A-C; Eitzen, S; Balakhadze, I; Fischer, B; Wölfer, J; Schiffbauer, H; Gorji, A; Greiner, C

    2011-08-01

    To date, there are only a few, non-evidence based, cerebroprotective therapeutic strategies for treatment and, accordingly, for prevention of secondary brain injuries following severe closed head trauma. In order to develop new therapy strategies, existing realistic animal models need to be advanced. The objective is to bridge standardized small animal models and actual patient medical care, since the results of experimental small animal studies often cannot be transferred to brain-injured humans. For improved standardization of high-velocity trauma, new trauma devices for initiating closed traumatic brain injury in sheep were developed. The following new devices were tested: 1. An anatomically shaped rubber bolt with an integrated oscillation absorber for prevention of skull fractures; 2. Stationary mounting of the bolt to guarantee stable experimental conditions; 3. Varying degrees of trauma severity, i. e., mild and severe closed traumatic brain injury, using different cartridges; and 4. Trauma analysis via high-speed video recording. Peritraumatic measurements of intracranial pressure, brain tissue pH, brain tissue oxygen, and carbon dioxide pressure, as well as neurotransmitter concentrations were performed. Cerebral injuries were documented with magnetic resonance imaging and compared to neuropathological results. Due to the new trauma devices, skull fractures were prevented. The high-speed video recording documented a realistic trauma mechanism for a car accident. Enhancement of extracellular glutamate, aspartate, and gamma amino butyric acid concentrations began 60 min after the trauma. Magnetic resonance imaging and neuropathological results showed characteristic injury patterns of mild, and severe, closed traumatic brain injury. The severe, closed traumatic brain injury group showed diffuse axonal injuries, traumatic subarachnoid hemorrhage, and hemorrhagic contusions with inconsistent distribution among the animals. The model presented here achieves

  16. Arterial hyperoxia in severe head injury: a useful or harmful option?

    PubMed

    Alves, O L; Daugherty, W P; Rios, M

    2004-01-01

    There is mounting evidence both from experimental and clinical studies that traumatic brain injury (TBI) is associated with a reduction of aerobic metabolism. This results from a variable combination of impaired substrate delivery and mitochondrial failure. Mitochondria, which are responsible for the production of 95% of cell adenosine triphosphate (ATP), may become compromised after TBI. On the other hand, in the very early period after the primary injury, oxygen delivery may be impaired due to arterial hypoxia and/or to a reduction of cerebral blood flow (CBF). As a consequence, 80-90% of patients who die of head injury show ischemia on histo-pathological examination of the brain tissue. In the absence of an appropriate treatment for TBI, these observations favored the hypothesis that manipulation of brain oxygen delivery could be a therapeutic tool to improve aerobic metabolism. Several strategies were developed, including the increase of cerebral perfusion pressure (CPP) using amines or the increase of arterial partial pressure of oxygen (PaO(2)) through hyperbaric oxygen (HBO) or normobaric hyperoxia. Several experimental and clinical studies, using normobaric hyperoxia, demonstrated an increase in brain tissue oxygen tension and a reduction of brain extracellular lactate levels, but there is no consensus about the biological meaning of these findings. For some authors, they translate an improvement of brain oxidative metabolism, while for others they represent only biological epiphenomena. The current review addresses the rational behind normobaric hyperoxia as a therapeutic application and discusses the experimental and clinical results achieved so far. PMID:15281892

  17. Head Injury, Alpha-Synuclein Rep1 and Parkinson’s Disease

    PubMed Central

    Goldman, Samuel M; Kamel, Freya; Ross, G Webster; Jewell, Sarah A; Bhudhikanok, Grace S; Umbach, David; Marras, Connie; Hauser, Robert A; Jankovic, Joseph; Factor, Stewart A; Bressman, Susan; Lyons, Kelly E; Meng, Cheryl; Korell, Monica; Roucoux, Diana F; Hoppin, Jane A; Sandler, Dale P; Langston, J William; Tanner, Caroline M

    2011-01-01

    Objective To test the hypothesis that variability in SNCA Rep1, a polymorphic dinucleotide microsatellite in the promoter region of the gene encoding α-synuclein, modifies the association between head injury and Parkinson’s disease (PD) risk. Methods Participants in Farming and Movement Evaluation (FAME) and Study of Environmental Association and Risk of Parkinsonism using Case-Control Historical Interviews (SEARCH), two independent case-control studies, were genotyped for Rep1 and interviewed regarding head injuries with loss of consciousness or concussion prior to PD diagnosis. Logistic regression modeling adjusted for potential confounding variables and tested interaction between Rep1 genotype and head injury. Results Consistent with prior reports, relative to medium-length Rep1, short Rep1 genotype was associated with reduced PD risk (pooled odds ratio (OR) 0.7, 95% confidence interval (CI) 0.5-0.9), and long Rep1 with increased risk (pooled OR 1.4, 95%CI 0.95-2.2). Overall, head injury was not significantly associated with PD (pooled OR 1.3, 95%CI 0.9-1.8). However, head injury was strongly associated with PD in those with long Rep1 (FAME OR 5.4, 95%CI 1.5-19; SEARCH OR 2.3, 95%CI 0.6-9.2; pooled OR 3.5, 95%CI 1.4-9.2, p-interaction 0.02). Individuals with both head injury and long Rep1 were diagnosed 4.9 years earlier than those with neither risk factor (p = 0.03). Interpretation While head injury alone was not associated with PD risk, our data suggest head injury may initiate and/or accelerate neurodegeneration when levels of synuclein are high, as in those with Rep1 expansion. Given the high population frequency of head injury, independent verification of these results is essential. PMID:22275250

  18. A conceptual model of emergency physician decision making for head computed tomography in mild head injury.

    PubMed

    Probst, Marc A; Kanzaria, Hemal K; Schriger, David L

    2014-06-01

    The use of computed tomographic scanning in blunt head trauma has increased dramatically in recent years without an accompanying rise in the prevalence of injury or hospital admission for serious conditions. Because computed tomography is neither harmless nor inexpensive, researchers have attempted to optimize utilization, largely through research that describes which clinical variables predict intracranial injury, and use this information to develop clinical decision instruments. Although such techniques may be useful when the benefits and harms of each strategy (neuroimaging vs observation) are quantifiable and amenable to comparison, the exact magnitude of these benefits and harms remains unknown in this clinical scenario. We believe that most clinical decision instrument development efforts are misguided insofar as they ignore critical, nonclinical factors influencing the decision to image. In this article, we propose a conceptual model to illustrate how clinical and nonclinical factors influence emergency physicians making this decision. We posit that elements unrelated to standard clinical factors, such as personality of the physician, fear of litigation and of missed diagnoses, patient expectations, and compensation method, may have equal or greater impact on actual decision making than traditional clinical factors. We believe that 3 particular factors deserve special consideration for further research: fear of error/malpractice, financial incentives, and patient engagement. Acknowledgement and study of these factors will be essential if we are to understand how emergency physicians truly make these decisions and how test-ordering behavior can be modified. PMID:24560384

  19. Development of a Finite Element Head Model for the Study of Impact Head Injury

    PubMed Central

    Yang, Bin; Tse, Kwong-Ming; Chen, Ning; Tan, Long-Bin; Zheng, Qing-Qian; Yang, Hui-Min; Hu, Min; Pan, Gang; Lee, Heow-Pueh

    2014-01-01

    This study is aimed at developing a high quality, validated finite element (FE) human head model for traumatic brain injuries (TBI) prediction and prevention during vehicle collisions. The geometry of the FE model was based on computed tomography (CT) and magnetic resonance imaging (MRI) scans of a volunteer close to the anthropometry of a 50th percentile male. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The cerebrospinal fluid (CSF) was simulated explicitly as a hydrostatic fluid by using a surface-based fluid modeling method. The model was validated in the loading condition observed in frontal impact vehicle collision. These validations include the intracranial pressure (ICP), brain motion, impact force and intracranial acceleration response, maximum von Mises stress in the brain, and maximum principal stress in the skull. Overall results obtained in the validation indicated improved biofidelity relative to previous FE models, and the change in the maximum von Mises in the brain is mainly caused by the improvement of the CSF simulation. The model may be used for improving the current injury criteria of the brain and anthropometric test devices. PMID:25405201

  20. Mechanisms of blast induced brain injuries, experimental studies in rats.

    PubMed

    Risling, M; Plantman, S; Angeria, M; Rostami, E; Bellander, B-M; Kirkegaard, M; Arborelius, U; Davidsson, J

    2011-01-01

    Traumatic brain injuries (TBI) potentially induced by blast waves from detonations result in significant diagnostic problems. It may be assumed that several mechanisms contribute to the injury. This study is an attempt to characterize the presumed components of the blast induced TBI. Our experimental models include a blast tube in which an anesthetized rat can be exposed to controlled detonations of explosives that result in a pressure wave with a magnitude between 130 and 260 kPa. In this model, the animal is fixed with a metal net to avoid head acceleration forces. The second model is a controlled penetration of a 2mm thick needle. In the third model the animal is subjected to a high-speed sagittal rotation angular acceleration. Immunohistochemical labeling for amyloid precursor protein revealed signs of diffuse axonal injury (DAI) in the penetration and rotation models. Signs of punctuate inflammation were observed after focal and rotation injury. Exposure in the blast tube did not induce DAI or detectable cell death, but functional changes. Affymetrix Gene arrays showed changes in the expression in a large number of gene families including cell death, inflammation and neurotransmitters in the hippocampus after both acceleration and penetration injuries. Exposure to the primary blast wave induced limited shifts in gene expression in the hippocampus. The most interesting findings were a downregulation of genes involved in neurogenesis and synaptic transmission. These experiments indicate that rotational acceleration may be a critical factor for DAI and other acute changes after blast TBI. The further exploration of the mechanisms of blast TBI will have to include a search for long-term effects. PMID:20493951

  1. Protective Performance of Plate-Cell Rubber Tiles against Childhood Head Injury on Playground Surfaces — A Finite Element Analysis

    NASA Astrophysics Data System (ADS)

    Chang, Li-Tung; Huang, Tsai-Jeon

    Rubber tiles are commonly used in playgrounds as protective surfacing to reduce the incidence of head injuries in children caused by falling from equipment. This study developed a rubber tile model consisting of a surface layer of solid and a base layer of plate-cell and used it to investigate head injury protective performance. An explicit finite element method based on the experimental data was used to simulate head impact on the rubber tile. The peak acceleration and head injury criterion (HIC) were employed to assess the shock-absorbing capability of the tile. The results showed that compared to the peak acceleration, use of the HIC index provided a more conservative assessment of the shock absorption ability, and ultimately the protection against head injuries. This study supports the feasibility of using rubber tile with plate-cell construction to improve shock-absorbing capability. The plate-cell structure provided an excellent cushioning effect via a lower axial shear stiffness of the surface layer and lower transverse shearing stiffness of the core. The core's dimensions were an important parameter in determining the shearing stiffness. The analysis suggested that the cushioning effect would significantly reduce the peak force on the head from a fall and delay the occurrence of the peak value during impact, resulting in a marked reduction in the peak acceleration and HIC values of the head. Two plate-cell constructions with honeycomb and box-like cores were proposed and validated in this study. The better protective ability of the honeycomb core was attributed to its lower transverse shearing stiffness.

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

    SciTech Connect

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

    2000-02-11

    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.

  3. Low velocity penetrating head injury with impacted foreign bodies in situ

    PubMed Central

    Kataria, Rashim; Singh, Deepak; Chopra, Sanjeev; Sinha, V. D.

    2011-01-01

    Penetrating head injury is a potentially life-threatening condition. Penetrating head injuries with impacted object (weapon) are rare. The mechanism of low velocity injury is different from high velocity missile injury. Impacted object (weapon) in situ poses some technical difficulties in the investigation and management of the victims, and if the anticipated problems are not managed properly, they may give rise to serious consequences. The management practice of eight patients with impacted object in situ in context of earlier reported similar cases in literature is presented. PMID:22059103

  4. Human head-neck computational model for assessing blast injury.

    PubMed

    Roberts, J C; Harrigan, T P; Ward, E E; Taylor, T M; Annett, M S; Merkle, A C

    2012-11-15

    A human head finite element model (HHFEM) was developed to study the effects of a blast to the head. To study both the kinetic and kinematic effects of a blast wave, the HHFEM was attached to a finite element model of a Hybrid III ATD neck. A physical human head surrogate model (HSHM) was developed from solid model files of the HHFEM, which was then attached to a physical Hybrid III ATD neck and exposed to shock tube overpressures. This allowed direct comparison between the HSHM and HHFEM. To develop the temporal and spatial pressures on the HHFEM that would simulate loading to the HSHM, a computational fluid dynamics (CFD) model of the HHFEM in front of a shock tube was generated. CFD simulations were made using loads equivalent to those seen in experimental studies of the HSHM for shock tube driver pressures of 517, 690 and 862 kPa. Using the selected brain material properties, the peak intracranial pressures, temporal and spatial histories of relative brain-skull displacements and the peak relative brain-skull displacements in the brain of the HHFEM compared favorably with results from the HSHM. The HSHM sensors measured the rotations of local areas of the brain as well as displacements, and the rotations of the sensors in the sagittal plane of the HSHM were, in general, correctly predicted from the HHFEM. Peak intracranial pressures were between 70 and 120 kPa, while the peak relative brain-skull displacements were between 0.5 and 3.0mm. PMID:23010219

  5. Development of a finite element human head model partially validated with thirty five experimental cases.

    PubMed

    Mao, Haojie; Zhang, Liying; Jiang, Binhui; Genthikatti, Vinay V; Jin, Xin; Zhu, Feng; Makwana, Rahul; Gill, Amandeep; Jandir, Gurdeep; Singh, Amrinder; Yang, King H

    2013-11-01

    This study is aimed to develop a high quality, extensively validated finite element (FE) human head model for enhanced head injury prediction and prevention. The geometry of the model was based on computed tomography (CT) and magnetic resonance imaging scans of an adult male who has the average height and weight of an American. A feature-based multiblock technique was adopted to develop hexahedral brain meshes including the cerebrum, cerebellum, brainstem, corpus callosum, ventricles, and thalamus. Conventional meshing methods were used to create the bridging veins, cerebrospinal fluid, skull, facial bones, flesh, skin, and membranes-including falx, tentorium, pia, arachnoid, and dura. The head model has 270,552 elements in total. Thirty five loading cases were selected from a range of experimental head impacts to check the robustness of the model predictions based on responses including the brain pressure, relative skull-brain motion, skull response, and facial response. The brain pressure was validated against intracranial pressure data reported by Nahum et al. (1977, "Intracranial Pressure Dynamics During Head Impact," Proc. 21st Stapp Car Crash Conference, SAE Technical Paper No. 770922) and Trosseille et al. (1992, "Development of a F.E.M. of the Human Head According to a Specific Test Protocol," Proc. 36th Stapp Car Crash Conference, SAE Technical Paper No. 922527). The brain motion was validated against brain displacements under sagittal, coronal, and horizontal blunt impacts performed by Hardy et al. (2001, "Investigation of Head Injury Mechanisms Using Neutral Density Technology and High-Speed Biplanar X-Ray," Stapp Car Crash Journal, 45, pp. 337-368; and 2007, "A Study of the Response of the Human Cadaver Head to Impact," Stapp Car Crash Journal, 51, pp. 17-80). The facial bone responses were validated under nasal impact (Nyquist et al. 1986, "Facial Impact Tolerance and Response," Proc. 30th Stapp Car Crash Conference, SAE Technical Paper No. 861896

  6. Head and neck injuries from the Boston Marathon bombing at four hospitals.

    PubMed

    Singh, Ajay K; Buch, Karen; Sung, Edward; Abujudeh, Hani; Sakai, Osamu; Aaron, Sodickson; Lev, Michael

    2015-10-01

    The aim of this study was to evaluate the imaging findings of head and neck injuries in patients from the Boston Marathon bombing. A total of 115 patients from the Boston Marathon bombing presenting to four hospitals who underwent imaging to evaluate for head and neck injuries were included in the study. Twelve patients with positive findings on radiography or cross-sectional imaging were included in the final analysis. The radiographic, computed tomography (CT), and magnetic resonance (MR) imaging features of these patients were evaluated for the presence of shrapnel and morphological abnormality. Head and neck injuries were seen in 12 out of 115 patients presenting to the four hospitals. There were secondary blast injuries to the head and neck in eight patients, indicated by the presence of shrapnel on imaging. In the four patients without shrapnel, there were two with subgaleal hematomas, one with facial contusion and one with mastoid injury. There were two patients with subarachnoid hemorrhage, one with brain contusion, one with cerebral laceration, and one with globe rupture. There was frontal bone, nasal bone, and orbital wall fracture in one patient each. Imaging identified 26 shrapnel fragments, 21 of which were ball bearings. Injuries to the head and neck region identified on imaging from the Boston Marathon bombing were not common. The injuries seen were predominantly secondary blast injuries from shrapnel, and did not result in calvarial penetration of the shrapnel fragments. PMID:25962489

  7. Comparison of risk factors for cervical spine, head, serious, and fatal injury in rollover crashes.

    PubMed

    Funk, James R; Cormier, Joseph M; Manoogian, Sarah J

    2012-03-01

    Previous epidemiological studies of rollover crashes have focused primarily on serious and fatal injuries in general, while rollover crash testing has focused almost exclusively on cervical spine injury. The purpose of this study was to examine and compare the risk factors for cervical spine, head, serious, and fatal injury in real world rollover crashes. Rollover crashes from 1995-2008 in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) were investigated. A large data set of 6015 raw cases (2.5 million weighted) was generated. Nonparametric univariate analyses, univariate logistic regression, and multivariate logistic regression were conducted. Complete or partial ejection, a lack of seatbelt use, a greater number of roof inversions, and older occupant age significantly increased the risk of all types of injuries studied (p<0.05). Far side seating position increased the risk of fatal, head, and cervical spine injury (p<0.05), but not serious injury in general. Higher BMI was associated with an increased risk of fatal, serious, and cervical spine injury (p<0.05), but not head injury. Greater roof crush was associated with a higher rate of fatal and cervical spine injury (p<0.05). Vehicle type, occupant height, and occupant gender had inconsistent and generally non-significant effects on injury. This study demonstrates both common and unique risk factors for different types of injuries in rollover crashes. PMID:22269486

  8. Experimental study of cadaver head transmittance

    NASA Astrophysics Data System (ADS)

    Lychagov, Vladislav V.; Tuchin, Valery V.; Vilensky, Maxim A.; Savchenko, Eugeny P.; Efimov, Alexander A.; Lakodina, Nina A.; De Taboada, Luis; Reznik, Boris N.

    2005-06-01

    The results of measurements of transmittance of high power laser irradiation through skull bones and scalp are presented. Dependences of transmittance on sample thickness were received. Character of transmittance was investigated and characteristics of heterogeneity of the scattering structure of the skull bones are proposed. Besides that, variation of temperature of skull and scalp surfaces under exposure of high power laser irradiation during experiments was controlled. Experimental results were verified by Monte-Carlo simulations.

  9. Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team

    PubMed Central

    John, Simon; Vincent, Andrea L; Reed, Peter

    2015-01-01

    Aim To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. Methods Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010. Results Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). Conclusions The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death. PMID:26130384

  10. Removing Part of Skull After Severe Head Injury Brings Mixed Results

    MedlinePlus

    ... gov/news/fullstory_160857.html Removing Part of Skull After Severe Head Injury Brings Mixed Results More ... 8, 2016 (HealthDay News) -- Removing part of the skull to relieve pressure in the brain following a ...

  11. Assessing the Prevalence of Traumatic Head Injury amongst Recreational Surfers in the United States

    PubMed Central

    2015-01-01

    Surfing is a popular recreational sport that carries a substantial risk of injury. Although head injuries are frequently documented in the surfing population, an in depth assessment of the prevalence of surfing-related head injury has not been reported. A web-based survey was conducted in May of 2015. Participants were asked a series of questions regarding surfing-related injuries and demographic characteristics. A total of 50 responses were obtained, of which 35 (70%) reported sustaining a head injury. The most common injury was laceration of the head/face (n=27), followed by concussion (n=13). Other injuries, such as skull fracture and broken nose, were also reported. Only 2 of the 50 participants reported wearing a protective helmet. Neurosurgical intervention was required in 2 instances. Increased emphasis on preventative measures by the medical community may reduce the future incidence of such injuries. Medical professionals should be aware of the most common forms of injury sustained by the surfing population in order to better recognize and treat these conditions. PMID:26668771

  12. A head impact model of early axonal injury in the sheep.

    PubMed

    Lewis, S B; Finnie, J W; Blumbergs, P C; Scott, G; Manavis, J; Brown, C; Reilly, P L; Jones, N R; McLean, A J

    1996-09-01

    Axonal injury (AI), one of the principal determinants of clinical outcome after head injury, may evolve over several hours after injury, raising the future possibility of therapeutic intervention during this period. A new head impact model of AI in sheep was developed to examine pathological and physiological changes in the brain resulting from a graded traumatic insult. In this preliminary study 10 anesthetized and ventilated Merino ewes were used. Head injury was produced by impact from a humane stunner to the temporal region of an unrestrained head. Eight sheep were studied for 1, 2, 4, or 6 h after impact. Two sham animals (no impact, 6 h survival) were also examined. Arterial blood pressure, intracranial pressure, and cerebral blood flow were monitored continuously. A physiological index of injury severity was calculated by weighting the percentage shift from preinjury values for each monitored parameter over the first hour after injury. Immunostaining with amyloid precursor protein (APP) was used as a marker of axonal damage and the distribution of APP positive axons was recorded according to a sector scoring method (APPS). Widespread AI was identified in 7 of the 8 impacted animals, around cerebral contusions and in hemispheric white matter, central gray matter, brain stem, and cerebellum, and was detected as early as 1 h after injury. The degree of axonal injury (APPS) correlated well with an index of physiological response to injury (r = 0.83, p = 0.005). PMID:8913967

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

    PubMed Central

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

    2016-01-01

    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. PMID:27213068

  14. A semi-automatic method of generating subject-specific pediatric head finite element models for impact dynamic responses to head injury.

    PubMed

    Li, Zhigang; Han, Xiaoqiang; Ge, Hao; Ma, Chunsheng

    2016-07-01

    To account for the effects of head realistic morphological feature variation on the impact dynamic responses to head injury, it is necessary to develop multiple subject-specific pediatric head finite element (FE) models based on computed tomography (CT) or magnetic resonance imaging (MRI) scans. However, traditional manual model development is very time-consuming. In this study, a new automatic method was developed to extract anatomical points from pediatric head CT scans to represent pediatric head morphological features (head size/shape, skull thickness, and suture/fontanel width). Subsequently, a geometry-adaptive mesh morphing method based on radial basis function was developed that can automatically morph a baseline pediatric head FE model into target FE models with geometries corresponding to the extracted head morphological features. In the end, five subject-specific head FE models of approximately 6-month-old (6MO) were automatically generated using the developed method. These validated models were employed to investigate differences in the head dynamic responses among subjects with different head morphologies. The results show that variations in head morphological features have a relatively large effect on pediatric head dynamic response. The results of this study indicate that pediatric head morphological variation had better be taken into account when reconstructing pediatric head injury due to traffic/fall accidents or child abuses using computational models as well as predicting head injury risk for children with obvious difference in head size and morphologies. PMID:27058003

  15. Clinical clues for head injuries amongst Malaysian infants: accidental or non-accidental?

    PubMed

    Thalayasingam, M; Veerakumarasivam, A; Kulanthayan, S; Khairuddin, F; Cheah, I G S

    2012-12-01

    Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not. PMID:22424957

  16. Fatal head injuries in children under the age of 5 years in Pretoria.

    PubMed

    du Toit-Prinsloo, Lorraine; Saayman, Gert

    2014-09-01

    The incidence of fatal injuries in children has been reported to be highest among children aged 1 to 4 years. Major causes of head injury include road traffic accidents, falls, and intentional or inflicted injury (such as nonaccidental injury syndrome). This study reviewed the profile of children (under 5 years of age) who had been admitted to a large urban medicolegal mortuary (in Pretoria, the capital city of South Africa), after having suffered fatal head injuries. This study was conducted over a 5-year period (from January 2004 through December 2008), and a total of 107 cases were identified for inclusion. These cases constituted nearly a fifth of admissions in this age group. The male-to-female ratio was 56%:44%, and the peak age of injury was less than 1 year. Most head injuries were sustained in road traffic accidents (70%) followed by falls (10%) and other types of blunt force injuries (9%). Only 1 case of nonaccidental injury syndrome (child abuse) was found. The great majority of deaths were deemed to have been accidental in nature (91%) with 6 (6%) homicides. Urgent review pertaining to the use of child restraint devices and the safety of pedestrians is required, and the institution of childhood injury registers could aid in reducing childhood fatalities in South Africa. PMID:25072811

  17. Characteristics of Syntactic Comprehension Deficits Following Closed Head Injury versus Left Cerebrovascular Accident.

    ERIC Educational Resources Information Center

    Butler-Hinz, Susan; And Others

    1990-01-01

    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.…

  18. Chronic Post-Traumatic Headache after Head Injury in Children and Adolescents

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

  19. Fatal pediatric head injuries: a 20-year review of cases through the Auckland coroner's office.

    PubMed

    John, Simon Mathew; Jones, Peter; Kelly, Patrick; Vincent, Andrea

    2013-09-01

    Inflicted pediatric head injury is a significant issue in New Zealand, fatal cases receiving extensive media attention. The primary aims of this article were to analyze injury patterns and reported mechanisms against both age and cause (accidental or inflicted). The secondary aims were to quantify these deaths and identify trends over time. We retrospectively reviewed pediatric deaths due to head injury in children younger than 15 years referred to the Coronial Service of Auckland, New Zealand, from January 1, 1991, to December 31, 2010. One hundred sixty-seven cases were identified. Overall incidence was stable over time; however, the rate of inflicted head injury increased significantly (from 0.1 to 0.4/100,000 per year). Evidence of impact was seen in 90% of cases. In children younger than 2 years, in the absence of motor vehicle or pedestrian trauma, subdural hemorrhage and diffuse axonal injury were both highly suggestive of inflicted injury. The absence of a history of trauma or a history of a fall less than 1 m was also highly suggestive of inflicted injury. Retinal hemorrhages in these fatal head injuries were severe in 77% of cases and moderate in the remainder. PMID:23949141

  20. The Implications of Head Injuries for Higher Education: Evidence from Psychology Students

    ERIC Educational Resources Information Center

    Richardson, John T. E.

    2005-01-01

    Roughly 20 per cent of all students in higher education have sustained clinically significant head injuries during childhood or adolescence. Although these injuries typically do not seem to lead to any long-term intellectual deficits, little is known about their possible impact upon the students' academic attainment. Nevertheless, many…

  1. [Fatal head injury caused by a crossbow arrow with unusually preserved posttraumatic volitional activity - case report].

    PubMed

    Řehulka, Hynek; Čechová, Eva; Mottlová, Jitka; Valenta, Martin; Mareška, Zdeněk

    2016-01-01

    The authors deal with a case of suicidal attempt resulting in a fatal head injury. A young man shot himself with a serially produced mechanical sports crossbow. The young man with a critical intracranial injury, a penetration, was nevertheless capable of basic locomotive activity, as well as of coherent communication with another people present at the scene. The critically injured patient was transported from the scene directly to medical centre where he subsequently underwent a neurologic surgery. On the eight day after the incident he died in the hospital as a result of sustained wounds. During the autopsy, a penetrating arrow-shot wound head injury was certified, occurring in the right and left temple area. Signs of a complex decompressive craniectomy were established too. The shooting channel was generally horizontally oriented, extending from the right to the left side, from behind in a 10 up to 15 degrees angle to the frontal plane, penetrating the brain from the right temple lobe and the frontal lobe, thereby pervading also frontal horns of lateral ventricles, and from the left afflicting the frontal lobe on the left side of the brain. In the course of the shooting channel, brain contusion occurred, accompanied by intraventricular haemorrhage. In addition, a heavy cerebral oedema, multiple secondary malacias, Durett haemorrhages and extensive thrombosis of cerebral sinuses were stated. In the course of police investigation, based mainly on the information given by the wounded man right after he had been found at the scene, it was revealed that another person might have been involved. The forensic autopsy, the investigation of the Police and the subsequent criminalist-ballistics expert investigation, supported by a series of experimental substitutive target shots, didnt, however, decidedly prove that any other culprit had been involved. PMID:27108656

  2. Three head injuries: the Biblical account of the deaths of Sisera, Abimelech and Goliath.

    PubMed

    Feinsod, M

    1997-12-01

    Three head injuries are described in the Bible: the death of Sisera at the hands of Jael, the skull fractures inflicted on Abimelech near the walls of Thebez, and the slaying of Goliath by David. The various attempts to understand the mechanisms of these head injuries are reviewed. We shall try to identify the site of the mortal blow on Sisera's head, to understand why Abimelech, still conscious, asked to die, and to clarify whether the Philistine giant from Gat was a rugged warrior or just an endocrinological cripple. PMID:11619867

  3. Inosine improves functional recovery after experimental traumatic brain injury.

    PubMed

    Dachir, Shlomit; Shabashov, Dalia; Trembovler, Victoria; Alexandrovich, Alexander G; Benowitz, Larry I; Shohami, Esther

    2014-03-25

    Despite years of research, no effective therapy is yet available for the treatment of traumatic brain injury (TBI). The most prevalent and debilitating features in survivors of TBI are cognitive deficits and motor dysfunction. A potential therapeutic method for improving the function of patients following TBI would be to restore, at least in part, plasticity to the CNS in a controlled way that would allow for the formation of compensatory circuits. Inosine, a naturally occurring purine nucleoside, has been shown to promote axon collateral growth in the corticospinal tract (CST) following stroke and focal TBI. In the present study, we investigated the effects of inosine on motor and cognitive deficits, CST sprouting, and expression of synaptic proteins in an experimental model of closed head injury (CHI). Treatment with inosine (100 mg/kg i.p. at 1, 24 and 48 h following CHI) improved outcome after TBI, significantly decreasing the neurological severity score (NSS, p<0.04 vs. saline), an aggregate measure of performance on several tasks. It improved non-spatial cognitive performance (object recognition, p<0.016 vs. saline) but had little effect on sensorimotor coordination (rotarod) and spatial cognitive functions (Y-maze). Inosine did not affect CST sprouting in the lumbar spinal cord but did restore levels of the growth-associated protein GAP-43 in the hippocampus, though not in the cerebral cortex. Our results suggest that inosine may improve functional outcome after TBI. PMID:24502983

  4. Children's head injuries in the Vietnamese refugee population in Hong Kong.

    PubMed

    Goh, K Y; Poon, W S

    1995-10-01

    All Vietnamese patients with head injuries from two of the largest refugee camps in Hong Kong are routinely referred to the Neurosurgical Unit of the Prince of Wales Hospital for management. In order to determine the epidemiology of head injuries in this population group, we have retrospectively reviewed all hospitalized cases over a 4 year period from January 1990 to December 1993. We have found a unique social situation in this population group, with an unusually high proportion of paediatric cases (2253 per 100,000 children aged 5 years or less), compared with other epidemiological studies. The most common mechanism of injury in between 57 and 75 per cent of cases was a fall from bed. Based on this information, appropriate preventive measures have been recommended and have successfully decreased the incidence of head injuries. This study demonstrates the value and effectiveness of epidemiological studies in identifying a previously unrecognized health risk in a specified population group. PMID:8550142

  5. Epidemiologic Impact of Rapid Industrialization on Head Injury Based on Traffic Accident Statistics in Korea

    PubMed Central

    Chung, You Nam; Park, Young Seok; Min, Kyung Soo; Lee, Mou Seop; Kim, Young Gyu

    2016-01-01

    Objective The aim of the present study is to estimate the incidence trend of head injury and the mortality based on traffic accident statistics and to investigate the impacts of rapid industrialization and economic growth on epidemiology of head injury in Korea over the period 1970–2012 including both pre-industrialized and post-industrialized stages. Methods We collected data of head injury estimated from traffic accident statistics and seven hospital based reports to see incidence trends between 1970 and 2012. We also investigated the population structure and Gross National Income (GNI) per capita of Korea over the same period. The age specific data were investigated from 1992 to 2012. Results The incidence of head injury gradually rose in the 1970s and the 1980s but stabilized until the 1990s with transient rise and then started to decline slowly in the 2000s. The mortality grew until 1991 but gradually declined ever since. However, the old age groups showed rather slight increase in both rates. The degree of decrease in the mortality has been more rapid than the incidence on head injury. Conclusion In Korea during the low income stage, rapid industrialization cause considerable increase in the mortality and the incidence of head injury. During the high income stage, the incidence of head injury gradually declined and the mortality dropped more rapidly than the incidence due to preventive measures and satisfactory medical care. Nevertheless, the old age groups revealed rather slight increase in both rates owing to the large population structure and the declining birth rate. PMID:26962421

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

    NASA Astrophysics Data System (ADS)

    Abookasis, David; Shochat, Ariel

    2016-03-01

    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. Head Injuries in School-Age Children Who Play Golf.

    PubMed

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

    2016-04-01

    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 severity of injury, and functional outcomes. Seventy percent of the children sustained a TBI from a fall. We also found that playing golf was associated with 40% of the TBIs, with three (30%) children being unrestrained passengers in a moving golf cart and another one (10%) was struck by a golf club. Injury awareness could have benefited or prevented most injuries, and school nurses are in the best position to provide preventative practice education. In golf-centric communities, prevention of golf-related injuries should include education within the schools. PMID:25899097

  8. Head Injuries in School-Age Children Who Play Golf

    PubMed Central

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

    2015-01-01

    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 severity of injury, and functional outcomes. Seventy percent of the children sustained a TBI from a fall. We also found that playing golf was associated with 40% of the TBIs, with three (30%) children being unrestrained passengers in a moving golf cart and another one (10%) was struck by a golf club. Injury awareness could have benefited or prevented most injuries, and school nurses are in the best position to provide preventative practice education. In golf-centric communities, prevention of golf-related injuries should include education within the schools. PMID:25899097

  9. [Acute head injuries in primary health care--internet survey conducted with general practitioners].

    PubMed

    Luoto, Teemu M; Artsola, Minna; Helminen, Mika; Liimatainen, Suvi; Kosunen, Elise; Ohman, Juha

    2013-01-01

    Patients with head injury constitute a large population treated in primary health care. It is essential to recognize patients with traumatic brain injury among this notable population to determine the need for more specific evaluation. General practitioners (n=331) in Pirkanmaa hospital district in Finland received an email link to answer the survey. The response rate was 54.1% (n=179). Mean survey score was 20.5 points (max. 25). Only acquaintance with the national traumatic brain injury practice guidelines was associated with greater survey scores. The general practitioners' level of knowledge in managing head injuries was good. Deficiencies were found in the questions dealt with post-traumatic amnesia and the definition of traumatic brain injury. PMID:23786110

  10. Source of head injury for pedestrians and pedal cyclists: Striking vehicle or road?

    PubMed

    Badea-Romero, Alexandro; Lenard, James

    2013-01-01

    The potential effectiveness of vehicle-based secondary safety systems for the protection of pedestrians and pedal cyclists is related to the proportion of cases where injury arises by contact with the road or ground rather than with the striking vehicle. A detailed case review of 205 accidents from the UK On-the-Spot study involving vulnerable road users with head injuries or impacts indicated that contact with the road was responsible in 110 cases. The vehicle however was associated with a majority of more serious casualties: 31 (vehicle) compared with 26 (road) at AIS 2+ head injury level and 20 (vehicle) compared with 13 (road) at AIS 3+ level. Further analysis using a multivariate classification model identified several factors that correlated with the source of injury, namely the type of interaction between the striking vehicle and vulnerable road user, the age of the vulnerable road user and the nature of injury. PMID:23046694

  11. Role of hyperbaric oxygen therapy in severe head injury in children

    PubMed Central

    Prakash, Advait; Parelkar, Sandesh V.; Oak, Sanjay N.; Gupta, Rahul K.; Sanghvi, Beejal V.; Bachani, Mitesh; Patil, Rajashekhar

    2012-01-01

    Aim: A brain injury results in a temporary or permanent impairment of cognitive, emotional, and/or physical function. Predicting the outcome of pediatric brain injury is difficult. 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 guide to the strengths and limitations of the use of hyperbaric oxygen therapy (HBOT) in treating pediatric patients with severe brain injury. Materials and Methods: We studied total 56 patients of head injury. Out of them 28 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 social 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. Conclusion: In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced the risk of complications. PMID:22837768

  12. Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports.

    PubMed

    Kawanishi, A; Nakayama, M; Kadota, K

    1999-03-01

    A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as "heading injury." Arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts. PMID:10344112

  13. “Studying Injured Minds” – The Vietnam Head Injury Study and 40 Years of Brain Injury Research

    PubMed Central

    Raymont, Vanessa; Salazar, Andres M.; Krueger, Frank; Grafman, Jordan

    2011-01-01

    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. PMID:21625624

  14. Head Injuries in School-Age Children Who Play Golf

    ERIC Educational Resources Information Center

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

    2016-01-01

    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.

    PubMed

    Levy, Naomi Kahana; Milgram, Noach

    2016-01-01

    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. PMID:25495376

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

    PubMed Central

    Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira; Juhl, Carsten Bogh; Mehlsen, Jesper; Petersen, Tue Hvass

    2016-01-01

    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. PMID:27168188

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

    PubMed

    Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira; Juhl, Carsten Bogh; Mehlsen, Jesper; Petersen, Tue Hvass

    2016-01-01

    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. PMID:27168188

  18. Experimental subarachnoid haemorrhage results in multifocal axonal injury.

    PubMed

    Kummer, Terrance T; Magnoni, Sandra; MacDonald, Christine L; Dikranian, Krikor; Milner, Eric; Sorrell, James; Conte, Valeria; Benetatos, Joey J; Zipfel, Gregory J; Brody, David L

    2015-09-01

    The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury-axonal injury-is also a functionally significant feature of subarachnoid haemorrhage, raising

  19. Biomechanical studies in an ovine model of non-accidental head injury.

    PubMed

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

    2014-08-22

    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. PMID:24974335

  20. Adding Insult to Injury: Nonconvulsive Seizures in Abusive Head Trauma.

    PubMed

    Greiner, Mary V; Greiner, Hansel M; Caré, Marguerite M; Owens, Deanna; Shapiro, Robert; Holland, Katherine

    2015-11-01

    The primary objectives of this study were to determine the prevalence of nonconvulsive seizures and nonconvulsive status epilepticus in patients with abusive head trauma who underwent electroencephalography (EEG) monitoring and to describe predictive factors for this population. Children with a diagnosis of abusive head trauma were studied retrospectively to determine the rate of EEG monitoring, the rate of nonconvulsive seizures and nonconvulsive status epilepticus, and the associated neuroimaging findings. Over 11 years, 73 of 199 (36.8%) children with abusive head trauma had electroencephalography monitoring performed. Of these, 20 (27.4%) had nonconvulsive seizures and 3 (4.1%) had nonconvulsive status epilepticus. The presence of subarachnoid hemorrhage and cortical T2 / fluid-attenuated inversion recovery signal abnormalities were both significantly associated with the presence of nonconvulsive seizures / nonconvulsive status epilepticus. Nonconvulsive seizures are relatively common in abusive head trauma and may go unrecognized. Specific neuroimaging characteristics increase the likelihood of nonconvulsive seizures on EEG. PMID:25900138

  1. Motorcycle helmet use and the risk of head, neck, and fatal injury: Revisiting the Hurt Study.

    PubMed

    Rice, Thomas M; Troszak, Lara; Ouellet, James V; Erhardt, Taryn; Smith, Gordon S; Tsai, Bor-Wen

    2016-06-01

    Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein's models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein's analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31-0.52) and fatal injury (RR 0.44, 95% CI 0.26-0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40-0.99), after controlling for multiple potential confounders. PMID:26998593

  2. Head injury in heroes of the Civil War and its lasting influence.

    PubMed

    Sabourin, Victor M; Holland, Ryan; Mau, Christine; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-07-01

    The Civil War era was an age-defining period in the history of the United States of America, the effects of which are still seen in the nation today. In this era, the issue of head injury pervaded society. From the president of the United States, Abraham Lincoln, to the officers and soldiers of the Union and Confederate armies, and to the population at large, head injury and its ramifications gripped the nation. This article focuses on 3 individuals: Major General John Sedgwick, First Lieutenant Alonzo Cushing, and Harriet Tubman, as examples of the impact that head injury had during this era. These 3 individuals were chosen for this article because of their lasting legacies, contributions to society, and interesting connections to one another. PMID:27364257

  3. Hyperventilation in head injury does it do more harm than good?

    PubMed

    Moore, C; Flood, C

    1993-12-01

    During the past decade the management of clients with severe head injuries has been influenced by the use of hyperventilation. Increased intracranial pressure (I.C.P.) is the major cause of death following head injury and outcome has been linked to the ability of the practitioner to control intracranial hypertension. Hyperventilation is one method that is frequently employed to control increases in I.C.P. There is no doubt that hyperventilation effectively reduces intracranial pressure, but controversy surrounds the influence that this procedure may inflict upon the cerebral hemodynamic reserve (C.H.R.). The literature indicates that in spite of normal cerebral perfusion pressure, associated with raised I.C.P., that C.H.R. may be compromised. This paper will examine the controversy that surrounds the use of hyperventilation in the client with severe head injury. PMID:8274395

  4. Neurotrauma in infants. Shaken impact syndrome (inflicted head injury).

    PubMed

    Wallis, W H; Goodman, G

    2000-12-01

    In summary, inflicted cerebral trauma is a devastating but ultimately preventable brain injury caused by unique physiologic mechanisms that result in a distinctive pattern of injury. Nurses in a variety of settings, from the clinic and emergency room to the pediatric intensive care unit, play a major role in the identification, documentation, diagnosis, treatment, and prevention of ICT. The nurse's unique training also promotes prevention education and nonjudgmental support of the family. PMID:11855252

  5. Experimental Injury Biomechanics of the Pediatric Neck

    NASA Astrophysics Data System (ADS)

    Nightingale, Roger W.; Luck, Jason F.

    Motor vehicle related crashes rank as the most common cause of spinal related injuries in the pediatric population (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Eleraky et al. 2000; Hamilton and Myles 1992a; Bonadio 1993; Babcock 1975). Pediatric spinal related trauma accounts for between 1 and 12 % of all spinal related injuries (Hamilton and Myles 1992a; Hadley et al. 1988; Aufdermaur 1974). Cervical spine trauma in children accounts for approximately 2 % of all cervical spinal injuries (Henrys et al. 1977). Approximately 1-2 % of all children admitted for traumatic injury are related to injuries to the cervical spine (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Orenstein et al. 1994; Rachesky et al. 1987). Overall, pediatric neck injury rates are significantly lower than adult rates; however, the neck injury rate in children between the ages of 11 and 15 years approaches the adult rate of 18.8 per 100,000 (McGrory et al 1993; Myers and Winkelstein 1995). For children less than 11 years of age, neck injuries are relatively rare (1.2 per 100,000), but have particularly devastating consequences (McGrory et al. 1993). The overall mortality rate amongst victims of pediatric spinal trauma is approximately 16-41 % but considerably higher for the youngest ages (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Eleraky et al. 2000; Givens et al. 1996; Orenstein et al. 1994; Hamilton and Myles 1992b).

  6. Predicting severe head injury after light motor vehicle crashes: implications for automatic crash notification systems.

    PubMed

    Talmor, Daniel; Thompson, Kimberly M; Legedza, Anna T R; Nirula, Ram

    2006-07-01

    Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system. A cross-sectional study with derivation and validation sets was performed. The cohort was drawn from drivers of vehicles involved in MVC obtained from the National Automotive Sampling System (NASS). Independent multivariable predictors of severe head injury were identified. The model was able to stratify drivers according to their risk of severe head injury indicating its validity. The areas under the receiver-operating characteristic (ROC) curves were 0.7928 in the derivation set and 0.7940 in the validation set. We have developed a prediction model for head injury in MVC. As the development of automatic crash notification systems improves, models such as this one will be necessary to permit triage of what would be an overwhelming increase in crash notifications to pre-hospital responders. PMID:16530717

  7. Toppled television sets and head injuries in the pediatric population: a framework for prevention.

    PubMed

    Cusimano, Michael D; Parker, Nadine

    2016-01-01

    Injuries to children caused by falling televisions have become more frequent during the last decade. These injuries can be severe and even fatal and are likely to become even more common in the future as TVs increase in size and become more affordable. To formulate guidelines for the prevention of these injuries, the authors systematically reviewed the literature on injuries related to toppling televisions. The authors searched MEDLINE, PubMed, Embase, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Google Scholar according to the Cochrane guidelines for all studies involving children 0-18 years of age who were injured by toppled TVs. Factors contributing to injury were categorized using Haddon's Matrix, and the public health approach was used as a framework for developing strategies to prevent these injuries. The vast majority (84%) of the injuries occurred in homes and more than three-fourths were unwitnessed by adult caregivers. The TVs were most commonly large and elevated off the ground. Dressers and other furniture not designed to support TVs were commonly involved in the TV-toppling incident. The case fatality rate varies widely, but almost all deaths reported (96%) were due to brain injuries. Toddlers between the ages of 1 and 3 years most frequently suffer injuries to the head and neck, and they are most likely to suffer severe injuries. Many of these injuries require brain imaging and neurosurgical intervention. Prevention of these injuries will require changes in TV design and legislation as well as increases in public education and awareness. Television-toppling injuries can be easily prevented; however, the rates of injury do not reflect a sufficient level of awareness, nor do they reflect an acceptable effort from an injury prevention perspective. PMID:26416669

  8. Experimental subarachnoid haemorrhage results in multifocal axonal injury

    PubMed Central

    Magnoni, Sandra; MacDonald, Christine L.; Dikranian, Krikor; Milner, Eric; Sorrell, James; Conte, Valeria; Benetatos, Joey J.; Zipfel, Gregory J.; Brody, David L.

    2015-01-01

    The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury—axonal injury—is also a functionally significant feature of subarachnoid haemorrhage

  9. Experimental spinal injuries with vertical impact.

    PubMed

    Yoganandan, N; Sances, A; Maiman, D J; Myklebust, J B; Pech, P; Larson, S J

    1986-11-01

    Fifteen fresh, intact, human male cadavers suspended head down were dropped vertically from a height of 0.9-1.5 meters. In eight specimens the heads were restrained to simulate muscle forces. The head-neck complex was oriented for maximal axial loading of the cervical and upper thoracic spine. In several cadavers, load cells were placed in cervical bodies. Head impact forces of 3,000-7,000 N in the unrestrained, and 9,800-14,600 N in the restrained, cadavers were recorded. There were more cervical and upper thoracic fractures in the restrained cadavers than in the nonrestrained subjects. The biomechanic and pathologic findings, including results of cryomicrotomography and computed tomography (CT), are discussed. PMID:3824059

  10. Paediatric head injuries in the Kwazulu-Natal Province of South Africa: a developing country perspective.

    PubMed

    Okyere-Dede, Ebenezer K; Nkalakata, Munyaradzi C; Nkomo, Tshepo; Hadley, G P; Madiba, Thandinkosi E

    2013-01-01

    We investigated the causes, management and outcome of head injuries in paediatric patients admitted to the paediatric surgery unit at King Edward VIII Hospital over a 3-year period, from 1999 to 2001. There were 506 patients (331 male; M:F ratio 2:1) and the mean age was 71.99 +36.8 months (2 weeks to 180 months). The injuries were due to: motor vehicle crashes (324); falls (121); assault (30); inadvertent injury (23); and unknown (11). Forty-nine patients (9%) were admitted with a Glasgow Coma Scale ≤8. The most common intracranial pathology on computed tomography was: intracranial haematoma/haemorrhage (44); contusion (16); and brain oedema (10). Nineteen patients (3.4%) underwent neurosurgical intervention and the rest were managed conservatively. Eighteen died in hospital (3.6%). The mean hospital stay was 5 ± 12 days. Twenty-three patients (4.5%) were discharged with neurological sequelae. Few paediatric patients are admitted with severe head injury: the majority from blunt injury caused by motor vehicle crashes. Management mainly requires simple neurological observation in a general ward with a surprisingly good prognosis. Specific protocols for paediatric head injuries have been proposed based on these findings. PMID:23550196

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

    PubMed

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

    2016-04-01

    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. PMID:27212925

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

    PubMed Central

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

    2016-01-01

    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. PMID:27212925

  13. Effects of methylprednisolone on experimental pulmonary injury.

    PubMed Central

    Cheney, F W; Huang, T H; Gronka, R

    1979-01-01

    We studied the effects of methylprednisolone on pulmonary function of unanesthetized dogs with oleic acid induced pulmonary edema observed over a four day period. Methylprednisolone (30 mg/kg) was administered to 11 dogs three and 24 hours after pulmonary injury. Eleven animals were untreated after pulmonary injury and served as controls. There was no difference between the two groups until 72 hours after injury, when the venous admixture of the steroid treated animals was 11 +/- 3% (SD) compared to 22 +/- 8% (p less than 0.001) in the untreated with respective PaO2 values of 76 +/- 6 torr and 64 +/- 8 torr (p less than 0.001). Light microscopic examination of the lungs 96 hours after injury revealed a marked proliferation of Type II pneumocytes in the methylprednisolone treated animals. We conclude that, in the oleic acid or fat embolism model of pulmonary injury, methylprednisolone significantly increases resolution of the pulmonary injury presumably by stimulation of active proliferation and maturation of Type II pneumocytes. Images Fig. 6. Fig. 7. PMID:464693

  14. Relations of blood pressure and head injury to regional cerebral blood flow.

    PubMed

    Kisser, Jason E; Allen, Allyssa J; Katzel, Leslie I; Wendell, Carrington R; Siegel, Eliot L; Lefkowitz, David; Waldstein, Shari R

    2016-06-15

    Hypertension confers increased risk for cognitive decline, dementia, and cerebrovascular disease. These associations have been attributed, in part, to cerebral hypoperfusion. Here we posit that relations of higher blood pressure to lower levels of cerebral perfusion may be potentiated by a prior head injury. Participants were 87 community-dwelling older adults - 69% men, 90% white, mean age=66.9years, 27.6% with a history of mild traumatic brain injury (mTBI) defined as a loss of consciousness ≤30min resulting from an injury to the head, and free of major medical (other than hypertension), neurological or psychiatric comorbidities. All engaged in clinical assessment of systolic and diastolic blood pressure (SBP, DBP) and single photon emission computed tomography (SPECT). Computerized coding of the SPECT images yielded relative ratios of blood flow in left and right cortical and select subcortical regions. Cerebellum served as the denominator. Sex-stratified multiple regression analyses, adjusted for age, education, race, alcohol consumption, smoking status, and depressive symptomatology, revealed significant interactions of blood pressure and head injury to cerebral blood flow in men only. Specifically, among men with a history of head injury, higher systolic blood pressure was associated with lower levels of perfusion in the left orbital (β=-3.21, p=0.024) and left dorsolateral (β=-2.61, p=0.042) prefrontal cortex, and left temporal cortex (β=-3.36, p=0.014); higher diastolic blood pressure was marginally associated with lower levels of perfusion in the left dorsolateral prefrontal cortex (β=-2.79, p=0.051). Results indicate that men with a history of head injury may be particularly vulnerable to the impact of higher blood pressure on cerebral perfusion in left anterior cortical regions, thus potentially enhancing risk for adverse brain and neurocognitive outcomes. PMID:27206865

  15. Head Injury and the Post-Trauma Vision Syndrome.

    ERIC Educational Resources Information Center

    Padula, William V.; Shapiro, Jannie B.

    1993-01-01

    This article considers the visual rehabilitation of patients recovering from traumatic brain injuries. Characteristics, symptoms, and associated neuromotor difficulties of posttrauma vision syndrome are listed, as are common posture and gait adaptations. A neuro-optometric rehabilitative and orientation/mobility evaluation is recommended, as is…

  16. The Use of Ophthalmic Ultrasonography to Identify Retinal Injuries Associated With Abusive Head Trauma.

    PubMed

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

    2016-05-01

    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. PMID:26481265

  17. Long term bicycle related head injury trends for New South Wales, Australia following mandatory helmet legislation.

    PubMed

    Olivier, Jake; Walter, Scott R; Grzebieta, Raphael H

    2013-01-01

    Since the 1991 enactment of mandatory helmet legislation (MHL) for cyclists in New South Wales (NSW), Australia, there has been extensive debate as to its effect on head injury rates at a population level. Many previous studies have focused on the impact of MHL around the time of enactment, while little has been done to examine the ongoing effects. We aimed to extend prior work by investigating long-term trends in cyclist head and arm injuries over the period 1991-2010. The counts of cyclists hospitalised with head or arm injuries were jointly modelled with log-linear regression. The simultaneous modelling of related injury mechanisms avoids the need for actual exposure data and accounts for the effects of changes in the cycling environment, cycling behaviour and general safety improvements. Models were run separately with population counts, bicycle imports, the average weekday counts of cyclists in Sydney CBD and cycling estimates from survey data as proxy exposures. Overall, arm injuries were higher than head injuries throughout the study period, consistent with previous post-MHL observations. The trends in the two injury groups also significantly diverged, such that the gap between rates increased with time. The results suggest that the initial observed benefit of MHL has been maintained over the ensuing decades. There is a notable additional safety benefit after 2006 that is associated with an increase in cycling infrastructure spending. This implies that the effect of MHL is ongoing and progress in cycling safety in NSW has and will continue to benefit from focusing on broader issues such as increasing cycling infrastructure. PMID:23026203

  18. Field Marshal Erwin Rommel: the head injury that may have prolonged the Second World War.

    PubMed

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

    2016-07-01

    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. PMID:27364261

  19. Depressed Skull Fractures: A Pattern of Abusive Head Injury in Three Older Children

    ERIC Educational Resources Information Center

    Lee, Anselm C. W.; Ou, Yvonne; Fong, Dawson

    2003-01-01

    Objective: To describe a pattern of abusive head injury in a series of children older than 4 years of age. Methods: A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described. Results: An 11-year-old girl and a pair…

  20. Epidemiology of Pediatric Closed Head Injury: Incidence, Clinical Characteristics, and Risk Factors.

    ERIC Educational Resources Information Center

    Goldstein, Felicia C.; Levin, Harvey S.

    1987-01-01

    The paper reviews the epidemiology of pediatric closed head injury. Incidence rates, etiologic/pathophysiologic correlates, and associated risk factors are discussed. Suggestions offered for future research concern relationships among age, etiology, and pathophysiology in outcome studies and premorbid measures of personality/intellectual…

  1. Symptomatic blunt head injury in children--a prospective, single-investigator study.

    PubMed

    Fisher, J D

    1997-08-01

    The goal of this study was to describe a single emergency physician's experience with symptomatic blunt head injury in children and prospectively assess the sensitivity and predictive value of the neurologic examination. The author utilized a prospective patient series comparing neurologic examination with computed tomography (CT) of the head. Nine of 42 patients had intracranial injury for a prevalence of 21%; two patients (5%) had intracranial injury with only subtle neurologic examination findings. Twenty-six patients had a negative neurologic examination, and all had normal-appearing CT scans. Sixteen patients had a positive neurologic examination, of whom nine had a positive CT scan. The properties of the neurologic examination as a diagnostic test, with CT as the gold standard, were as follows: sensitivity = 100%, specificity = 78%, positive predictive value = 56%, negative predictive value = 100%. Normal findings from neurologic examination can be used in some children with symptomatic blunt head injury to delay or eliminate the need for CT of the head. PMID:9272320

  2. Non-Accidental Head Injury in New Zealand: The Outcome of Referral to Statutory Authorities

    ERIC Educational Resources Information Center

    Kelly, Patrick; MacCormick, Judith; Strange, Rebecca

    2009-01-01

    Objectives: To describe the outcome of referral to the statutory authorities for infants under 2 years with non-accidental head injury (NAHI), and to establish whether the authorities held sufficient information to develop a risk profile for these cases. Methods: Retrospective review of cases admitted to hospital in Auckland, New Zealand from 1988…

  3. Hemiplegia Following Mild Head Injury in a Child with Sturge-Weber Syndrome - A Diagnostic Dilemma.

    PubMed

    Ahmed, Shameem; Paul, Siba Prosad

    2016-08-01

    Sturge-Weber syndrome (SWS) is a neurocutaneous disorder with skin, eye, and brain involvement. Hemiplegia in children with SWS after a mild head injury is known to occur in up to one-fifth of cases. A3-year male child presented with a sudden onset hemiplegia following a mild head injury. He was known to have seizure disorder and was being treated with sodium valproate. CTscan of the brain showed contusion. He was admitted for neurological observations and the patient made complete recovery with conservative treatment. MRI scan of the brain done 5 days later which showed venous malformation of choroid plexus on the left side. These changes were considered to be consistent with a preexisting cerebral lesion which coincidentally got detected at neuroimaging done after the mild head injury. There is need for good seizure control as it is likely to be associated with better neurological outcome. The case emphasizes the need for clinical correlation with findings at neuroimaging in children with SWS presenting with head injuries. PMID:27539768

  4. An Occupational Therapy Work Skills Assessment for Individuals with Head Injury.

    ERIC Educational Resources Information Center

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

    2003-01-01

    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)

  5. Referential Cohesion and Logical Coherence of Narration after Closed Head Injury

    ERIC Educational Resources Information Center

    Davis, G. Albyn; Coelho, Carl A.

    2004-01-01

    A group with closed head injury was compared to neurologically intact controls regarding the referential cohesion and logical coherence of narrative production. A sample of six stories was obtained with tasks of cartoon-elicited story-telling and auditory-oral retelling. We found deficits in the clinical group with respect to referential cohesion,…

  6. Playgrounds and Head Injuries: A Problem for the School Business Manager.

    ERIC Educational Resources Information Center

    Sweeney, Theodora Briggs

    1987-01-01

    A survey of hospital emergency rooms revealed that nearly half of all playground falls resulted in head injuries. Playground surfaces should be evaluated for "Surface Impact Performance" and the "Severity Index"--both measures to determine ability to absorb impact. Nine other playground hazards are illustrated and described. (MLF)

  7. Differential Pragmatic Language Loss after Closed Head Injury: Ability to Comprehend Conversational Implicature.

    ERIC Educational Resources Information Center

    McDonald, Skye

    1992-01-01

    Experiments compared two closed head injury (CHI) subjects with normal subject's ability to interpret indirect speech acts with the ability of uninjured individuals. The CHI individuals displayed difficulty in interpreting indirect speech or rejecting literal meanings. The results are discussed in terms of common cognitive deficits after closed…

  8. Measuring Executive Function Deficits Following Head Injury: An Application of SMS Simulation Technology

    ERIC Educational Resources Information Center

    Satish, Usha; Streufert, Siegfried; Eslinger, Paul J.

    2006-01-01

    Neuropsychological tests have limited sensitivity in identifying subtle residual cognitive impairments in patients with good medical recovery from head injury and post-concussive syndrome. Detecting and characterizing residual "real life" cognitive difficulties can be problematic for treatment purposes. This study investigated the usefulness of a…

  9. Self-reported head injuries before and after age 13 in pedophilic and nonpedophilic men referred for clinical assessment.

    PubMed

    Blanchard, Ray; Kuban, Michael E; Klassen, Philip; Dickey, Robert; Christensen, Bruce K; Cantor, James M; Blak, Thomas

    2003-12-01

    Previous research has found that pedophilic men referred for clinical assessment of their sexual behavior are more likely to report that they suffered head injuries before their 13th birthday than are nonpedophilic men referred for the same purpose. This study investigated whether pedophilic patients are also more likely to report head injuries after their 13th birthday. The 685 participants represented all patients with usable data from a consecutive series of men referred to a clinical laboratory specializing in phallometric assessment of erotic preferences. In addition to phallometric testing, participants were administered a brief neuropsychological test battery and a companion interview, which included questions on head injury, drug abuse, and childhood diagnosis of attention-deficit/hyperactivity disorder. The results showed that the pedophilic patients reported more head injuries before age 13 than did the nonpedophilic patients, but they did not report more head injuries after age 13. The association between pedophilia and childhood head injuries could mean either that subtle brain damage after birth increases a boy's risk of pedophilia, or that neurodevelopmental problems before birth increase a boy's accident-proneness along with his risk of pedophilia. Additional analyses showed that self-reported head injuries before age 13 were associated with attentional problems and with left-handedness; in contrast, head injuries after age 13 were associated with drug abuse and promiscuity. These analyses suggest that, among patients with primary presenting complaints of sexual rather than cognitive problems, childhood head injuries cluster with neuropsychological phenomena, whereas later head injuries cluster with lifestyle variables. PMID:14574100

  10. Neuropathological investigation of cerebral white matter lesions caused by closed head injury.

    PubMed

    Onaya, Mitsumoto

    2002-12-01

    In order to ascertain whether there is widespread axonal disruption of cerebral white matter in the so-called 'diffuse axonal injury' (DAI), a type of closed head injury, proposed by Adams et al. the author investigated his own cases clinicopathologically. Twenty-six male autopsied cases of head injury, aged between 19 and 84, 15 of which had sustained road traffic accidents, were examined; the others were due to falling from heights and so on. The study group all belonged to non-missile head injuries and included 12 cases of diffuse brain injury, as well as 14 cases of focal brain injury, according to the classification of Gennarelli et al. The survival time ranged from 2 h to 21 years. Formalin-fixed brains were cut coronally so as to make paraffin-embedded hemispheric sections. Then these sections were stained conventionally (HE, Bodian, Kluver-Barrera and Holzer) and immunohistochemically (GFAP) to assess axonal decrease, myelin pallor and gliosis by the use of light microscopy. In the 13 chronic cases that died more than 1 month after the accidents, the intensities of gliosis, myelin pallor and axonal decrease tended to correlate with each other. In the 13 acute cases who died less than 1 month after their accident, the degree of axonal decrease in white matter seemed to correlate with the severity of myelin pallor. Regardless of types of trauma, however, axonal retraction balls, the so-called hallmark of DAI, were found only with myelin pallor suggesting the presence of brain swelling after the injury. Therefore these findings indicate that it may be difficult to accept the notion of DAI, that is, the presence of axonal retraction balls without brain swelling. In addition, diffuse vascular injury (2 cases) as well as rarefaction of subcortical white matter (6 cases) were presented and their pathogenesis individually discussed based on a literature review. PMID:12564763

  11. Who Gets Head Trauma or Recruited in Mild Traumatic Brain Injury Research?

    PubMed

    Isokuortti, Harri; Iverson, Grant L; Kataja, Anneli; Brander, Antti; Öhman, Juha; Luoto, Teemu M

    2016-01-15

    Mild traumatic brain injury (mTBI) is a public health problem. Outcome from mTBI is heterogeneous in part due to pre-injury individual differences that typically are not well described or understood. Pre-injury health characteristics of all consecutive patients (n=3023) who underwent head computed tomography due to acute head trauma in the emergency department of Tampere University Hospital, Finland, between August 2010 and July 2012 were examined. Patients were screened to obtain a sample of working age adults with no pre-injury medical or mental health problems who had sustained a "pure" mTBI. Of all patients screened, 1990 (65.8%) fulfilled the mTBI criteria, 257 (8.5%) had a more severe TBI, and 776 (25.7%) had a head trauma without obvious signs of brain injury. Injury-related data and participant-related data (e.g., age, sex, diagnosed diseases, and medications) were collected from hospital records. The most common pre-injury diseases were circulatory (39.4%-43.2%), neurological (23.7%-25.2%), and psychiatric (25.8%-27.5%) disorders. Alcohol abuse was present in 18.4%-26.8%. The most common medications were for cardiovascular (33.1%-36.6%), central nervous system (21.4%-30.8%), and blood clotting and anemia indications (21.5%-22.6%). Of the screened patients, only 2.5% met all the enrollment criteria. Age, neurological conditions, and psychiatric problems were the most common reasons for exclusion. Most of the patients sustaining an mTBI have some pre-injury diseases or conditions that could affect clinical outcome. By excluding patients with pre-existing conditions, the patients with known risk factors for poor outcome remain poorly studied. PMID:26054639

  12. Vehicle Related Factors that Influence Injury Outcome in Head-On Collisions

    PubMed Central

    Blum, Jeremy J.; Scullion, Paul; Morgan, Richard M.; Digges, Kennerly; Kan, Cing-Dao; Park, Shinhee; Bae, Hanil

    2008-01-01

    This study specifically investigated a range of vehicle-related factors that are associated with a lower risk of serious or fatal injury to a belted driver in a head-on collision. This analysis investigated a range of structural characteristics, quantities that describes the physical features of a passenger vehicle, e.g., stiffness or frontal geometry. The study used a data-mining approach (classification tree algorithm) to find the most significant relationships between injury outcome and the structural variables. The algorithm was applied to 120,000 real-world, head-on collisions, from the National Highway Traffic Safety Administration’s (NHTSA’s) State Crash data files, that were linked to structural attributes derived from frontal crash tests performed as part of the USA New Car Assessment Program. As with previous literature, the analysis found that the heavier vehicles were correlated with lower injury risk to their drivers. This analysis also found a new and significant correlation between the vehicle’s stiffness and injury risk. When an airbag deployed, the vehicle’s stiffness has the most statistically significant correlation with injury risk. These results suggest that in severe collisions, lower intrusion in the occupant cabin associated with higher stiffness is at least as important to occupant protection as vehicle weight for self-protection of the occupant. Consequently, the safety community might better improve self-protection by a renewed focus on increasing vehicle stiffness in order to improve crashworthiness in head-on collisions. PMID:19026230

  13. Two cases of 16th century head injuries managed in royal European families.

    PubMed

    Dowling, Kamilah A; Goodrich, James Tait

    2016-07-01

    In Europe, during the 16th century, there were a number of prominent general surgeons adventurous enough to consider operating on the brain for head injuries. From the time of Hippocrates, operating on the skull and brain was considered both treacherous and too dangerous to be undertaken except on rare occasions. Operating on a member of a royal court was considered even more exceptional because if the outcome was poor, the surgeon could lose a hand or limb, or, even worse, be beheaded. The authors present two interesting cases of royal family members who underwent surgery for head injuries that were quite severe. The surgeons involved, Ambroise Paré, Andreas Vesalius, and Berengario da Carpi, were among the most prominent surgeons in Europe. Despite very challenging political situations, all were willing to undertake a complex surgical intervention on the member of a prominent royal family. The individuals involved, both royal and medical, plus the neurosurgical injuries are discussed. PMID:27364255

  14. Head injury potential and the effectiveness of headgear in women's lacrosse.

    PubMed

    Rodowicz, Kathleen Allen; Olberding, Joseph E; Rau, Andrew C

    2015-04-01

    Over the past 10 years, lacrosse has grown increasingly popular, making it one of the fastest growing team sports in the country. Similar to other sporting activities, head injuries in lacrosse can and do occur, and the number of lacrosse-related head injuries has increased in recent years. In women's lacrosse, protective headgear is not required, but U.S. Lacrosse and the American Society for Testing and Materials are currently working to develop a headgear standard for the women's game. In the interim, some female lacrosse programs and individual players are wearing soft headgear during play. The effectiveness of this headgear is unknown. Testing was conducted to better understand the material properties of various types of headgear that may be used in lacrosse and the effect of this headgear on head impact response and head injury potential. For the evaluation of head impact response, an instrumented Hybrid III anthropomorphic test device (ATD) was impacted on the side of the head with lacrosse balls and the front and side of the head with a lacrosse stick. The linear and rotational impact response of the head and corresponding acceleration-based injury metrics are reported. Testing was then repeated with the ATD wearing different types of headgear. Tested headgear included a men's lacrosse helmet and two brands of commercially-available soft headgear. For the higher velocity ball impacts, there was no statistically-significant difference in the measured linear and rotational response of the head for the no headgear and soft headgear test conditions. For the lower velocity ball impacts, there was a small, yet statistically-significant, reduction in head linear acceleration for one of the soft headgears tested in comparison to the no headgear test condition, but there was not a statistically-significant difference in the rotational impact response with this headgear. These results indicate that the soft headgear would not be effective in reducing head injury

  15. Spinal injuries in belt-wearing car occupants killed by head-on collisions.

    PubMed

    Sköld, G; Voigt, G E

    1977-11-01

    In 34 post-mortem examinations of car occupants wearing seat belts and killed in straight or oblique head-on collisions, a thorough investigation of the spine was performed. The autopsy results were correlated with the findings in the cars in order to reconstruct the events when the occupant's body struck the interior of the car. In 2 cases the victims had worn lap belts, in 15 cases shoulder belts and in 17 cases combined shoulder-lap belts (three-point belts). In victims involved in head-on collisions while wearing lap belts, fractures of the neural arch of the axis were found which were probably due to flexion of the neck pivoting round the lower part of the impacting face and simultaneous stretching of the neck. Severe injuries to the cervical spine in those victims wearing shoulder belts were mainly due to the occupant sliding under the belt which then caught the neck and mandible. Such injuries were also caused by the impact of the head against forward parts of the car. In those wearing shoulder-lap belts injuries to the upper part of the cervical spine resulted from the impact of the head against internal parts of the car. When a slight impact of the head occurred minor injuries to the lower cervical spine were seen. Injuries to the thoracolumbar spine in the cases examined were the consequence of a violent extension between the upper part of the trunk held back by the shoulder belt and the pelvis restrained by the lap belt or by the knees striking the fascia panel. In front seat occupants this extension can be increased if either rear seat occupants without belts or heavy objects on the rear seat are projected forwards against their backs. PMID:591051

  16. A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study

    PubMed Central

    Chong, Shu-Ling; Chew, Su Yah; Feng, Jasmine Xun Yi; Teo, Penny Yun Lin; Chin, Sock Teng; Liu, Nan; Ong, Marcus Eng Hock

    2016-01-01

    Objective To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention. Design This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015. Setting Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System. Participants We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved. Primary and secondary outcome measures Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention. Results We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints. Conclusions Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital. PMID:26908533

  17. Mild head injury in preschool children: evidence that it can be associated with a persisting cognitive defect.

    PubMed

    Wrightson, P; McGinn, V; Gronwall, D

    1995-10-01

    This study describes the effect of mild head injury in preschool children on aspects of their cognitive performance in the year after injury and at the age of 6.5 years, with particular reference to the development of reading skills. Mild head injury was defined by diagnosis at a hospital emergency department of a head injury which was not severe enough to need admission for observation. Seventy eight such children were compared with a group of 86 with a minor injury elsewhere. The groups had similar developmental, family, and socioeconomic status. There were no differences in cognitive tests soon after the injury, but at six months and one year children with mild head injury scored less than controls on one test, solving a visual puzzle (visual closure); they were also more likely to have had another mild head injury. At 6.5 years of age they still scored less than controls, reading ability was related to their visual closure score at one year, and they were more likely to have needed help with reading. Mild head injury seems to be able to produce subtle but significant changes which can affect school performance. PMID:7561915

  18. Chronic Histopathological and Behavioral Outcomes of Experimental Traumatic Brain Injury in Adult Male Animals.

    PubMed

    Osier, Nicole D; Carlson, Shaun W; DeSana, Anthony; Dixon, C Edward

    2015-12-01

    The purpose of this review is to survey the use of experimental animal models for studying the chronic histopathological and behavioral consequences of traumatic brain injury (TBI). The strategies employed to study the long-term consequences of TBI are described, along with a summary of the evidence available to date from common experimental TBI models: fluid percussion injury; controlled cortical impact; blast TBI; and closed-head injury. For each model, evidence is organized according to outcome. Histopathological outcomes included are gross changes in morphology/histology, ventricular enlargement, gray/white matter shrinkage, axonal injury, cerebrovascular histopathology, inflammation, and neurogenesis. Behavioral outcomes included are overall neurological function, motor function, cognitive function, frontal lobe function, and stress-related outcomes. A brief discussion is provided comparing the most common experimental models of TBI and highlighting the utility of each model in understanding specific aspects of TBI pathology. The majority of experimental TBI studies collect data in the acute postinjury period, but few continue into the chronic period. Available evidence from long-term studies suggests that many of the experimental TBI models can lead to progressive changes in histopathology and behavior. The studies described in this review contribute to our understanding of chronic TBI pathology. PMID:25490251

  19. Simulated Aeromedical Evacuation Exacerbates Experimental Brain Injury.

    PubMed

    Skovira, Jacob W; Kabadi, Shruti V; Wu, Junfang; Zhao, Zaorui; DuBose, Joseph; Rosenthal, Robert; Fiskum, Gary; Faden, Alan I

    2016-07-15

    Aeromedical evacuation, an important component in the care of many patients with traumatic brain injury (TBI), particularly in war zones, exposes them to prolonged periods of hypobaria. The effects of such exposure on pathophysiological changes and outcome after TBI are largely unexplored. The objective of this study was to investigate whether prolonged hypobaria in rats subjected to TBI alters behavioral and histological outcomes. Adult male Sprague-Dawley rats underwent fluid percussion induced injury at 1.5-1.9 atmospheres of pressure. The effects of hypobaric exposure (6 h duration; equivalent to 0.75 atmospheres) at 6, 24, and 72 h, or 7 days after TBI were evaluated with regard to sensorimotor, cognitive, and histological changes. Additional groups were evaluated to determine the effects of two hypobaric exposures after TBI, representing primary simulated aeromedical evacuation (6 h duration at 24 h after injury) and secondary evacuation (10 h duration at 72 h after injury), as well as the effects of 100% inspired oxygen concentrations during simulated evacuation. Hypobaric exposure up to 7 days after injury significantly worsened cognitive deficits, hippocampal neuronal loss, and microglial/astrocyte activation in comparison with injured controls not exposed to hypobaria. Hyperoxia during hypobaric exposure or two exposures to prolonged hypobaric conditions further exacerbated spatial memory deficits. These findings indicate that exposure to prolonged hypobaria up to 7 days after TBI, even while maintaining physiological oxygen concentration, worsens long-term cognitive function and neuroinflammation. Multiple exposures or use of 100% oxygen further exacerbates these pathophysiological effects. PMID:26593382

  20. Designing of Phantom Head Used in Optical Diagnostics of Brain Injury

    NASA Astrophysics Data System (ADS)

    Aristov, A.; Timchenko, K.; Novoseltseva, A.; Kustov, D.; Larioshina, I. A.

    2016-01-01

    This article shows the results of an experimental research on properties of the materials chosen for designing of a phantom head, which is to be used in testing of a brain hematoma diagnostics device. We have conducted a comparative research of the optical properties of model materials and real head tissues

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

    PubMed

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

    2016-06-01

    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. PMID:27065055

  2. Diffuse Axonal Injury-A Distinct Clinicopathological Entity in Closed Head Injuries.

    PubMed

    Davceva, Natasha; Basheska, Neli; Balazic, Joze

    2015-09-01

    The knowledge about the diffuse axonal injury (DAI) as a clinicopathological entity has matured in the last 30 years. It has been defined clinically (immediate and prolonged unconsciousness leading to death or severe disability) and pathologically (the triad of DAI specific changes). In terms of its biomechanics, DAI is occurring as a result of acceleration forces of longer duration and has been fully reproduced experimentally.In the process of diagnosing DAI, the performance of a complete forensic neuropathological examination is essential and the immunohistochemistry method using antibodies against β-amyloid precursor protein (β-APP) has been proved to be highly sensitive and specific, selectively targeting the damaged axons.In this review, we are pointing to the significant characteristics of DAI as a distinct clinicopathological entity that can cause severe impairment of the brain function, and in the forensic medicine setting, it can be found as the concrete cause of death. We are discussing not only its pathological feature, its mechanism of occurrence, and the events on a cellular level but also the dilemmas about DAI that still exist in science: (1) regarding the strict criteria for its diagnosis and (2) regarding its biomechanical significance, which can be of a big medicolegal importance. PMID:26010053

  3. Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury

    PubMed Central

    Chambers, I R; Jones, P A; Lo, T Y M; Forsyth, R J; Fulton, B; Andrews, P J D; Mendelow, A D; Minns, R A

    2006-01-01

    Background The principal strategy for managing head injury is to reduce the frequency and severity of secondary brain insults from intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and hence improve outcome. Precise critical threshold levels have not been determined in head injured children. Objective To create a novel pressure–time index (PTI) measuring both duration and amplitude of insult, and then employ it to determine critical insult thresholds of ICP and CPP in children. Methods Prospective, observational, physiologically based study from Edinburgh and Newcastle, using patient monitored blood pressure, ICP, and CPP time series data. The PTI for ICP and CPP for 81 children, using theoretical values derived from physiological norms, was varied systematically to derive critical insult thresholds which delineate Glasgow outcome scale categories. Results The PTI for CPP had a very high predictive value for outcome (receiver operating characteristic analyses: area under curve = 0.957 and 0.890 for mortality and favourable outcome, respectively) and was more predictive than for ICP. Initial physiological values most accurately predicted favourable outcome. The CPP critical threshold values determined for children aged 2–6, 7–10, and 11–15 years were 48, 54, and 58 mm Hg. respectively. Conclusions The PTI is the first substantive paediatric index of total ICP and CPP following head injury. The insult thresholds generated are identical to age related physiological values. Management guidelines for paediatric head injuries should take account of these CPP thresholds to titrate appropriate pressor therapy. PMID:16103043

  4. The Preventive Effect of Head Injury by Helmet Type in Motorcycle Crashes: A Rural Korean Single-Center Observational Study

    PubMed Central

    Sung, Kang-Min; Noble, Jennifer; Kim, Sang-Chul; Jeon, Hyeok-Jin; Kim, Jin-Yong; Do, Han-Ho; Park, Sang-O; Lee, Kyeong-Ryong; Baek, Kwang-Je

    2016-01-01

    Introduction. The goal of this study was to determine the preventive effect on head injury by helmet type: full face helmet (FFH), open face helmet (OFH), and half-coverage helmet (HCH). Methods. This is a retrospective observational study of motorcycle crash victims between June 2012 and May 2015 in a rural town in Korea. We performed multiple linear regression to predict the effect of each type of helmet compared to unhelmeted status in preventing head injury using dependent variables based on the Abbreviated Injury Scale (AIS) and applied logistic regression modeling to compare the incidence of head injury. Results. Of the 738 patients, the number of FFH patients was 33.5%, followed by unhelmeted (27.8%), OFH (17.6%), and HCH (13.0%) patients. The FFH and OFH group had a lower head maximum AIS than unhelmeted group (coefficient: −0.368, 95% CI: −0.559 to −0.177 and coefficient: −0.235, 95% CI: −0.459 to −0.010, resp.) and only FFHs experienced a reduction effect of severe and minor head injury (OR: 0.206, 95% CI: 0.080 to 0.533 and OR: 0.589, 95% CI: 0.377 to 0.920, resp.). Conclusions. FFHs and OFHs reduce the risk of head injury, and FFHs have a more preventive effect on head injury in motorcycle crashes. PMID:27340652

  5. The Preventive Effect of Head Injury by Helmet Type in Motorcycle Crashes: A Rural Korean Single-Center Observational Study.

    PubMed

    Sung, Kang-Min; Noble, Jennifer; Kim, Sang-Chul; Jeon, Hyeok-Jin; Kim, Jin-Yong; Do, Han-Ho; Park, Sang-O; Lee, Kyeong-Ryong; Baek, Kwang-Je

    2016-01-01

    Introduction. The goal of this study was to determine the preventive effect on head injury by helmet type: full face helmet (FFH), open face helmet (OFH), and half-coverage helmet (HCH). Methods. This is a retrospective observational study of motorcycle crash victims between June 2012 and May 2015 in a rural town in Korea. We performed multiple linear regression to predict the effect of each type of helmet compared to unhelmeted status in preventing head injury using dependent variables based on the Abbreviated Injury Scale (AIS) and applied logistic regression modeling to compare the incidence of head injury. Results. Of the 738 patients, the number of FFH patients was 33.5%, followed by unhelmeted (27.8%), OFH (17.6%), and HCH (13.0%) patients. The FFH and OFH group had a lower head maximum AIS than unhelmeted group (coefficient: -0.368, 95% CI: -0.559 to -0.177 and coefficient: -0.235, 95% CI: -0.459 to -0.010, resp.) and only FFHs experienced a reduction effect of severe and minor head injury (OR: 0.206, 95% CI: 0.080 to 0.533 and OR: 0.589, 95% CI: 0.377 to 0.920, resp.). Conclusions. FFHs and OFHs reduce the risk of head injury, and FFHs have a more preventive effect on head injury in motorcycle crashes. PMID:27340652

  6. Motor Vehicle Crash Brain Injury in Infants and Toddlers: A Suitable Model for Inflicted Head Injury?

    ERIC Educational Resources Information Center

    Shah, Mahim; Vavilala, Monica S.; Feldman, Kenneth W.; Hallam, Daniel K.

    2005-01-01

    Objective: Children involved in motor vehicle crash (MVC) events might experience angular accelerations similar to those experienced by children with inflicted traumatic brain injury (iTBI). This is a pilot study to determine whether the progression of signs and symptoms and radiographic findings of MVC brain injury (mvcTBI) in children of the age…

  7. Urgent Intracranial Carotid Artery Decompression after Penetrating Head Injury

    PubMed Central

    Kim, Seong Joon

    2013-01-01

    We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient. PMID:23634269

  8. [Modern technology in the surgical treatment of head injury sequelae].

    PubMed

    Potapov, A A; Kornienko, V N; Kravchuk, A D; Likhterman, L B; Okhlopkov, V A; Eolchiian, S A; Gavrilov, A G; Zakharova, N E; Iakovlev, S B; Shurkhaĭ, V A

    2012-01-01

    The paper presents main types of surgically relevant posttraumatic lesions in 4136 patients with skull vault as well as skull base defects, craniofacial deformities, recurrent CSF leaks, arterio-venous fistulas, aneurysms and pseudoaneurysms etc. Classification of TBI sequelae and complications as well as its clinical course grading is presented. The use of modern neuroimaging techniques for studying pathophysiologic mechanisms and complications of TBI has been demonstrated. Special emphasis was given to minimally invasive and reconstructive surgery; computer modeling with subsequent full-copy stereolitographic laser implant setup was shown which is of great importance in cases of large and complex skull base and craniofacial deformities. Patient selection for transcranial and endonasal CSF leak closure techniques was justified. Treatment of post-traumatic vascular injuries using Serbinenko balloon-catheters as well as modern techniques such as stents, coils and embolization has been demonstrated. PMID:23210170

  9. Parkinson's syndrome after closed head injury: a single case report.

    PubMed

    Doder, M; Jahanshahi, M; Turjanski, N; Moseley, I F; Lees, A J

    1999-03-01

    A 36 year old man, who sustained a skull fracture in 1984, was unconscious for 24 hours, and developed signs of Parkinson's syndrome 6 weeks after the injury. When assessed in 1995, neuroimaging disclosed a cerebral infarction due to trauma involving the left caudate and lenticular nucleus. Parkinson's syndrome was predominantly right sided, slowly progressive, and unresponsive to levodopa therapy. Reaction time tests showed slowness of movement initiation and execution with both hands, particularly the right. Recording of movement related cortical potentials suggested bilateral deficits in movement preparation. Neuropsychological assessment disclosed no evidence of major deficits on tests assessing executive function or working memory, with the exception of selective impairments on the Stroop and on a test of self ordered random number sequences. There was evidence of abulia. The results are discussed in relation to previous literature on basal ganglia lesions and the effects of damage to different points of the frontostriatal circuits. PMID:10084539

  10. Update on injury mechanisms in abusive head trauma--shaken baby syndrome.

    PubMed

    Nadarasa, Jeyendran; Deck, Caroline; Meyer, Franck; Willinger, Rémy; Raul, Jean-Sébastien

    2014-12-01

    Violently shaking a baby leads to clinical presentations ranging from seizures to cardiopulmonary arrest. The main injuries sustained are retinal hemorrhages, subdural hemorrhages, and sometimes fractures and spine injury. It is important to have a global view of the injuries sustained by the infant to correctly discuss the biomechanical aspects of abusive head trauma. Recent works based on finite element models have shown that whiplash-shaking alone is enough to generate vitreo-retinal traction leading to retinal hemorrhage and to cause the rupture of bridging veins leading to subdural hemorrhage. We will review the main papers dealing with the mechanisms of shaken baby syndrome and present the most relevant hypothesis concerning the biomechanical aspects of injuries related to shaken baby syndrome. PMID:25501728

  11. Did Emperor Moctezuma II's head injury and subsequent death hasten the fall of the Aztec nation?

    PubMed

    Sanchez, Gonzalo M

    2015-07-01

    This article analyzes the head injury of Emperor Moctezuma as one of those injuries that affected the course of history. The Emperor's death arguably changed the fate of an entire nation and led to the destruction of the Aztec civilization. Moctezuma died in the evening hours of June 30, 1520, in his palace in the Aztec capital, Tenochtitlan, while a prisoner of the Spanish conquistadors. The Emperor had been speaking to his people in an effort to persuade them to cease hostilities against Hernán Cortés, his Spanish soldiers, and Indian allies. Both Spanish and Indian contemporary sources document that he sustained a severe head injury when one of his own warriors hit him with a rock thrown from a sling. However, after the Conquest of Mexico some of the information collected by Spanish friars from Indian stories, songs, and pictorial representations raised the possibility that Moctezuma died of strangulation or stabbing at the hands of the Spaniards. There is even a suggestion of suicide. This issue remains unresolved and emotionally charged. The historical and clinical analysis of the events surrounding Moctezuma's death indicates that the Emperor most likely died as a consequence of head injury. The author has attempted to present a neutral analysis but agrees with Benjamin Keen that neutrality may be unattainable, no matter how remote the subject of historical inquiry is from the present. PMID:26126401

  12. A Porcine Model of Traumatic Brain Injury via Head Rotational Acceleration.

    PubMed

    Cullen, D Kacy; Harris, James P; Browne, Kevin D; Wolf, John A; Duda, John E; Meaney, David F; Margulies, Susan S; Smith, Douglas H

    2016-01-01

    Unique from other brain disorders, traumatic brain injury (TBI) generally results from a discrete biomechanical event that induces rapid head movement. The large size and high organization of the human brain makes it particularly vulnerable to traumatic injury from rotational accelerations that can cause dynamic deformation of the brain tissue. Therefore, replicating the injury biomechanics of human TBI in animal models presents a substantial challenge, particularly with regard to addressing brain size and injury parameters. Here we present the historical development and use of a porcine model of head rotational acceleration. By scaling up the rotational forces to account for difference in brain mass between swine and humans, this model has been shown to produce the same tissue deformations and identical neuropathologies found in human TBI. The parameters of scaled rapid angular accelerations applied for the model reproduce inertial forces generated when the human head suddenly accelerates or decelerates in falls, collisions, or blunt impacts. The model uses custom-built linkage assemblies and a powerful linear actuator designed to produce purely impulsive non-impact head rotation in different angular planes at controlled rotational acceleration levels. Through a range of head rotational kinematics, this model can produce functional and neuropathological changes across the spectrum from concussion to severe TBI. Notably, however, the model is very difficult to employ, requiring a highly skilled team for medical management, biomechanics, neurological recovery, and specialized outcome measures including neuromonitoring, neurophysiology, neuroimaging, and neuropathology. Nonetheless, while challenging, this clinically relevant model has proven valuable for identifying mechanisms of acute and progressive neuropathologies as well as for the evaluation of noninvasive diagnostic techniques and potential neuroprotective treatments following TBI. PMID:27604725

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

    PubMed Central

    Cavalcanti, Alessandro Leite; Lino, Thiago Henrique de Araujo; de Oliveira, Thaliny Batista Sarmento; de Oliveira, Thaisy Sarmento Batista; Cardoso, Andreia Medeiros Rodrigues; de Macedo, Rodrigo Feliciano; Padilha, Wilton Wilney Nascimento; Xavier, Alidianne Fabia Cabral

    2014-01-01

    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. PMID:25574492

  14. The Current State of Head and Neck Injuries in Extreme Sports

    PubMed Central

    Sharma, Vinay K.; Rango, Juan; Connaughton, Alexander J.; Lombardo, Daniel J.; Sabesan, Vani J.

    2015-01-01

    Background: Since their conception during the mid-1970s, international participation in extreme sports has grown rapidly. The recent death of extreme snowmobiler Caleb Moore at the 2013 Winter X Games has demonstrated the serious risks associated with these sports. Purpose: To examine the incidence and prevalence of head and neck injuries (HNIs) in extreme sports. Study Design: Descriptive epidemiological study. Methods: The National Electronic Injury Surveillance System (NEISS) was used to acquire data from 7 sports (2000-2011) that were included in the Winter and Summer X Games. Data from the NEISS database were collected for each individual sport per year and type of HNI. Cumulative data for overall incidence and injuries over the entire 11-year period were calculated. National estimates were determined using NEISS-weighted calculations. Incidence rates were calculated for extreme sports using data from Outdoor Foundation Participation Reports. Results: Over 4 million injuries were reported between 2000 and 2011, of which 11.3% were HNIs. Of all HNIs, 83% were head injuries and 17% neck injuries. The 4 sports with the highest total incidence of HNI were skateboarding (129,600), snowboarding (97,527), skiing (83,313), and motocross (78,236). Severe HNI (cervical or skull fracture) accounted for 2.5% of extreme sports HNIs. Of these, skateboarding had the highest percentage of severe HNIs. Conclusion: The number of serious injuries suffered in extreme sports has increased as participation in the sports continues to grow. A greater awareness of the dangers associated with these sports offers an opportunity for sports medicine and orthopaedic physicians to advocate for safer equipment, improved on-site medical care, and further research regarding extreme sports injuries. PMID:26535369

  15. Head and neck control varies with perturbation acceleration but not jerk: implications for whiplash injuries

    PubMed Central

    Siegmund, Gunter P; Blouin, Jean-Sébastien

    2009-01-01

    Recent studies have proposed that a high rate of acceleration onset, i.e. high jerk, during a low-speed vehicle collision increases the risk of whiplash injury by triggering inappropriate muscle responses and/or increasing peak head acceleration. Our goal was to test these proposed mechanisms at realistic jerk levels and then to determine how collision jerk affects the potential for whiplash injuries. Twenty-three seated volunteers (8 F, 15 M) were exposed to multiple experiments involving perturbations simulating the onset of a vehicle collision in eyes open and eyes closed conditions. In the first experiment, subjects experienced five forward and five rearward perturbations to look for the inappropriate muscle responses and ‘floppy’ head kinematics previously attributed to high jerk perturbations. In the second experiment, we independently varied the jerk (∼125 to 3 000 m s−3) and acceleration (∼0.65 to 2.6 g) of the perturbation to assess their effect on the electromyographic (EMG) responses of the sternocleidomastoid (SCM), scalene (SCAL) and cervical paraspinal (PARA) muscles and the kinematic responses of the head and neck. In the first experiment, we found neither inappropriate muscle responses nor floppy head kinematics when subjects had their eyes open, but observed two subjects with floppy head kinematics with eyes closed. In the second experiment, we found that about 70% of the variations in the SCM and SCAL responses and about 95% of the variations in head/neck kinematics were explained by changes in perturbation acceleration in both the eyes open and eyes closed conditions. Less than 2% of the variation in the muscle and kinematic responses was explained by changes in perturbation jerk and, where significant, response amplitudes diminished with increasing jerk. Based on these findings, collision jerk appears to have little or no role in the genesis of whiplash injuries in low-speed vehicle crashes. PMID:19237420

  16. Effects of edaravone on experimental brain injury in view of free radical reaction.

    PubMed

    Nakamura, H; Uzura, M; Uchida, K; Nakayama, H; Furuya, Y; Hayashi, T; Sekino, H; Ominato, M; Owada, S

    2003-01-01

    The purpose of this study is to clarify the influence of a novel free radical scavenger edaravone on experimental brain injury. Male Wistar rats were anesthetized with 1-2% halothane. Brain injury was produced using a controlled cortical impact injury device. Experimental rats were divided into 2 groups. In the edaravone group, edaravone (3 mg/kg) was twice administered intravenously for 30 minutes. In the saline group, saline solution was administered in the same way. This administration of edaravone or saline solution made it possible to evaluate the relative effects of edaravone by assessment of free radical reaction and water content. As a result, the level of oxygen free radicals at 50 minutes after brain injury was significantly lower in the edaravone group than in the saline group. The water content in the injured brain at 180 minutes was significantly lower in the edaravone group than in the saline group. Therefore, we propose that edaravone may be effective for treatment in head injury. PMID:14753459

  17. Combat body armor and injuries to the head, face, and neck region: a systematic review.

    PubMed

    Tong, Darryl; Beirne, Ross

    2013-04-01

    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. PMID:23707828

  18. Closed Head Injury in a Mouse Model Results in Molecular Changes Indicating Inflammatory Responses

    PubMed Central

    Israelsson, Charlotte; Wang, Yun; Kylberg, Annika; Pick, Chaim G.; Hoffer, Barry J.

    2009-01-01

    Abstract Cerebral gene expression changes in response to traumatic brain injury will provide useful information in the search for future trauma treatment. In order to characterize the outcome of mild brain injury, we studied C57BL/6J mice in a weight-drop, closed head injury model. At various times post-injury, mRNA was isolated from neocortex and hippocampus and transcriptional alterations were studied using quantitative reverse transcriptase PCR and gene array analysis. At three days post-injury, the results showed unilateral injury responses, both in neocortex and hippocampus, with the main effect seen on the side of the skull hit by the dropping weight. Upregulated transcripts encoded products characterizing reactive astrocytes, phagocytes, microglia, and immune-reactive cells. Markers for oligodendrocytes and T-cells were not altered. Notably, strong differences in the responses among individual mice were seen (e.g., for the Gfap transcript expressed by reactive astrocytes and the chemokine Ccl3 transcript expressed by activated microglial cells). In conclusion, mild TBI chiefly activates transcripts leading to tissue signaling, inflammatory processes, and chemokine signaling, as in focal brain injury, suggesting putative targets for drug development. PMID:19317611

  19. Post-concussional symptoms, financial compensation and outcome of severe blunt head injury.

    PubMed Central

    McKinlay, W W; Brooks, D N; Bond, M R

    1983-01-01

    Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group were pursuing claims for financial compensation while patients in the other were not. Patients were assessed on cognitive tests, and both patients and relatives were interviewed at 3, 6 and 12 months after injury. There were few differences between claimants and non-claimants: post-concussional symptoms were common in both, cognitive performance was equal, and the reports given by relatives of changes in the patients were very similar. However, the reports given by patients themselves differed with claimants reporting slightly more symptoms than non-claimants. PMID:6663307

  20. Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite.

    PubMed

    Roka, Yam B; Roka, Narayani; Shrestha, Manzil; Puri, Puspa R; Adhikari, Hari B

    2012-12-01

    The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully. PMID:23216732

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

    PubMed

    Shadymov, A B; Kazymov, M A

    2014-01-01

    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. PMID:25269169

  2. Injury-induced asymmetric cell death as a driving force for head regeneration in Hydra.

    PubMed

    Galliot, Brigitte

    2013-03-01

    The freshwater Hydra polyp provides a unique model system to decipher the mechanisms underlying adult regeneration. Indeed, a single cut initiates two distinct regenerative processes, foot regeneration on one side and head regeneration on the other side, the latter relying on the rapid formation of a local head organizer. Two aspects are discussed here: the asymmetric cellular remodeling induced by mid-gastric bisection and the signaling events that trigger head organizer formation. In head-regenerating tips (but not in foot ones), a wave of cell death takes place immediately, leading the apoptotic cells to transiently release Wnt3 and activate the β-catenin pathway in the neighboring cycling cells to push them through mitosis. This process, which mimics the apoptosis-induced compensatory proliferation process deciphered in Drosophila larvae regenerating their discs, likely corresponds to an evolutionarily conserved mechanism, also at work in Xenopus tadpoles regenerating their tail or mice regenerating their skin or liver. How is this process generated in Hydra? Several studies pointed to the necessary activation of the extracellular signal-regulated kinase (ERK) 1-2 and mitogen-activated protein kinase (MAPK) pathways during early head regeneration. Indeed inhibition of ERK 1-2 or knockdown of RSK, cAMP response element-binding protein (CREB), and CREB-binding protein (CBP) prevent injury-induced apoptosis and head regeneration. The current scenario involves an asymmetric activation of the MAPK/CREB pathway to trigger injury-induced apoptosis in the interstitial cells and in the epithelial cells a CREB/CBP-dependent transcriptional activation of early genes essential for head-organizing activity as wnt3, HyBra1, and prdl-a. The question now is how bisection in the rather uniform central region of the polyp can generate this immediately asymmetric signaling. PMID:22833103

  3. Cerebrovascular Time Constant in Patients with Head Injury.

    PubMed

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

    2016-01-01

    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. PMID:26463964

  4. Influence of two anesthetic techniques on blood sugar level in head injury patients: A comparative study

    PubMed Central

    Kumar, Manoj; Tripathi, Manoj; Malviya, Deepak; Malviya, P. S.; Kumar, Virendra; Tyagi, Amit

    2016-01-01

    Background: Head injury presents a major worldwide social, economic, and health problem. Hyperglycemia is a significant indicator of the severity of injury and predictor of outcome, which can easily be prevented. There has been a long-standing controversy regarding the use of inhalational or intravenous (i.v.) anesthetic agents for surgery of head injury cases and impact of these agents on blood sugar level. Aims and Objectives: The aim of this study is to find out anesthetic drugs and technique having minimal or no effect on the blood sugar, and Glasgow Coma Scale (GCS) of patients with a head injury by comparing two types of anesthetic techniques in surgery of head injury patients. Materials and Methods: This was a prospective, randomized, and comparative study, conducted on 60 adult head injury patients. The patients were divided into two groups of 30 each. Group I patients received induction with sevoflurane and then had O2 + air + sevoflurane for maintenance with controlled ventilation. Group II patients received induction with i.v. propofol and then had O2 + air + propofol for maintenance with controlled ventilation. Injection fentanyl was used in both the groups at the time of induction and in intermittent boluses in maintenance. In observation, blood sugar level and mean arterial pressure were assessed at different time periods perioperatively in both groups while GCS was analyzed pre- and post-operatively. Statistical Analysis: Statistical analysis was performed by Microsoft Excel 2010 using t-test for comparison between the two groups and Z-test for comparison of proportions. Results and Conclusion: Blood sugar level was found significantly higher in patients of sevoflurane group at 30 min after induction, at the end of surgery, and 1 h after the end of anesthesia than propofol group patients. This increase of blood sugar level did not have any significant alteration in the GCS profile of the patients in sevoflurane group as compared to propofol group

  5. Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood

    PubMed Central

    Heather, Natasha L.; Derraik, José G. B.; Beca, John; Hofman, Paul L.; Dansey, Rangi; Hamill, James; Cutfield, Wayne S.

    2013-01-01

    Objective To assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment. Methods Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children’s Hospital (Auckland, New Zealand, 2000–2010) with THI. Results We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13–15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious–critical THI (AIS-HR 3–5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. Conclusion Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up. PMID:24312648

  6. Hemodynamic and morphologic responses in mouse brain during acute head injury imaged by multispectral structured illumination

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

    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.

  7. Quality-Adjusted Life-Years and Helmet Use Among Motorcyclists Sustaining Head Injuries

    PubMed Central

    Lee, Hsin-Yi; Chen, Yeh-Hsin; Chiu, Wen-Ta; Hwang, Jing-Shiang

    2010-01-01

    Objectives. We estimated loss of quality-adjusted life expectancy (QALE) among motorcyclists in Taiwan who sustained head injuries while wearing or not wearing a helmet. Methods. Patients with head injuries (n = 3328) were grouped into categories representing good and poor outcomes (moderate disability or death) at discharge. After linkage with the National Mortality Registry, survival functions were determined and extrapolated over a 50-year period on the basis of the survival ratio between patients and age- and gender-matched reference populations, as calculated from available Taiwan vital statistics. Survival functions were then multiplied by scores from quality-of-life measures. Results. Percentages of good and poor outcomes were 87.2% and 12.8%, respectively, in the helmeted group and 66.4% and 33.6% in the nonhelmeted group. The mean QALE for helmeted motorcyclists, calculated by weighting percentages of good and poor outcomes, was 31.7 quality-adjusted life-years (QALYs), with an average loss of 5.8 QALYs. For nonhelmeted motorcyclists, the mean QALE was 25.9 QALYs, with a loss of 10.7 QALYs. Conclusions. Helmet use could save approximately 5 QALYs among motorcyclists sustaining head injuries. Future cost-effectiveness analysis can calculate the incremental cost-effectiveness ratio for regulation of helmet use. PMID:19910346

  8. Serious head and neck injury as a predictor of occupant position in fatal rollover crashes.

    PubMed

    Freeman, M D; Dobbertin, K; Kohles, S S; Uhrenholt, L; Eriksson, A

    2012-10-10

    Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at the occupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked composite head and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8 cm of roof crush compared with <8 cm by 4%, for ≥15 cm of roof crush compared to <8 cm by 6% and for ≥30 cm of roof crush compared to <8 cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality. PMID:22742739

  9. Head injuries in the accident and emergency department: are we using resources effectively?

    PubMed Central

    Wallace, S A; Bennett, J; Perez-Avila, C A; Gullan, R W

    1994-01-01

    This paper reports a retrospective criterion based audit which reviewed head injury management in two accident and emergency (A&E) departments. Management was compared with regionally agreed criteria for ordering a skull radiograph (SXR) and a computerized tomogram (CT scan) and for admission, and the quality of medical documentation was assessed. A total of 158 patients were reviewed and 132 patients (84%) satisfied the three key areas of recommended head injury management. Failures to satisfy recommended guidelines were present in 19 patients (12%) for SXR, four (2%) for admission and three (2%) for CT scanning. Three skull fractures (two in young babies) would have been missed if the criteria had been adhered to strictly. There was one adverse outcome when a patient who should have been admitted returned to A&E 8 days after initial attendance with a subdural haemorrhage and died shortly afterwards. Apart from 'loss of consciousness', the quality both in content and legibility of the medical documentation was poor. The result of 84% correctly managed patients may be over-optimistic according to the criteria used. Although criteria have a valuable role to play, there are problems with prescriptive standard setting. A recommendation was made to develop a head injury pro forma to address the poor quality medical documentation and it was also recommended that the SXR, CT scan and admission criteria for babies and young children be reviewed. PMID:7921546

  10. [Sequential changes in acute phase reactant proteins and complement activation in patients with acute head injuries].

    PubMed

    Ikeda, Y; Matsuura, H; Nakazawa, S

    1987-12-01

    The role of immunological mechanisms in head injury is not clearly defined. In this study we investigated the immunological function in patients with acute head injuries. Serum acute phase reactant proteins (APRP), complement activation and immunoglobulines as immunological parameters were studied. APRP are produced in the liver and increase in cancer patients as well as those with acute and chronic inflammations, trauma and autoimmune diseases. APRP are known to be one of the immunosuppressive factors in the serum. Forty patients with acute head injuries were studied. Thirty-four patients were male and six patients were female, ages ranged from 12 to 81 years. Serial blood samples were obtained during the first seven days of trauma. The Glasgow Coma Score (GCS) were recorded at the time of admission for all patients. Clinical outcome was assessed at the time of discharge according to the Glasgow Outcome Scale. The "good" group consisted of patients with good recovery or moderate disability. The "bad" group consisted of patients with severe disability, persistent vegetative state and death. The concentrations of immunoglobulines (IgG, IgM, IgA) were within normal range and humoral immunity was not affected. Complement activation at the time of admission was closely related to GCS (p less than 0.01), but the levels of C4, C3, and C3 activator except for these of CH50 were within normal range.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2451531

  11. Managing traumatic brain injury in children: When do we need a computed tomography of the head?

    PubMed Central

    Kambal, Mohammed A; Abou, Manal E; Gadi, Iman Al; Al Boukai, Ahmad Amer; Al Jurayyan, Nasir A

    2014-01-01

    Accidents still represent a major cause of death and disability in children. The resultant traumatic brain injury (TBI) usually needs a multidisciplinary approach of management. Although computed tomographic (CT) head scan is generally a preferred investigation in TBI, however, clear guidelines are required to help decision making by different team members on “when a head CT scan is needed”, its limitations, and “when it is likely to be informative”. The answers to these queries are highlighted, in the present article, with other aspects of treatment of children with TBI. This article discusses different worldwide-accepted approaches for managing children with TBI, and places special emphasis on the issue of “indications for a head CT scan”.

  12. Computational modeling of human head under blast in confined and open spaces: primary blast injury.

    PubMed

    Rezaei, A; Salimi Jazi, M; Karami, G

    2014-01-01

    In this paper, a computational modeling for biomechanical analysis of primary blast injuries is presented. The responses of the brain in terms of mechanical parameters under different blast spaces including open, semi-confined, and confined environments are studied. In the study, the effect of direct and indirect blast waves from the neighboring walls in the confined environments will be taken into consideration. A 50th percentile finite element head model is exposed to blast waves of different intensities. In the open space, the head experiences a sudden intracranial pressure (ICP) change, which vanishes in a matter of a few milliseconds. The situation is similar in semi-confined space, but in the confined space, the reflections from the walls will create a number of subsequent peaks in ICP with a longer duration. The analysis procedure is based on a simultaneous interaction simulation of the deformable head and its components with the blast wave propagations. It is concluded that compared with the open and semi-confined space settings, the walls in the confined space scenario enhance the risk of primary blast injuries considerably because of indirect blast waves transferring a larger amount of damaging energy to the head. PMID:23996897

  13. Incidental cranial CT findings in head injury patients in a Nigerian tertiary hospital

    PubMed Central

    Ogbole, Godwin I.; Adeleye, Amos O.; Owolabi, Mayowa O.; Olatunji, Richard B.; Yusuf, Bolutife P.

    2015-01-01

    Background: Incidental findings on computed tomography (CT) scans are occasionally noted in patients presenting with head injury. Since it can be assumed that head injured patients are of normal health status before the accident, these findings may be a representation of their frequency in the general population. Our aim was to determine the prevalence of such incidental findings among head injured patients in Nigeria's foremost center of clinical neurosciences. Materials and Methods: We conducted a retrospective review of CT scan images of 591 consecutive eligible patients over a 5-year period (2006-2010) to identify incidental findings. The images were evaluated by consensus agreement of two radiologists. Associations with gender and age were explored using appropriate statistical tests with an alpha level of 0.05. Results: The mean patient age was 34.6 ± 21.2 years, and male to female ratio was 3.2: 1. Incidental findings were noted in 503/591 (85.1 %) of the scans. Intracranial calcification was the commonest finding occurring in 61.8% of patients. Over 90% of the findings were benign. Compared with older ones, patients under the age of 60 were less likely, (P < 0.001), to have incidental findings. Conclusion: Although the majority of incidental findings in this African cohort of head injury patients are benign some clinically significant lesions were detectable. It is therefore recommended that such findings be adequately described in the radiological reports for proper counseling and follow-up. PMID:25949036

  14. Neuronal cytoskeletal changes are an early consequence of repetitive head injury.

    PubMed

    Geddes, J F; Vowles, G H; Nicoll, J A; Révész, T

    1999-08-01

    While neuropathological studies have established the pathology of dementia pugilistica to be similar to that of Alzheimer's disease, there is little information about the early histological changes caused by the repetitive trauma that eventually produces dementia pugilistica. We have examined the brains of four young men and a frontal lobectomy specimen from a fifth, age range 23-28 years, all of whom suffered mild chronic head injury. There were two boxers, a footballer, a mentally subnormal man with a long history of head banging, and an epileptic patient who repeatedly hit his head during seizures. The four autopsy cases were widely sampled; the lobectomy specimen was serially sliced after fixation. Routine stains were performed; inmmunostaining included beta-amyloid precursor protein, amyloid beta-protein (Abeta), tau and apolipoprotein E (apoE). Pathological findings in all five cases were of neocortical neurofibrillary tangles (NFTs) and neuropil threads, with groups of tangles consistently situated around blood vessels in the worst affected regions. No Abeta immunoreactivity was detected. The amount of neuronal apoE expression varied widely between the cases with no clear relation to the NFTs. The apoE genotype was determined in only two cases (both epsilon3/epsilon3). It appears that repetitive head injury in young adults is initially associated with neocortical NFT formation in the absence of Abeta deposition. The distribution of the tau pathology suggests that the pathogenesis of cytoskeletal abnormalities may involve damage to blood vessels or perivascular elements. PMID:10442557

  15. Diffuse optical monitoring of hemodynamic changes in piglet brain with closed head injury

    NASA Astrophysics Data System (ADS)

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

    2009-05-01

    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.

  16. Temporal MRI characterization, neurobiochemical and neurobehavioral changes in a mouse repetitive concussive head injury model

    PubMed Central

    Yang, Zhihui; Wang, Ping; Morgan, Drake; Lin, Dan; Pan, Jianchun; Lin, Fan; Strang, Kevin H.; Selig, Tyler M.; Perez, Pablo D.; Febo, Marcelo; Chang, Binggong; Rubenstein, Richard; Wang, Kevin K.W.

    2015-01-01

    Single and repeated sports-related mild traumatic brain injury (mTBI), also referred to as concussion, can result in chronic post-concussive syndrome (PCS), neuropsychological and cognitive deficits, or chronic traumatic encephalopathy (CTE). However PCS is often difficult to diagnose using routine clinical, neuroimaging or laboratory evaluations, while CTE currently only can be definitively diagnosed postmortem. We sought to develop an animal model to simulate human repetitive concussive head injury for systematic study. In this study, mice received single or multiple head impacts by a stereotaxic impact device with a custom-made rubber tip-fitted impactor. Dynamic changes in MRI, neurobiochemical markers (Tau hyperphosphorylation and glia activation in brain tissues) and neurobehavioral functions such as anxiety, depression, motor function and cognitive function at various acute/subacute (1-7 day post-injury) and chronic (14-60 days post-injury) time points were examined. To explore the potential biomarkers of rCHI, serum levels of total Tau (T-Tau) and phosphorylated Tau (P-Tau) were also monitored at various time points. Our results show temporal dynamics of MRI consistent with structural perturbation in the acute phase and neurobiochemical changes (P-Tau and GFAP induction) in the subacute and chronic phase as well as development of chronic neurobehavioral changes, which resemble those observed in mTBI patients. PMID:26058556

  17. Magnetic Resonance Imaging in Experimental Traumatic Brain Injury.

    PubMed

    Shen, Qiang; Watts, Lora Tally; Li, Wei; Duong, Timothy Q

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in the USA. Common causes of TBI include falls, violence, injuries from wars, and vehicular and sporting accidents. The initial direct mechanical damage in TBI is followed by progressive secondary injuries such as brain swelling, perturbed cerebral blood flow (CBF), abnormal cerebrovascular reactivity (CR), metabolic dysfunction, blood-brain-barrier disruption, inflammation, oxidative stress, and excitotoxicity, among others. Magnetic resonance imaging (MRI) offers the means to noninvasively probe many of these secondary injuries. MRI has been used to image anatomical, physiological, and functional changes associated with TBI in a longitudinal manner. This chapter describes controlled cortical impact (CCI) TBI surgical procedures, a few common MRI protocols used in TBI imaging, and, finally, image analysis pertaining to experimental TBI imaging in rats. PMID:27604743

  18. Use of a pro forma for head injuries in the accident and emergency department--the way forward.

    PubMed Central

    Wallace, S A; Gullan, R W; Byrne, P O; Bennett, J; Perez-Avila, C A

    1994-01-01

    The aim of this study was to assess the quality of documentation of head-injured patients seen in three accident and emergency (A&E) departments using a specially designed head injury pro forma. A 4-week prospective study of a single head injury pro forma was followed by a second similar study with an improved version (two head injury pro formas, one for young children and babies, the other for older children and adults). The main outcome measures were the degree of completion of the pro forma and questionnaire responses from receptionists, nurses and doctors. A total of 1260 patients had their details completed on the pro forma in both studies. Compared with standard hand written A&E notes, the degree of completion of clinical details specific to the head injury were high, eg. over 95% for symptoms. The pro forma was generally well received by A&E staff, particularly after recommended improvements were made, and the majority of staff felt it should be introduced permanently into the A&E department. Concern about its use in cases of very minor head injury and multiple injuries were raised. As well as improved documentation, the pro forma facilitates the process of audit and may have an important role to play in information technology and computers in the future. Images p39-a p40-a p41-a p42-a PMID:7921548

  19. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case–control study

    PubMed Central

    Persaud, Navindra; Coleman, Emily; Zwolakowski, Dorothy; Lauwers, Bert; Cass, Dan

    2012-01-01

    Background: The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury. Methods: We used a case–control design involving 129 fatalities using data from a coroner’s review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet. Results: Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3–7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4–8.5) and when we used a more stringent case definition (i.e., only a head injury with no other substantial injuries; adjusted OR 3.6, 95% CI 1.2–10.2). Interpretation: Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths. PMID:23071369

  20. Galveston Brain Injury Conference 2010: clinical and experimental aspects of blast injury.

    PubMed

    Masel, Brent E; Bell, Randy S; Brossart, Shawn; Grill, Raymond J; Hayes, Ronald L; Levin, Harvey S; Rasband, Matthew N; Ritzel, David V; Wade, Charles E; DeWitt, Douglas S

    2012-08-10

    Blast injury is the most prevalent source of mortality and morbidity among combatants in Operations Iraqi and Enduring Freedom. Blast-induced neurotrauma (BINT) is a common cause of mortality, and even mild BINT may be associated with chronic cognitive and emotional deficits. In addition to military personnel, the increasing use of explosives by terrorists has resulted in growing numbers of blast injuries in civilian populations. Since the medical and rehabilitative communities are likely to be faced with increasing numbers of patients suffering from blast injury, the 2010 Galveston Brain Injury Conference focused on topics related to the diagnosis, treatment, and mechanisms of BINT. Although past military actions have resulted in large numbers of blast casualties, BINT is considered the signature injury of the conflicts in Iraq and Afghanistan. The attention focused on BINT has led to increased financial support for research on blast effects, contributing to the development of better experimental models of blast injury and a clearer understanding of the mechanisms of BINT. This more thorough understanding of blast injury mechanisms will result in novel and more effective therapeutic and rehabilitative strategies designed to reduce injury and facilitate recovery, thereby improving long-term outcomes in patients suffering from the devastating and often lasting effects of BINT. The following is a summary of the 2010 Galveston Brain Injury Conference, that included presentations related to the diagnosis and treatment of acute BINT, the evaluation of the long-term neuropsychological effects of BINT, summaries of current experimental models of BINT, and a debate about the relative importance of primary blast effects on the acute and long-term consequences of blast exposure. PMID:22655746

  1. Charges associated with pediatric head injuries: a five year retrospective review of 41 pediatric hospitals in the US

    PubMed Central

    Robertson, Brian D.; McConnel, Charles E.; Green, Sally

    2013-01-01

    Abstract: Background: Brain injuries are a significant public health problem, particularly among the pediatric population. Brain injuries account for a significant portion of pediatric injury deaths, and are the highest contributor to morbidity and mortality in the pediatric and young adult populations. Several studies focus on particular mechanisms of brain injury and the cost of treating brain injuries, but few studies exist in the literature examining the highest contributing mechanisms to pediatric brain injury and the billed charges associated with them. Methods: Data were extracted from the Pediatric Health Information System (PHIS) from member hospitals on all patients admitted with diagnosed head injuries and comparisons were made between ICU and non-ICU admissions. Collected data included demographic information, injury information, total billed charges, and patient outcome. Results: Motor vehicle collisions, falls, and assaults/abuse are the three highest contributors to brain injury in terms of total numbers and total billed charges. These three mechanisms of injury account for almost $1 billion in total charges across the five-year period, and account for almost half of the total charges in this dataset over that time period. Conclusions: Research focusing on brain injury should be tailored to the areas of the most pressing need and the highest contributing factors. While this study is focused on a select number of pediatric hospitals located throughout the country, it identifies significant contributors to head injuries, and the costs associated with treating them. PMID:22821220

  2. The efficacy of sequential compression devices in multiple trauma patients with severe head injury.

    PubMed

    Gersin, K; Grindlinger, G A; Lee, V; Dennis, R C; Wedel, S K; Cachecho, R

    1994-08-01

    Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism. Bilateral lower extremity technetium venoscans and ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days following trauma. Twenty-five patients had normal or low probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary arteriograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, Injury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patients with DVT or PE. All but one patient with DVT or PE underwent placement of a vena caval filter. Multiple trauma patients with severe head injury (GCS score < or = 8) are at high risk for thromboembolism. The available means of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective. PMID:8064917

  3. Some Observations on the Use of the Woodcock-Johnson Tests of Cognitive Ability in Adults with Head Injury.

    ERIC Educational Resources Information Center

    Tupper, David E.

    1990-01-01

    The study provides descriptive data on use of the Woodcock-Johnson Tests of Cognitive Ability with 39 adults with closed head injury. Correlational analyses indicated significant relationships between coma duration and performance on the Perceptual Speed and Memory clusters of the test. Time since injury did not correlate with test results.…

  4. Finite element analysis of occupant head injuries: parametric effects of the side curtain airbag deployment interaction with a dummy head in a side impact crash.

    PubMed

    Deng, Xingqiao; Potula, S; Grewal, H; Solanki, K N; Tschopp, M A; Horstemeyer, M F

    2013-06-01

    In this study, we investigated and assessed the dependence of dummy head injury mitigation on the side curtain airbag and occupant distance under a side impact of a Dodge Neon. Full-scale finite element vehicle simulations of a Dodge Neon with a side curtain airbag were performed to simulate the side impact. Owing to the wide range of parameters, an optimal matrix of finite element calculations was generated using the design method of experiments (DOE); the DOE method was performed to independently screen the finite element results and yield the desired parametric influences as outputs. Also, analysis of variance (ANOVA) techniques were used to analyze the finite element results data. The results clearly show that the influence of moving deformable barrier (MDB) strike velocity was the strongest influence parameter on both cases for the head injury criteria (HIC36) and the peak head acceleration, followed by the initial airbag inlet temperature. Interestingly, the initial airbag inlet temperature was only a ~30% smaller influence than the MDB velocity; also, the trigger time was a ~54% smaller influence than the MDB velocity when considering the peak head accelerations. Considering the wide range in MDB velocities used in this study, results of the study present an opportunity for design optimization using the different parameters to help mitigate occupant injury. As such, the initial airbag inlet temperature, the trigger time, and the airbag pressure should be incorporated into vehicular design process when optimizing for the head injury criteria. PMID:23567214

  5. Social interaction attenuates the extent of secondary neuronal damage following closed head injury in mice

    PubMed Central

    Doulames, Vanessa M.; Vilcans, Meghan; Lee, Sangmook; Shea, Thomas B.

    2015-01-01

    Recovery following Traumatic Brain Injury (TBI) can vary tremendously among individuals. Lifestyle following injury, including differential social interactions, may modulate the extent of secondary injury following TBI. To examine this possibility under controlled conditions, closed head injury (CHI) was induced in C57Bl6 mice using a standardized weight drop device after which mice were either housed in isolation or with their original cagemates (“socially-housed”) for 4 weeks. CHI transiently impaired novel object recognition (NOR) in both isolated and social mice, confirming physical and functional injury. By contrast, Y maze navigation was impaired in isolated but not social mice at 1–4 weeks post CHI. CHI increased excitotoxic signaling in hippocampal slices from all mice, which was transiently exacerbated by isolation at 2 weeks post CHI. CHI slightly increased reactive oxygen species and did not alter levels of amyloid beta (Abeta), total or phospho-tau, total or phosphorylated neurofilaments. CHI increased serum corticosterone in both groups, which was exacerbated by isolation. These findings support the hypothesis that socialization may attenuate secondary damage following TBI. In addition, a dominance hierarchy was noted among socially-housed mice, in which the most submissive mouse displayed indices of stress in the above analyses that were statistically identical to those observed for isolated mice. This latter finding underscores that the nature and extent of social interaction may need to vary among individuals to provide therapeutic benefit. PMID:26528156

  6. Predicting clearing of post-traumatic amnesia following closed-head injury.

    PubMed

    Saneda, D L; Corrigan, J D

    1992-01-01

    The ability to predict the resolution of post-traumatic amnesia (PTA) early in the course of acute rehabilitation was studied in a sample of 98 closed-head injury (CHI) patients admitted for acute rehabilitation. The subjects' age, length of coma, time post-injury and Orientation Group Monitoring System (OGMS) subscale and aggregate scores were evaluated for the ability to predict if and when a patient would clear PTA. The results indicated that the combination of time post-injury and week one OGMS aggregate score provided the best prediction of whether and when PTA would clear. A shorter time from injury to acute rehabilitation was a positive prognostic indicator, accounting for more variance than either age or duration of coma. Whereas the aggregate OGMS score was a better indicator than any of the subscale scores, the results also suggested that specific aspects of cognition have differential predictive power, which may derive from different types of injury to the brain. Although the prediction model was statistically significant, its practical significance was limited. In particular, the high base rate for clearing PTA, 83.7%, attenuated the potential for differential prediction. Finally, this study provided additional support for the construct validity of the OGMS as a measure of cognitive function during the acute phase of recovery from CHI. PMID:1571721

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

    PubMed Central

    Alharthy, Nesrin; Al Queflie, Sulaiman; Alyousef, Khalid; Yunus, Faisel

    2015-01-01

    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. PMID:25949038

  8. Patterns, aetiology and risk factors of intimate partner violence-related injuries to head, neck and face in Chinese women

    PubMed Central

    2014-01-01

    Background Intimate partner violence (IPV) related injuries have been recognized among health care professionals. However, few studies have provided detailed information on injuries to the head, neck and face regions in Chinese women. As abused Chinese women are generally unwilling to disclose IPV and there are differences in socio-demographic characteristics, societal norms and behaviours, the women may exhibit different patterns, aetiology and risk factors of IPV-related HNF injuries. This study aims to examine the patterns of head, neck and face injuries presenting to Accident and Emergency departments, including the anatomical regions, types, severity, aetiology and demographic and non-demographic risk factors of injuries inflicted by intimate partners in Chinese context. Methods Medical charts of 223 women presented to the Accident and Emergency departments of two regional hospitals in Hong Kong between January 2010 and December 2011 were reviewed independently by two reviewers. Results Head, neck and face injuries remained the most common injuries found in abused Chinese women (77.6%), and punching with a fist was the most common aetiology (60.2%). In particular, punching with a fist was significantly associated on the upper third of the maxillofacial region (p = .01) and the back part of the head (p = .03). Moreover, cohabiting and separated women were more likely to have multiple injuries than those who were married (OR = 3.3, 95% CI = 1.4, 7.8; OR = 2.1, 95% CI = .4, 11.9). Conclusions The findings enhance the understanding of head, neck and face injuries and inform clinicians about the linkage among injuries and risks in abused Chinese women. PMID:24410868

  9. Simulative investigation on head injuries of electric self-balancing scooter riders subject to ground impact.

    PubMed

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

    2016-04-01

    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. PMID:26866282

  10. Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.

    PubMed

    Plackett, Timothy P; Asturias, Sabrina; Tadlock, Matthew; Wright, Franklin; Ton-That, Hieu; Demetriades, Demetrios; Esposito, Thomas; Inaba, Kenji

    2015-10-01

    There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 ± 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission. PMID:25957025

  11. Animal models of sports-related head injury: bridging the gap between pre-clinical research and clinical reality

    PubMed Central

    Angoa-Pérez, Mariana; Kane, Michael J.; Briggs, Denise I.; Herrera-Mundo, Nieves; Viano, David C.; Kuhn, Donald M.

    2016-01-01

    Sports-related head impact and injury has become a very highly contentious public health and medico-legal issue. Near-daily news accounts describe the travails of concussed athletes as they struggle with depression, sleep disorders, mood swings, and cognitive problems. Some of these individuals have developed chronic traumatic encephalopathy, a progressive and debilitating neurodegenerative disorder. Animal models have always been an integral part of the study of traumatic brain injury in humans but, historically, they have concentrated on acute, severe brain injuries. This review will describe a small number of new and emerging animal models of sports-related head injury that have the potential to increase our understanding of how multiple mild head impacts, starting in adolescence, can have serious psychiatric, cognitive and histopathological outcomes much later in life. PMID:24673291

  12. Comparison of cutaneous nerve injury and vessel disruption complications following saphenous vein stripping using big or small olive heads

    PubMed Central

    Cicek, Mustafa Cuneyt; Cicek, Omer Faruk; Lafci, Gokhan; Uzun, Alper

    2016-01-01

    Objective: To compare the nerve injury and vessel disruption complicaitons in patients undergoing saphenous vein stripping using olive heads of different sizes. Methods: Big olive heads were used in group A (n=50) and small olive heads were used in group B (n=50) from the ankle to the groin; in group C (n=50), the vein was stripped in two sections; in an upward fashion by stripping the distal portion from the ankle to the level of the knee using small olive heads and by stripping the proximal portion from the knee to the level of the groin using big olive heads. Results: Six months after the operation, nerve injury symptoms were identified in 26%, 4%, 6% of patients in groups A, B, and C respectively. Vessel disruption occurred 2% in group A, 32% in group B, and 4% in group C. Both vessel disruption and nerve injury complications of group C were significantly lower than group A and B (p<0.001). Conclusion: Saphenous stripping using big olive heads for the proximal portion from the groin down to the level of the knee and using small olive heads for the distal portion from the knee to the level of the ankle is the alternative method which results in minimal nerve injury and vessel disruption. PMID:27375703

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

    PubMed

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

    2009-01-01

    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. PMID:19214235

  14. Spillway-Induced Salmon Head Injury Triggers the Generation of Brain αII-Spectrin Breakdown Product Biomarkers Similar to Mammalian Traumatic Brain Injury

    PubMed Central

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

    2009-01-01

    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 αII-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. PMID:19214235

  15. Effects of intact versus non-intact families on adolescent head injury rehabilitation.

    PubMed

    Barry, P; Clark, D

    1992-01-01

    Forty-one children, aged 8-18 years, were admitted to a comprehensive in-patient head injury rehabilitation facility over a 5-year period. Over half (59%) came from families with only one biological parent in the home. Data from intact versus non-intact families suggest that the children from the latter were significantly younger and remained as in-patients significantly longer than their counterparts. The severity of injuries and incidence of premorbid psychosocial documentation were equivalent for the two groups. The implications for treatment and future research are discussed. A previous version of this paper was presented at the 97th convention of the American Psychological Association in New Orleans on August 13, 1989. The authors are grateful to Dr Mark Ylvisaker for his comments and suggestions. PMID:1581746

  16. Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact.

    PubMed

    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

    2015-01-01

    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. PMID:25039407

  17. Aspirin as a risk factor for hemorrhage in patients with head injuries.

    PubMed

    Reymond, M A; Marbet, G; Radü, E W; Gratzl, O

    1992-01-01

    The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. Aspirin should not be prescribed to patients with post-traumatic headaches. PMID:1584433

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

    PubMed Central

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

    2015-01-01

    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. PMID:26417498

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

    PubMed

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

    2015-09-01

    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. PMID:26417498

  20. The fake bad scale in atypical and severe closed head injury litigants.

    PubMed

    Greiffenstein, M Frank; Baker, W John; Gola, Thomas; Donders, Jacobus; Miller, Lori

    2002-12-01

    The correlational and diagnostic properties of Lees-Haley's MMPI-2 Fake Bad Scale (FBS) were examined in litigating atypical minor, litigating moderate-severe, and non-litigating moderate-severe head injury samples. Overall, the FBS was sensitive to both litigation status and nonconforming versus conforming symptom courses. The FBS appeared superior to the MMPI-2 F and F-K scales in differentiating atypical from real brain-injury outcomes. High FBS scorers also had higher scores on somatic complaining (Hs, Hy) and to a lesser degree with psychotic complaints (F, Pa, Sc). FBS showed significant associations with various neuropsychological symptom validity measures. FBS appears to capture a hybrid of infrequent symptom reporting styles with an emphasis on unauthentic physical complaints. However, FBS also correlated with documented abnormal neurological signs within a litigating moderate-severe brain-injury group. Its use as a symptom infrequency measure may have to be modified in more severe injury litigants, as some FBS items may reflect true long-term outcome in severe cerebral dysfunction. PMID:12455024

  1. Quantitative Relationship between Axonal Injury and Mechanical Response in a Rodent Head Impact Acceleration Model

    PubMed Central

    Li, Yan; Kallakuri, Srinivasu; Zhou, Runzhou; Cavanaugh, John M.

    2011-01-01

    Abstract 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 (R2=0.612, p<0.05), and time to surface right (R2=0.545, p<0.05). Our study suggested that a 2.25-m drop in the Marmarou model may not always result in a severe injury, and TAI level is related to the linear and angular acceleration response of the rat head during impact, not necessarily the drop height. PMID:21895482

  2. Use of the Disability Rating Scale Recovery curve as a predictor of psychosocial outcome following closed-head injury.

    PubMed

    McCauley, S R; Hannay, H J; Swank, P R

    2001-05-01

    Rapid rate of recovery has been associated with better outcome following closed-head injuries, but few studies have compellingly demonstrated this. This study used growth curve analyses of Disability Rating Scale (DRS) scores at acute hospitalization discharge, 1, 3, and 6 months post injury in a sample of 55 patients with a closed-head injury. Six month post-injury outcome measures were taken from significant other (SO) responses on the NYU Head Injury Family Interview (NYU-HIFI) including severity and burden ratings of affective/neurobehavioral disturbance, cognitive deficits, and physical/dependency status. Rate of recovery (linear and curvilinear recovery curve components) was significantly related to the level of affective/neurobehavioral severity, and the severity and burden of SO-perceived cognitive deficits. Only the intercept of the DRS recovery curve was associated with the SO-perceived severity and burden of physical/dependency status. Growth curve modeling is a meaningful and powerful tool in predicting head injury outcome. PMID:11396548

  3. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST)

    PubMed Central

    2014-01-01

    Background Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. Methods/design This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The

  4. Experimental study of head loss and filtration for LOCA debris

    SciTech Connect

    Rao, D.V.; Souto, F.J.

    1996-02-01

    A series of controlled experiments were conducted to obtain head loss and filtration characteristics of debris beds formed of NUKON{trademark} fibrous fragments, and obtain data to validate the semi-theoretical head loss model developed in NUREG/CR-6224. A thermally insulated closed-loop test set-up was used to conduct experiments using beds formed of fibers only and fibers intermixed with particulate debris. A total of three particulate mixes were used to simulate the particulate debris. The head loss data were obtained for theoretical fiber bed thicknesses of 0.125 inches to 4.0 inches; approach velocities of 0.15 to 1.5 ft/s; temperatures of 75 F and 125 F; and sludge-to-fiber nominal concentration ratios of 0 to 60. Concentration measurements obtained during the first flushing cycle were used to estimate the filtration efficiencies of the debris beds. For test conditions where the beds are fairly uniform, the head loss data were predictable within an acceptable accuracy range by the semi-theoretical model. The model was equally applicable for both pure fiber beds and the mixed beds. Typically the model over-predicted the head losses for very thin beds and for thin beds at high sludge-to-fiber mass ratios. This is attributable to the non-uniformity of such debris beds. In this range the correlation can be interpreted to provide upper bound estimates of head loss. This is pertinent for loss of coolant accidents in boiling water reactors.

  5. Oxidative metabolic activity of cerebral cortex after fluid-percussion head injury in the cat.

    PubMed

    Duckrow, R B; LaManna, J C; Rosenthal, M; Levasseur, J E; Patterson, J L

    1981-05-01

    To assess the metabolic and vascular effects of head trauma, fluid-percussion pressure waves were transmitted to the brains of anesthetized, paralyzed, and artificially ventilated cats. Changes in the redox state of cytochrome a,a3, and relative local blood volume were measured in situ by dual-wavelength reflection spectrophotometry of the cortical surface viewed through an acrylic cranial window implanted within the closed skull. Initial fluid-percussion impacts of 0.5 to 2.8 atm peak pressure produced consistent transient oxidation of cytochrome a,a3 and increases of cortical blood volume. These changes occurred despite the presence of transient posttraumatic hypotension i some cases. Also, impact-induced alterations of vascular tone occurred, independent of the presence or absence of transient hypertension in the posttraumatic period. These data demonstrate that hypoxia does not play a role in the immediate posttraumatic period in cerebral cortex, and are consistent with the idea that after injury there is increased cortical energy conservation. These data also support the concept that head trauma alters the relationship of metabolism and cerebral circulation in the period immediately after injury. PMID:7229699

  6. Experimental Models Combining Traumatic Brain Injury and Hypoxia.

    PubMed

    Thelin, Eric P

    2016-01-01

    Traumatic brain injury (TBI) is one of the most common causes of death and disability, and cerebral hypoxia is a frequently occurring harmful secondary event in TBI patients. The hypoxic conditions that occur on the scene of accident, where the airways are often obstructed or breathing is in other ways impaired, could be reproduced using animal TBI models where oxygen delivery is strictly controlled throughout the entire experimental procedure. Monitoring physiological parameters of the animal is of utmost importance in order to maintain an adequate quality of the experiment. Peripheral oxygen saturation, O2 pressure (pO2) in the blood, or fraction of inhaled O2 (FiO2) could be used as goals to validate the hypoxic conditions. Different models of traumatic brain injury could be used to inflict desired injury type, whereas effects then could be studied using radiological, physiological and functional tests. In order to confirm that the brain has been affected by a hypoxic injury, appropriate substances in the affected cerebral tissue, cerebrospinal fluid, or serum should be analyzed. PMID:27604734

  7. Lightning injury as a blast injury of skull, brain, and visceral lesions: clinical and experimental evidences.

    PubMed

    Ohashi, M; Hosoda, Y; Fujishiro, Y; Tuyuki, A; Kikuchi, K; Obara, H; Kitagawa, N; Ishikawa, T

    2001-12-01

    The present study attempts to better understand the mechanism of injuries associated with direct lightning strikes. We reviewed the records of 256 individuals struck by lightning between 1965 and 1999, including 56 people who were killed. Basal skull fracture, intracranial haemorrhage, pulmonary haemorrhage, or solid organ rupture was suspected in three men who died. Generally these lesions have been attributed to current flow or falling after being struck. However, examination of surface injuries sustained suggested that the true cause was concussion secondary to blast injury resulting from vaporization of water on the body surface by a surface flashover spark. To investigate this hypothesis, an experimental model of a lightning strike was created in the rat. Saline-soaked blotting paper was used to simulate wet clothing or skin, and an artificial lightning impulse was applied. The resultant lesions were consistent with our hypothesis that the blast was reinforced by the concussive effect of water vaporization. The concordance between the clinical and experimental evidence argues strongly for blast injury as an important source of morbidity and mortality in lightning strikes. PMID:11806503

  8. Experimental Traumatic Brain Injury Alters Ethanol Consumption and Sensitivity

    PubMed Central

    Lowing, Jennifer L.; Susick, Laura L.; Caruso, James P.; Provenzano, Anthony M.; Raghupathi, Ramesh

    2014-01-01

    Abstract Altered alcohol consumption patterns after traumatic brain injury (TBI) can lead to significant impairments in TBI recovery. Few preclinical models have been used to examine alcohol use across distinct phases of the post-injury period, leaving mechanistic questions unanswered. To address this, the aim of this study was to describe the histological and behavioral outcomes of a noncontusive closed-head TBI in the mouse, after which sensitivity to and consumption of alcohol were quantified, in addition to dopaminergic signaling markers. We hypothesized that TBI would alter alcohol consumption patterns and related signal transduction pathways that were congruent to clinical observations. After midline impact to the skull, latency to right after injury, motor deficits, traumatic axonal injury, and reactive astrogliosis were evaluated in C57BL/6J mice. Amyloid precursor protein (APP) accumulation was observed in white matter tracts at 6, 24, and 72 h post-TBI. Increased intensity of glial fibrillary acidic protein (GFAP) immunoreactivity was observed by 24 h, primarily under the impact site and in the nucleus accumbens, a striatal subregion, as early as 72 h, persisting to 7 days, after TBI. At 14 days post-TBI, when mice were tested for ethanol sensitivity after acute high-dose ethanol (4 g/kg, intraperitoneally), brain-injured mice exhibited increased sedation time compared with uninjured mice, which was accompanied by deficits in striatal dopamine- and cAMP-regulated neuronal phosphoprotein, 32 kDa (DARPP-32) phosphorylation. At 17 days post-TBI, ethanol intake was assessed using the Drinking-in-the-Dark paradigm. Intake across 7 days of consumption was significantly reduced in TBI mice compared with sham controls, paralleling the reduction in alcohol consumption observed clinically in the initial post-injury period. These data demonstrate that TBI increases sensitivity to ethanol-induced sedation and affects downstream signaling mediators of

  9. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration.

    PubMed

    Rowson, Steven; Duma, Stefan M

    2013-05-01

    Recent research has suggested possible long term effects due to repetitive concussions, highlighting the importance of developing methods to accurately quantify concussion risk. This study introduces a new injury metric, the combined probability of concussion, which computes the overall risk of concussion based on the peak linear and rotational accelerations experienced by the head during impact. The combined probability of concussion is unique in that it determines the likelihood of sustaining a concussion for a given impact, regardless of whether the injury would be reported or not. The risk curve was derived from data collected from instrumented football players (63,011 impacts including 37 concussions), which was adjusted to account for the underreporting of concussion. The predictive capability of this new metric is compared to that of single biomechanical parameters. The capabilities of these parameters to accurately predict concussion incidence were evaluated using two separate datasets: the Head Impact Telemetry System (HITS) data and National Football League (NFL) data collected from impact reconstructions using dummies (58 impacts including 25 concussions). Receiver operating characteristic curves were generated, and all parameters were significantly better at predicting injury than random guessing. The combined probability of concussion had the greatest area under the curve for all datasets. In the HITS dataset, the combined probability of concussion and linear acceleration were significantly better predictors of concussion than rotational acceleration alone, but not different from each other. In the NFL dataset, there were no significant differences between parameters. The combined probability of concussion is a valuable method to assess concussion risk in a laboratory setting for evaluating product safety. PMID:23299827

  10. [Traumatic rupture of the aortic isthmus in a patient with severe head injury].

    PubMed

    Lassié, P; Tentillier, E; Thicoïpé, M; Pinaquy, C; Laborde, N

    1993-01-01

    A 32-year-old man sustained a severe head injury in a road traffic accident. On admission, he was in deep coma (6 on the Glasgow coma scale). The aortic knuckle was difficult to identify on a plain chest film. Twenty hours after admission, the aortic knuckle had completely disappeared and the mediastinal shadow had become enlarged. The diagnosis of a ruptured aortic isthmus was confirmed by angiography. Surgical repair of this lesion may be carried out either with simple aortic cross-clamping, or by using cardiopulmonary bypass (CPB). Either technique may worsen other injuries, especially head injury, by initiating severe arterial hypertension or coagulation disturbances. In this patient, the technique chosen was aortic cross-clamping with permanent monitoring of the intracranial and cerebral perfusion pressures. Anaesthesia was obtained with 5 mg.kg-1 of thiopentone, 30 mg.kg-1 x h-1 of sodium gamma hydroxybutyrate and 8 micrograms.kg-1 x h-1 of fentanyl. Surgery lasted for 90 min, with 33 min of aortic clamping. The increase in arterial blood pressure was controlled with 0.25 mg.kg-1 x h-1 of thiopentone and nicardipine which was stopped 8 min before unclamping. The postoperative course was uneventful. Sedation was stopped after 8 days, and the patient regained consciousness two days later. These remained a paraplegia with no sensory deficit, which had totally receded 15 months later. Carrying out this emergency surgery without CPB means that the intracranial pressure must imperatively be monitored during surgery. Any intracranial hypertension should delay the surgery. PMID:8338263

  11. Spatiotemporal Pattern of Neuroinflammation After Impact-Acceleration Closed Head Injury in the Rat

    PubMed Central

    Rooker, Servan; Jander, Sebastian; Reempts, Jos Van; Stoll, Guido; Jorens, Philippe G.; Borgers, Marcel; Verlooy, Jan

    2006-01-01

    Inflammatory processes have been implicated in the pathogenesis of traumatic brain damage. We analyzed the spatiotemporal expression pattern of the proinflammatory key molecules: interleukin-1β, interleukin-6, tumor necrosis factor-α, and inducible nitric oxide synthase in a rat closed head injury (CHI) paradigm. 51 rats were used for RT-PCR analysis after CHI, and 18 for immunocytochemistry. We found an early upregulation of IL-1β, IL-6, and TNF-α mRNA between 1 h and 7 h after injury; the expression of iNOS mRNA only revealed a significant increase at 4 h. After 24 h, the expression decreased towards baseline levels, and remained low until 7 d after injury. Immunocytochemically, IL-1β induction was localized to ramified microglia in areas surrounding the primary impact place as well as deeper brain structures. Our study shows rapid induction of inflammatory gene expression that exceeds by far the primary impact site and might therefore contribute to tissue damage at remote sites. PMID:16864909

  12. Influence of impact speed on head and brain injury outcome in vulnerable road user impacts to the car hood.

    PubMed

    Fredriksson, Rikard; Zhang, Liying; Boström, Ola; Yang, King

    2007-10-01

    EuroNCAP and regulations in Europe and Japan evaluate the pedestrian protection performance of cars. The test methods are similar and they all have requirements for the passive protection of the hood area at a pedestrian to car impact speed of 40 km/h. In Europe, a proposal for a second phase of the regulation mandates a brake-assist system along with passive requirements. The system assists the driver in optimizing the braking performance during panic braking, resulting in activation only when the driver brakes sufficiently. In a European study this was estimated to occur in about 50% of pedestrian accidents. A future system for brake assistance will likely include automatic braking, in response to a pre-crash sensor, to avoid or mitigate injuries of vulnerable road users. An important question is whether these systems will provide sufficient protection, or if a parallel, passive pedestrian protection system will be necessary. This study investigated the influence of impact speed on head and brain injury risk, in impacts to the carhood. One car model was chosen and a rigid adjustable plate was mounted under the hood. Free-flying headform impacts were carried out at 20 and 30 km/h head impact velocities at different under-hood distances, 20 to 100 mm; and were compared to earlier tests at 40 km/h. The EEVC WG17 adult pedestrian headform was used for non-rotating tests and a Hybrid III adult 50th percentile head was used for rotational tests where linear and rotational acceleration was measured. Data from the rotational tests was used as input to a validated finite element model of the human head, the Wayne State University Head Injury Model (WSUHIM). The model was utilized to assess brain injury risk and potential injury mechanism in a pedestrian-hood impact. Although this study showed that it was not necessarily true that a lower HIC value reduced the risk for brain injury, it appeared, for the tested car model, under-hood distances of 60 mm in 20 km/h and 80 mm

  13. The management of trauma victims with head injury: a study by the national confidential enquiry into patient outcome and death

    PubMed Central

    Smith, NCE; Findlay, GP; Weyman, D

    2013-01-01

    Introduction In 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients. Methods Case note data were collected for all trauma patients admitted to all hospitals accepting emergencies in England, Wales, Northern Ireland and the Channel Islands over a three-month period. Severely injured patients with an injury severity score (ISS) of ≥16 were included in the study. The case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received. Results Of the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381). Conclusions This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities. PMID:23484990

  14. Injuries in combat from 1982-2005 with particular reference to those to the head and neck: A review.

    PubMed

    Rustemeyer, Jan; Kranz, Volker; Bremerich, Andreas

    2007-10-01

    The aim of this review was to examine the range of combat injuries with particular reference to those of the head and neck. We evaluated 10 retrospective studies selected from the period 1982-2005 that covered war injuries from Vietnam, Lebanon, Slovenia, Croatia, Iraq, Somalia, and Afghanistan. We found differences in the causes of injuries. Injuries from fragments were more common during the 90s than during the Vietnam War, where shooting injuries predominated. Injuries to the trunk were reduced in conflicts from 1991 onwards as military personal armour systems including protective vests were used. However, the mortality of wounded soldiers in all conflicts was consistently between 10% and 14%. There was a high incidence of injuries to the head and neck (up to 40%) though they affected only 12% of the body surface area. Though the data from the different military conflicts are not totally comparable, there are trends in the type of injuries and mortality, which may lead to changes in existing systems of medical care. PMID:17316932

  15. Secondary skull fractures in head wounds inflicted by captive bolt guns: autopsy findings and experimental simulation.

    PubMed

    Perdekamp, Markus Grosse; Kneubuehl, Beat P; Ishikawa, Takaki; Nadjem, Hadi; Kromeier, Jan; Pollak, Stefan; Thierauf, Annette

    2010-11-01

    Apart from one article published by Rabl and Sigrist in 1992 (Rechtsmedizin 2:156-158), there are no further reports on secondary skull fractures in shots from captive bolt guns. Up to now, the pertinent literature places particular emphasis on the absence of indirect lesions away from the impact point, when dealing with the wounding capacity of slaughterer's guns. The recent observation of two suicidal head injuries accompanied by skull fractures far away from the bolt's path gave occasion to experimental studies using simulants (glycerin soap, balls from gelatin) and skull–brain models. As far as ballistic soap was concerned, the dimensions of the bolt's channel were assessed by multi-slice computed tomography before cutting the blocks open. The test shots to gelatin balls and to skull-brain models were documented by means of a high-speed motion camera. As expected, the typical temporary cavity effect of bullets fired from conventional guns could not be observed when captive bolt stunners were discharged. Nevertheless, the visualized transfer of kinetic energy justifies the assumption that the secondary fractures seen in thin parts of the skull were caused by a hydraulic burst effect. PMID:20393855

  16. Understanding of literal truth, ironic criticism, and deceptive praise following childhood head injury.

    PubMed

    Dennis, M; Purvis, K; Barnes, M A; Wilkinson, M; Winner, E

    2001-07-01

    Children with closed head injury (CHI) have semantic-pragmatic language problems that include difficulty in understanding and producing both literal and nonliteral statements. For example, they are relatively insensitive to some of the social messages in nonstandard communication as well as to words that code distinctions among mental states. This suggests that they may have difficulty with comprehension tasks involving first- and second-order intentionality, such as those involved in understanding irony and deception. We studied how 6- to 15-year-old children, typically developing or with CHI, interpret scenarios involving literal truth, ironic criticism, and deceptive praise. Children with severe CHI had overall poorer mastery of the task. Even mild CHI impaired the ability to understand the intentionality underlying deceptive praise. CHI, especially biologically significant CHI, appears to place children at risk for failure to understand language as externalized thought. PMID:11412012

  17. Famous head injuries of the first aerial war: deaths of the "Knights of the Air".

    PubMed

    Koul, Prateeka; Mau, Christine; Sabourin, Victor M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2015-07-01

    World War I advanced the development of aviation from the concept of flight to the use of aircraft on the battlefield. Fighter planes advanced technologically as the war progressed. Fighter pilot aces Francesco Baracca and Manfred von Richthofen (the Red Baron) were two of the most famous pilots of this time period. These courageous fighter aces skillfully maneuvered their SPAD and Albatros planes, respectively, while battling enemies and scoring aerial victories that contributed to the course of the war. The media thrilled the public with their depictions of the heroic feats of fighter pilots such as Baracca and the Red Baron. Despite their aerial prowess, both pilots would eventually be shot down in combat. Although the accounts of their deaths are debated, it is undeniable that both were victims of traumatic head injury. PMID:26126404

  18. Paramedic intubation of patients with severe head injury: a review of current Australian practice and recommendations for change.

    PubMed

    Bernard, Stephen A

    2006-06-01

    Secondary brain injury may occur early after severe traumatic brain injury due to hypoxia and/or hypotension. Prehospital care by ambulance paramedics has the goal of preventing and treating these complications and, thus, improving outcomes. In Australia, most ambulance services recommend paramedics attempt endotracheal intubation in patients with severe head injury. Even though most patients with severe head injury retain airway reflexes, most states do not allow the use of appropriate drugs to facilitate intubation. In contrast, recent evidence from trauma registries suggests that this approach may be associated with significantly worse outcomes compared with no intubation. Two states allow intubation facilitated by sedative (but not relaxant) drugs, but this has a low success rate and could worsen brain injury because of a decrease in cerebral perfusion pressure. For road-based paramedics, the role of rapid sequence intubation is uncertain. Given the risks of this procedure and the lack of proven benefit, this procedure should not be introduced without supportive evidence from randomised, controlled trials. In contrast, for safety reasons, comatose patients transported by helicopter should undergo rapid sequence intubation prior to flight. However, this is not authorised in most states, despite good supportive evidence that this can be safely and effectively undertaken by paramedics. Finally, there is evidence that inadvertent hyperventilation is associated with adverse outcome, yet only two ambulance services use waveform capnography in head injury patients who are intubated. Overall, current paramedic airway practice in most states of Australia is not supported by the evidence and is probably associated with worse patient outcomes after severe head injury. For road-based paramedics, rapid transport to hospital without intubation should be regarded as the current standard of care. Rapid sequence intubation should be limited to use within appropriate clinical

  19. An audit of distribution and use of guidelines for management of head injury.

    PubMed Central

    Madhok, R; Thomson, R G; Mordue, A; Mendelow, A D; Barker, J

    1993-01-01

    Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey, in March 1992, assessed the impact of modifying the distribution. All (175) SHOs working in general surgery, accident and emergency medicine, orthopaedics, and neurosciences on 1 February 1990 in 19 hospitals including two neurosurgical units in Northern region were sent self completion questionnaires about awareness, receipt, use, and perceived usefulness of the guidelines. 131 of 163(80%) SHOs in post responded (median response from hospitals 83% (range 50%-100%)). Over three quarters (103, 79%) of SHOs were aware of the guidelines and 82(63%) had ever possessed a guidelines card. Only 36(44%) acquired the card in the induction pack. 92%(98/107) found them useful and 81% (89/110) referred to them to some extent. Owning and carrying the card and referring to guidelines were associated with departmental encouragement to use the guidelines. Increasing the displays of guidelines in wards and departments and the supply of cards to consultants in accident and emergency medicine as a result of this survey did not increase the number of SHOs who received cards (52/83, 63%), but more (71/83, 86%) were aware of the guidelines. The guidelines were welcomed by SHOs and used in treating patients with head injury, but their distribution requires improvement. Increased use of the guidelines may be achieved by introducing other distribution methods and as a result of encouragement by senior staff. PMID:10132074

  20. Head Impact Severity Measures for Evaluating Mild Traumatic Brain Injury Risk Exposure

    PubMed Central

    Greenwald, Richard M.; Gwin, Joseph T.; Chu, Jeffrey J.; Crisco, Joseph J.

    2009-01-01

    Objective To quantify sensitivity of various biomechanical measures of head impact (linear acceleration, rotational acceleration, impact duration, impact location) to clinical diagnosis of concussion in American football players and to develop a novel measure of head impact severity which combines these measures into a single score that better predicts the incidence of concussion. Methods On-field head impact data were collected from 449 football players at 13 organizations (n = 289,916) using in-helmet systems of six single axis accelerometers. 1,2,3,4,5 Concussions were diagnosed by medical staff and later associated with impact data. Principal Component Analysis 6, 7 and a weighting coefficient based on impact location were used to transform correlated head impact measures into a new composite variable (wPCS). The predictive power of linear acceleration, rotational acceleration, Head Injury Criteria, and wPCS was quantified using Receiver Operating Characteristic8,9,10 curves. The null hypothesis that a measure was no more predictive than guessing was tested (α=0.05). Additionally, ROC curves for wPCS and classical measures were directly compared to test the hypothesis that wPCS was more predictive of concussion than classic measures (α=0.05). Results When all impacts were considered, every biomechanical measure evaluated was statistically more predictive of concussion than guessing (p < 0.005). However, for the top 1% and 2% of impacts based on linear acceleration, a subset that consisted of 82% of all diagnosed concussions, only wPCS was significantly more predictive of concussion than guessing (p<0.03), and, when compared to each other, wPCS was more predictive of concussion than classical measures for the top 1% and 2% of all data (p < 0.04). Conclusions A weighted combination of several biomechanical inputs, including impact location, is more predictive of concussion than a single biomechanical measure. This study is the first to quantify improvements in

  1. Dissecting firearm injury to the head and neck with non-linear bullet trajectory: a case report.

    PubMed

    Can, Muhammet; Yildirim, Nadir; Ataç, Gökçe Kaan

    2010-04-15

    Firearm injuries to the head and neck have a potential for fatal complications caused by damage to neurovascular structures in the region. We herewith present a case of a missile injury to the face, caused by a bullet from a rifle with high muzzle energy that slackened while penetrating a vehicle before hitting the victim. The bullet advanced through the retrofacial spaces following a non-linear course and was retained within the opposite parapharyngeal region without injuring any vital structure. The resultant damage was a 'low-velocity injury'. However, it is noteworthy that the missile had still retained enough energy to penetrate the tissue and travel in a 'dissecting' fashion. It is likely that the blunting of the missile during vehicle penetration and the compactness of the anatomical structures bordering the head and neck spaces, such as fascia and tendons, forced the projectile to follow a non-linear inter-structural path. This case yet again demonstrates that the magnitude of firearm-related tissue damage may also depend upon the shape of the projectile and confirms that the head and neck spaces have anatomical integrity rather than just being arbitrarily designated topographical areas. It has also been confirmed that non-surgical approach with regular follow-ups is a viable option for uncomplicated head and neck injuries. PMID:20106613

  2. Effects of Two Types of Information on Malingering of Closed Head Injury on the MMPI-2: An Analog Investigation.

    ERIC Educational Resources Information Center

    Lamb, David G.; And Others

    1994-01-01

    The impact of detailed information on closed head injury (CHI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scales on malingering psychological symptoms of CHI on the MMPI-2 was studied in an analog experiment with 270 undergraduates. Results suggest the impact of such coaching on simulation of CHI. (SLD)

  3. Susceptibility of the MMPI-2-RF neurological complaints and cognitive complaints scales to over-reporting in simulated head injury.

    PubMed

    Bolinger, Elizabeth; Reese, Caitlin; Suhr, Julie; Larrabee, Glenn J

    2014-02-01

    We examined the effect of simulated head injury on scores on the Neurological Complaints (NUC) and Cognitive Complaints (COG) scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Young adults with a history of mild head injury were randomly assigned to simulate head injury or give their best effort on a battery of neuropsychological tests, including the MMPI-2-RF. Simulators who also showed poor effort on performance validity tests (PVTs) were compared with controls who showed valid performance on PVTs. Results showed that both scales, but especially NUC, are elevated in individuals simulating head injury, with medium to large effect sizes. Although both scales were highly correlated with all MMPI-2-RF over-reporting validity scales, the relationship of Response Bias Scale to both NUC and COG was much stronger in the simulators than controls. Even accounting for over-reporting on the MMPI-2-RF, NUC was related to general somatic complaints regardless of group membership, whereas COG was related to both psychological distress and somatic complaints in the control group only. Neither scale was related to actual neuropsychological performance, regardless of group membership. Overall, results provide further evidence that self-reported cognitive symptoms can be due to many causes, not necessarily cognitive impairment, and can be exaggerated in a non-credible manner. PMID:24191968

  4. Intraparenchymal hemorrhage segmentation from clinical head CT of patients with traumatic brain injury

    NASA Astrophysics Data System (ADS)

    Roy, Snehashis; Wilkes, Sean; Diaz-Arrastia, Ramon; Butman, John A.; Pham, Dzung L.

    2015-03-01

    Quantification of hemorrhages in head computed tomography (CT) images from patients with traumatic brain injury (TBI) has potential applications in monitoring disease progression and better understanding of the patho-physiology of TBI. Although manual segmentations can provide accurate measures of hemorrhages, the processing time and inter-rater variability make it infeasible for large studies. In this paper, we propose a fully automatic novel pipeline for segmenting intraparenchymal hemorrhages (IPH) from clinical head CT images. Unlike previous methods of model based segmentation or active contour techniques, we rely on relevant and matching examples from already segmented images by trained raters. The CT images are first skull-stripped. Then example patches from an "atlas" CT and its manual segmentation are used to learn a two-class sparse dictionary for hemorrhage and normal tissue. Next, for a given "subject" CT, a subject patch is modeled as a sparse convex combination of a few atlas patches from the dictionary. The same convex combination is applied to the atlas segmentation patches to generate a membership for the hemorrhages at each voxel. Hemorrhages are segmented from 25 subjects with various degrees of TBI. Results are compared with segmentations obtained from an expert rater. A median Dice coefficient of 0.85 between automated and manual segmentations is achieved. A linear fit between automated and manual volumes show a slope of 1.0047, indicating a negligible bias in volume estimation.

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

    PubMed Central

    Bolton Hall, Amanda N.; Joseph, Binoy; Brelsfoard, Jennifer M.; Saatman, Kathryn E.

    2016-01-01

    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. PMID:27427961

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

    PubMed

    Bolton Hall, Amanda N; Joseph, Binoy; Brelsfoard, Jennifer M; Saatman, Kathryn E

    2016-01-01

    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. PMID:27427961

  7. Intractable epilepsy and craniocerebral trauma: analysis of 163 patients with blunt and penetrating head injuries sustained in war.

    PubMed

    Kazemi, Hadi; Hashemi-Fesharaki, Sohrab; Razaghi, Soodeh; Najafi, Masomeh; Kolivand, Peir Hossein; Kovac, Stjepana; Gorji, Ali

    2012-12-01

    Post-traumatic epileptic seizure is a common complication of brain trauma including military injuries. We present clinical characteristics and correlates of post-traumatic epilepsy in 163 head-injured veterans suffering from intractable epilepsy due to blunt or penetrating head injuries sustained during the Iraq-Iran war. The medical records of 163 war veterans who were admitted by the Epilepsy Department of the Shefa Neuroscience Center between 2005 and 2009 were retrospectively reviewed. The mean follow-up period after developing epilepsy was 17.2 years. The time interval between the trauma and the first seizure was shorter and the seizure frequency was higher in epileptic patients suffering from penetrating head trauma. There was no difference in seizure type between epileptic patients traumatised by blunt or penetrating injury. Patients with seizure frequency of more than 30 per month mostly had simple partial seizure. Frontal and parietal semiologies were observed more frequently in patients with penetrating trauma, whereas patients with blunt trauma showed a higher temporal semiology. The most common brain lesion observed by CT scan was encephalomalacia followed by porencephaly and focal atrophy. There was no association between intracerebral retained fragments and different characteristic features of epilepsy. Patients with military brain injury carry a high risk of intractable post-traumatic epilepsy decades after their injury, and thus require a long-term medical follow-up. PMID:22763317

  8. Head injury from falls in children younger than 6 years of age

    PubMed Central

    Burrows, P; Trefan, L; Houston, R; Hughes, J; Pearson, G; Edwards, R J; Hyde, P; Maconochie, I; Parslow, R C; Kemp, A M

    2015-01-01

    The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described. Method Cross-sectional study of HIs from falls in children (<6 years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results. Results Of 1775 cases ascertained (median age 18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1 year)) had a significant relative OR for a skull fracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3 years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65). Conclusions Most HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known. PMID:26297697

  9. Antiepileptic and Antiepileptogenic Performance of Carisbamate after Head Injury in the Rat: Blind and Randomized Studies

    PubMed Central

    Eastman, Clifford L.; Verley, Derek R.; Fender, Jason S.; Stewart, Tessandra H.; Nov, Eytan; Curia, Giulia

    2011-01-01

    Carisbamate (CRS) exhibits broad acute anticonvulsant activity in conventional anticonvulsant screens, genetic models of absence epilepsy and audiogenic seizures, and chronic spontaneous motor seizures arising after chemoconvulsant-induced status epilepticus. In add-on phase III trials with pharmacoresistant patients CRS induced <30% average decreases in partial-onset seizure frequency. We assessed the antiepileptogenic and antiepileptic performance of subchronic CRS administration on posttraumatic epilepsy (PTE) induced by rostral parasaggital fluid percussion injury (rpFPI), which closely replicates human contusive closed head injury. Studies were blind and randomized, and treatment effects were assessed on the basis of sensitive electrocorticography (ECoG) recordings. Antiepileptogenic effects were assessed in independent groups of control and CRS-treated rats, at 1 and 3 months postinjury, after completion of a 2-week prophylactic treatment initiated 15 min after injury. The antiepileptic effects of 1-week CRS treatments were assessed in repeated measures experiments at 1 and 4 months postinjury. The studies were powered to detect ∼50 and ∼40% decreases in epilepsy incidence and frequency of seizures, respectively. Drug/vehicle treatment, ECoG analysis, and [CRS]plasma determination all were performed blind. We detected no antiepileptogenic and an equivocal transient antiepileptic effects of CRS despite [CRS]plasma comparable with or higher than levels attained in previous preclinical and clinical studies. These findings contrast with previous preclinical data demonstrating large efficacy of CRS, but agree with the average effect of CRS seen in clinical trials. The data support the use of rpFPI-induced PTE in the adolescent rat as a model of pharmacoresistant epilepsy for preclinical development. PMID:21123672

  10. Surgical Decision Making for the Elderly Patients in Severe Head Injuries

    PubMed Central

    Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

    2014-01-01

    Objective Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion Ethical training and developing decision-making skills are necessary including shared decision making. PMID:25024822

  11. Antiepileptic and antiepileptogenic performance of carisbamate after head injury in the rat: blind and randomized studies.

    PubMed

    Eastman, Clifford L; Verley, Derek R; Fender, Jason S; Stewart, Tessandra H; Nov, Eytan; Curia, Giulia; D'Ambrosio, Raimondo

    2011-03-01

    Carisbamate (CRS) exhibits broad acute anticonvulsant activity in conventional anticonvulsant screens, genetic models of absence epilepsy and audiogenic seizures, and chronic spontaneous motor seizures arising after chemoconvulsant-induced status epilepticus. In add-on phase III trials with pharmacoresistant patients CRS induced < 30% average decreases in partial-onset seizure frequency. We assessed the antiepileptogenic and antiepileptic performance of subchronic CRS administration on posttraumatic epilepsy (PTE) induced by rostral parasaggital fluid percussion injury (rpFPI), which closely replicates human contusive closed head injury. Studies were blind and randomized, and treatment effects were assessed on the basis of sensitive electrocorticography (ECoG) recordings. Antiepileptogenic effects were assessed in independent groups of control and CRS-treated rats, at 1 and 3 months postinjury, after completion of a 2-week prophylactic treatment initiated 15 min after injury. The antiepileptic effects of 1-week CRS treatments were assessed in repeated measures experiments at 1 and 4 months postinjury. The studies were powered to detect ~50 and ~40% decreases in epilepsy incidence and frequency of seizures, respectively. Drug/vehicle treatment, ECoG analysis, and [CRS](plasma) determination all were performed blind. We detected no antiepileptogenic and an equivocal transient antiepileptic effects of CRS despite [CRS](plasma) comparable with or higher than levels attained in previous preclinical and clinical studies. These findings contrast with previous preclinical data demonstrating large efficacy of CRS, but agree with the average effect of CRS seen in clinical trials. The data support the use of rpFPI-induced PTE in the adolescent rat as a model of pharmacoresistant epilepsy for preclinical development. PMID:21123672

  12. The War of Independence: a surgical algorithm for the treatment of head injury in the continental army.

    PubMed

    Sabourin, Victor M; Shah, Manan; Yick, Frederick; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-01-01

    The American Revolution was a gruesome warthat resulted in the independence of the United States of America from the British crown and countless casualties to both belligerents. However, from these desperate times, the treatment of traumatic head injury was elucidated, as were the origins of American neurosurgery in the 18th century. During the war, the surgical manual used by military field surgeons was titled Plain Concise Practical Remarks on the Treatment of Wounds and Fractures, by Dr. John Jones. This manual explains the different types of cranial injuries understood at that time as well as the relevant surgical treatment. This article seeks to review the surgical treatment of head injury in the Revolutionary War as outlined by Dr. Jones's manual. PMID:26274994

  13. Spontaneous and bilateral necrosis of the femoral head in a young experimental beagle dog

    PubMed Central

    Kobayashi, Ryosuke; Kurotaki, Tetsuro; Yamada, Naoaki; Kumabe, Shino; Doi, Takuya; Wako, Yumi; Tsuchitani, Minoru

    2015-01-01

    This report describes the pathological characterizations of a rare case of necrosis of the femoral head that was spontaneous, bilateral, avascular and nontraumatic. A 14-month-old beagle dog was presented with pain in the hind limbs. At necropsy, the articular surface in the bilateral femoral head was markedly irregular. There were no gross abnormalities other than in the hip joints. Microscopically, a wide range of trabecular bone necrosis localized in the subchondral area was observed in both femoral heads. In the right femoral head, fibrosis and proliferative vessels were noted in the subchondral area. The articular cartilage was thickened irregularly, but there was no evidence of cartilage necrosis. The bone marrow adjacent to the affected area showed severe depression. In the metaphysis, atrophic bone marrow, but not bone necrosis, was observed. This was a rare case of spontaneous necrosis of the femoral head in an experimental beagle dog. PMID:26028821

  14. Caregivers' voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood.

    PubMed

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

    2016-04-01

    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. PMID:26088208

  15. Alterations of functional properties of hippocampal networks following repetitive closed-head injury.

    PubMed

    Logue, Omar C; Cramer, Nathan P; Xu, Xiufen; Perl, Daniel P; Galdzicki, Zygmunt

    2016-03-01

    Traumatic brain injury (TBI) is the leading cause of death for persons under the age of 45. Military service members who have served on multiple combat deployments and contact-sport athletes are at particular risk of sustaining repetitive TBI (rTBI). Cognitive and behavioral deficits resulting from rTBI are well documented. Optimal associative LTP, occurring in the CA1 hippocampal Schaffer collateral pathway, is required for both memory formation and retrieval. Surprisingly, ipsilateral Schaffer collateral CA1 LTP evoked by 100Hz tetanus was enhanced in mice from the 3× closed head injury (3× CHI) treatment group in comparison to LTP in contralateral or 3× Sham CA1 area, and in spite of reduced freezing during contextual fear conditioning at one week following 3× CHI. Electrophysiological activity of CA1 neurons was evaluated with whole-cell patch-clamp recordings. 3× CHI ipsilateral CA1 neurons exhibited significant increases in action potential amplitude and maximum rise and decay slope while the action potential duration was decreased. Recordings of CA1 neuron postsynaptic currents were conducted to detect spontaneous excitatory and inhibitory postsynaptic currents (sEPSCs/sIPSCs) and respective miniature currents (mEPSCs and mIPSCs). In the 3× CHI mice, sEPSCs and sIPSCs in ipsilateral CA1 neurons had an increased frequency of events but decreased amplitudes. In addition, 3× CHI altered the action potential-independent miniature postsynaptic currents. The mEPSCs of ipsilateral CA1 neurons exhibited both an increased frequency of events and larger amplitudes. Moreover, the effect of 3× CHI on mIPSCs was opposite to that of the sIPSCs. Specifically, the frequency of the mIPSCs was decreased while the amplitudes were increased. These results are consistent with a mechanism in which repetitive closed-head injury affects CA1 hippocampal function by promoting a remodeling of excitatory and inhibitory synaptic inputs leading to impairment in hippocampal

  16. Injuries to the head and face in Brazilian adolescents and teenagers victims of non-natural deaths.

    PubMed

    Leite Cavalcanti, A; Barros De Alencar, C Y; Sant'Anna Araujo Rodrigues, I; Suenya de Almeida Pinto, M; Fabia Cabral Xavier, A; Leite Cavalcanti, C; Gondim Valenciq, A M

    2012-07-01

    This study aimed to evaluate the occurrence of injuries to the head and face in adolescent and teenager victims of non-natural deaths. A retrospective study was undertaken by the analysis of medical forensic reports obtained from medical forensic examinations performed at the Department of Forensic Medicine of the city of Campina Grande, PB, Brazil, between January 2003 and December 2007. From a total of 607 reports issued during this time span, the study sample consisted of 423 reports (69.6%) referring to adolescents and teenagers of both genders, aged 12 to 18 years, who were confirmed to have died from external causes. The causes of death were encoded according to the Chapter XX of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The majority of victims were 17 year old males (25.8%). Firearms (33.3%) and transport accidents (32.2%) were the most common causes of death, with boys showing a 3.7 times greater likelihood of getting killed by firearms than girls. There was statistically significant relationship between the occurrence of transport accidents and gender. The majority of victims (71.6%) presented with multiple injuries throughout the body. There was statistically significant relationship between the occurrence of transport accidents and the presence of multiple injuries. A high percentage of the victims presented with injuries to the head and face. There was statistically significant relationship between the occurrence of transport accidents and the presence of injury to the head. Fatal gunshot wounds and transport accidents were the main causes of death of male adolescents and teenagers. The victims presented with multiple injuries, especially to the head and face, and the mandible was the most frequently injured facial bone. . PMID:23000807

  17. An experimental evaluation of head-up display formats

    NASA Technical Reports Server (NTRS)

    Naish, J. M.; Miller, D. L.

    1980-01-01

    Three types of head-up display format are investigated. Type 1 is an unreferenced (conventional) flight director, type 2 is a ground referenced flight path display, and type 3 is a ground referenced director. Formats are generated by computer and presented by reflecting collimation against a simulated forward view in flight. Pilots, holding commercial licenses, fly approaches in the instrument flight mode and in a combined instrument and visual flight mode. The approaches are in wind shear with varied conditions of visibility, offset, and turbulence. The displays are equivalent in pure tracking but there is a slight advantage for the unreferenced director in poor conditions. Flight path displays are better for tracking in the combined flight mode, possibly because of poor director control laws and the division of attention between superimposed fields. Workloads is better for the type 2 displays. The flight path and referenced director displays are criticized for effects of symbol motion and field limiting. In the subjective judgment of pilots familiar with the director displays, they are rated clearly better than path displays, with a preference for the unreferenced director. There is a fair division of attention between superimposed fields.

  18. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

    PubMed Central

    Lecky, Fiona; Russell, Wanda; Fuller, Gordon; McClelland, Graham; Pennington, Elspeth; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damien; Freeman, Jennifer; Chapman, Nathan; Stevenson, Matt; Byers, Sonia; Mason, Suzanne; Potter, Hugh; Coats, Tim; Mackway-Jones, Kevin; Peters, Mary; Shewan, Jane; Strong, Mark

    2016-01-01

    and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%; p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury. CONCLUSIONS Current NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating 'early neurosurgery through bypass' and address the challenge of reliable TBI diagnosis at the scene of injury. TRIAL REGISTRATION Current Controlled Trials ISRCTN68087745. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology

  19. A computational simulation study of the influence of helmet wearing on head injury risk in adult cyclists.

    PubMed

    McNally, D S; Whitehead, S

    2013-11-01

    Evidence for the effectiveness of cycle helmets has relied either on simplified experiments or complex statistical analysis of patient cohorts or populations. This study directly assesses the effectiveness of cycle helmets over a range of accident scenarios, from basic loss of control to vehicle impact, using computational modelling. Simulations were performed using dynamics modelling software (MADYMO) and models of a 50% Hybrid III dummy, a hybrid cross bicycle and a car. Loss of control was simulated by a sudden turn of the handlebars and striking a curb, side and rear-on impacts by a car were also simulated. Simulations were run over a representative range of cycle speeds (2.0-14.0 m s(-1)) and vehicle speeds (4.5-17.9 m s(-1)). Bicycle helmets were found to be effective in reducing the severity of head injuries sustained in common accidents. They reduced the risk of an AIS>3 injury, in cases with head impacts, by an average of 40%. In accidents that would cause up to moderate (AIS=2) injuries to a non-helmeted rider, helmets eliminated the risk of injury. Helmets were also found to be effective in preventing fatal head injuries in some instances. The effectiveness of helmets was demonstrated over the entire range of cycle speeds studied, up to and including 14 m s(-1). There was no evidence that helmet wearing increased the risk of neck injury, indeed helmets were found to be protective of neck injuries in many cases. Similarly, helmets were found to offer an increase in protection even when an increase in cycle speed due to risk compensation was taken into consideration. PMID:24005027

  20. Development of Experimental Tissue Models for Blast Injury

    NASA Astrophysics Data System (ADS)

    Butler, Benjamin; Bo, Chiara; Williams, Alun; Jardine, Andy; Brown, Katherine

    2013-06-01

    There is a pressing need to better understand the relationship between the intensity of a blast wave and the clinical consequences for victims of an explosion. In order to quantitatively study how these factors correlate with one another, blast injury tissue models are being developed. Sections of larynx, trachea and pulmonary tissue were excised from a recently sacrificed pig and maintained on ice prior to testing. The samples were subjected to strain rates of between 0.001 s-1 and 1000 s-1 in the laboratory by using a Split Hopkinson Pressure Bar and quasi-static testing apparatus. During high strain rate testing, samples were housed in a polycarbonate chamber which permitted experimentation on tissue held in fluid. Data were analysed using 1, 2 and 3 wave analysis software in Matlab to yield information about the material properties of both undamaged and damaged tissues. In addition, macroscopic changes in tissue organization were also visualized using histopathological techniques. This work is being extended to cellular and animal models to derive more detailed information about the underlying molecular changes relating to blast-induced damage and repair. The Royal British Legion Centre for Blast Injury Studies.

  1. Demographics, Velocity Distributions, and Impact Type as Predictors of AIS 4+ Head Injuries in Motor Vehicle Crashes

    PubMed Central

    Yoganandan, Narayan; Fitzharris, Michael; Pintar, Frank A.; Stemper, Brian D.; Rinaldi, James; Maiman, Dennis J.; Fildes, Brian N.

    2011-01-01

    The objective of the study was to determine differences between the United States-based NASS and CIREN and Australia-based ANCIS databases in occupant-, crash-, and vehicle-related parameters for AIS 4+ head injuries in motor vehicle crashes. Logistic regression analysis was performed to examine roles of the change in velocity (DV), crash type (frontal, far-side, nearside, rear impact), seatbelt use, and occupant position, gender, age, stature, and body mass in cranial traumas. Belted and unbelted non-ejected occupant (age >16 years) data from 1997–2006 were used for the NASS and CIREN datasets, and 2000–2010 for ANCIS. Vehicle model year, and occupant position and demographics including body mass index (BMI) data were obtained. Injuries were coded using AIS 1990–1998 update. Similarities were apparent across all databases: mean demographics were close to the mid-size anthropometry, mean BMI was in the normal to overweight range, and representations of extreme variations were uncommon. Side impacts contributed to over one-half of the ensemble, implying susceptibility to head trauma in this mode. Odds of sustaining head injury increased by 4% per unit increase in DV (OR: 1.04, 95% CI: 1.03–1.04, p<0.001; adjusted for other variables); one-half for belted compared to unbelted occupants (OR: 0.48, 95% CI: 0.37–0.61, p<0.001); nearside, then far-side had significantly higher odds than frontal, and no difference by gender or position (front-left, front-right). Similar crash- and occupant-related outcomes from the two continents indicate a worldwide need to revise the translation acceleration-based head injury criterion to include the angular component in an appropriate format for improved injury assessment and mitigation. PMID:22105402

  2. Demographics, Velocity Distributions, and Impact Type as Predictors of AIS 4+ Head Injuries in Motor Vehicle Crashes.

    PubMed

    Yoganandan, Narayan; Fitzharris, Michael; Pintar, Frank A; Stemper, Brian D; Rinaldi, James; Maiman, Dennis J; Fildes, Brian N

    2011-01-01

    The objective of the study was to determine differences between the United States-based NASS and CIREN and Australia-based ANCIS databases in occupant-, crash-, and vehicle-related parameters for AIS 4+ head injuries in motor vehicle crashes. Logistic regression analysis was performed to examine roles of the change in velocity (DV), crash type (frontal, far-side, nearside, rear impact), seatbelt use, and occupant position, gender, age, stature, and body mass in cranial traumas. Belted and unbelted non-ejected occupant (age >16 years) data from 1997-2006 were used for the NASS and CIREN datasets, and 2000-2010 for ANCIS. Vehicle model year, and occupant position and demographics including body mass index (BMI) data were obtained. Injuries were coded using AIS 1990-1998 update. Similarities were apparent across all databases: mean demographics were close to the mid-size anthropometry, mean BMI was in the normal to overweight range, and representations of extreme variations were uncommon. Side impacts contributed to over one-half of the ensemble, implying susceptibility to head trauma in this mode. Odds of sustaining head injury increased by 4% per unit increase in DV (OR: 1.04, 95% CI: 1.03-1.04, p<0.001; adjusted for other variables); one-half for belted compared to unbelted occupants (OR: 0.48, 95% CI: 0.37-0.61, p<0.001); nearside, then far-side had significantly higher odds than frontal, and no difference by gender or position (front-left, front-right). Similar crash- and occupant-related outcomes from the two continents indicate a worldwide need to revise the translation acceleration-based head injury criterion to include the angular component in an appropriate format for improved injury assessment and mitigation. PMID:22105402

  3. Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

    PubMed

    Akber, E B; Alam, M T; Rahman, K M; Jahan, I; Musa, S A

    2016-04-01

    Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%). PMID:27277363

  4. Repeated mild closed head injury impairs short-term visuospatial memory and complex learning.

    PubMed

    Hylin, Michael J; Orsi, Sara A; Rozas, Natalia S; Hill, Julia L; Zhao, Jing; Redell, John B; Moore, Anthony N; Dash, Pramod K

    2013-05-01

    Concussive force can cause neurocognitive and neurobehavioral dysfunction by inducing functional, electrophysiological, and/or ultrastructural changes within the brain. Although concussion-triggered symptoms typically subside within days to weeks in most people, in 15%-20% of the cases, symptomology can continue beyond this time point. Problems with memory, attention, processing speed, and cognitive flexibility (e.g., problem solving, conflict resolution) are some of the prominent post-concussive cognitive symptoms. Repeated concussions (with loss or altered consciousness), which are common to many contact sports, can exacerbate these symptoms. The pathophysiology of repeated concussions is not well understood, nor is an effective treatment available. In order to facilitate drug discovery to treat post-concussive symptoms (PCSs), there is a need to determine if animal models of repeated mild closed head injury (mCHI) can mimic the neurocognitive and histopathological consequences of repeated concussions. To this end, we employed a controlled cortical impact (CCI) device to deliver a mCHI directly to the skull of mice daily for 4 days, and examined the ensuing neurological and neurocognitive functions using beam balance, foot-fault, an abbreviated Morris water maze test, context discrimination, and active place avoidance tasks. Repeated mCHI exacerbated vestibulomotor, motor, short-term memory and conflict learning impairments as compared to a single mCHI. Learning and memory impairments were still observed in repeated mCHI mice when tested 3 months post-injury. Repeated mCHI also reduced cerebral perfusion, prolonged the inflammatory response, and in some animals, caused hippocampal neuronal loss. Our results show that repeated mCHI can reproduce some of the deficits seen after repeated concussions in humans and may be suitable for drug discovery studies and translational research. PMID:23489238

  5. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries

    PubMed Central

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

    2015-01-01

    Objective: We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Subjects and methods: Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Results: Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Conclusion: Rib fracture patients have increased risk for truncal injuries and

  6. Costs of a Predictable Switch Between Simple Cognitive Tasks Following Severe Closed-Head Injury

    PubMed Central

    Schmitter-Edgecombe, Maureen; Langill, Michelle

    2007-01-01

    The authors used a predictable, externally cued task-switching paradigm to investigate executive control in a severe closed-head injury (CHI) population. Eighteen individuals with severe CHI and 18 controls switched between classifying whether a digit was odd or even and whether a letter was a consonant or vowel on every 4th trial. The target stimuli appeared in a circle divided into 8 equivalent parts. Presentation of the stimuli rotated clockwise. Participants performed the switching task at both a short (200 ms) and a long (1,000 ms) preparatory interval. Although the participants with CHI exhibited slower response times and greater switch costs, similar to controls, additional preparatory time reduced the switch costs, and the switch costs were limited to the 1st trial in the run. These findings indicate that participants with severe CHI were able to take advantage of time to prepare for the task switch, and the executive control processes involved in the switch costs were completed before the 1st trial of the run ended. PMID:17100512

  7. Prolonged hippocampal cell death following closed-head traumatic brain injury in rats.

    PubMed

    Tsuda, Shigeharu; Hou, Jiamei; Nelson, Rachel L; Wilkie, Zachary J; Mustafa, Golam; Sinharoy, Ankita; Watts, Joseph V; Thompson, Floyd J; Bose, Prodip K

    2016-07-01

    Traumatic brain injury (TBI) leads to enduring cognitive disorders. Although recent evidence has shown that controlled cortical impact in a rodent may induce memory deficits with prolonged cell death in the dentate gyrus (DG) of the hippocampus, few studies have reported long-term chronic hippocampal cell death following 'closed-head' TBI (cTBI), the predominant form of human TBI. Therefore, the aim of this study was to quantify terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)(+) apoptotic hippocampal cells as well as hippocampal cells with hallmark morphological features of degenerating cells in a chronic setting of cTBI in rats. TUNEL assays and Cresyl violet staining were performed using 6-month post-TBI fixed hippocampal sections. Evidence of prolonged hippocampal cell death was shown by the presence of a significantly increased number of TUNEL(+) cells in the cornu ammonis 1-3 (CA1-CA3) and DG of the hippocampus compared with intact controls. In addition, Cresyl violet staining indicated a significantly elevated number of cells with the degenerative morphological features in all hippocampal subregions (CA1-CA3, hilus, and DG). These results suggest that prolonged cell death may occur in multiple regions of the hippocampus following cTBI. PMID:27213933

  8. Risk factors for chronic subdural hematoma after a minor head injury in the elderly: a population-based study.

    PubMed

    Tseng, Jen-Ho; Tseng, Ming-Yuan; Liu, Ann-Jeng; Lin, Wen-Hsiung; Hu, Hsiao-Yun; Hsiao, Sheng-Huang

    2014-01-01

    Chronic subdural hematoma (CSDH) is one of the major comorbidities in elderly resulting in disability and death. Early recognition of CSDH is important for early management. However, manifestations of CSDH are nonspecific and subtle. Therefore, identification of risk factors of CSDH can offer clinical follow-up strategies for patients after episodes of head injury. The purpose of the study aimed at identifying risk factors of CSDH of Taiwanese. Analysis of data from the National Health Insurance provides important information on predictive factors influencing the early diagnosis of CSDH in elderly patients following minor head injuries. The current study is the first nationwide population-based study in Taiwan, showing that old age (≥75 years), male gender, and coexisting hydrocephalus are significantly predictive factors, irrespective to their medical comorbidities. PMID:25295251

  9. Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing

    PubMed Central

    Sharma, Sunanda; Nanda, Aditi; Koli, Dheeraj; Daksh, Sapna; Verma, Mahesh

    2014-01-01

    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. PMID:25125873

  10. Differential activation of microglia after experimental spinal cord injury.

    PubMed

    Watanabe, T; Yamamoto, T; Abe, Y; Saito, N; Kumagai, T; Kayama, H

    1999-03-01

    This study sought to experimentally clarify time-dependent, differential microglial activation at various spinal cord locations in response to injury. The spinal cords of Wistar rats were either sharply transected at the Th 11 or subjected to compression at the same site. Immediately to 4 weeks after injury, each spinal cord was fixed and cut into longitudinal frozen sections, and was immunostained with OX42 for resident and activated microglia, OX-6 for activated microglia, GFAP for activated astrocytes, and biotinylated BS-I, a lectin for both resident and activated microglia. From three to 24 hours after injury, we observed a narrow belt around the transection site in which OX42 positive microglia were dramatically reduced in number, or often absent. BS-I labeling of the zone disclosed the rapid transformation of those microglia possessing typical antler-like processes to macrophage-like cells. At day 1 and thereafter, the zone of reduced OX42 immunoreactivity was gradually replaced by macrophage-like OX42-positive round cells, and the lesion itself was ultimately capped by fibrogliotic scar tissue. By 2-4 weeks postinjury, another phase of microglial activation was observed in those white matter tracts undergoing Wallerian degeneration. These microglia characterized by the presence of newly-expressed MHC class II antigens. We posit that the decreased OX42 immunoreactivity suggests that CR3 is quickly saturated by activated iC3b and internalized, but not down-regulated. The trigger for this transformation most likely occurs through signaling by iC3b-saturated CR3. In contrast, microglia activation along those degenerating tracts undergoing Wallerian degeneration does not appear to be CR3-related, as the CR3 is upregulated. These observations indicate microglia have at least two different spatial and temporal patterns of activation. One is rapid and most likely involves the blood-borne complement activating system. The other accompanies Wallerian degeneration and

  11. Effect of Aspirin on Spinal Cord Injury: An Experimental Study

    PubMed Central

    Kermani, Hamed Reihani; Nakhaee, Nouzar; Fatahian, Reza; Najar, Ahmad Gholamhosseinian

    2016-01-01

    Aspirin is an anti-inflammatory drug, peroxyl radical scavenger, and antioxidant agent that inhibits phospholipases, nitric oxide synthetases, and cyclooxygenase enzymes. The existing literature contains no studies on the effects of various doses of aspirin on spinal cord injury (SCI). Therefore, we sought to investigate the putative effects of aspirin on experimental SCI. The weight-drop injury model was used to produce SCI in 100 albino Wistar rats. The animals were allocated to five groups: a control group, where the rats did not undergo any surgical or medical intervention except for anesthesia; a sham-treated group, where laminectomy was performed without SCI and no further therapy was administered; and three other groups, where the rats with SCI received low-dose aspirin [20 mg/kg], high-dose aspirin [80 mg/kg], and a vehicle, respectively. Half of the rats were sacrificed 24 hours later, and their spinal cords were excised for biochemical studies. The other rats were subjected to Basso, Beattie, and Bresnahan (BBB) locomotor rating scale scoring once a week for 6 consecutive weeks. Aspirin decreased lipid peroxidation following SCI as the mean (± standard error) catalase level was significantly higher in the high-dose aspirin group (46.10±12.01) than in the sham-treated group (16.07±2.42) and the vehicle-treated group (15.31±3.20) (P<0.05; P<0.05, respectively). Both of the groups treated with high-dose and low-dose aspirin demonstrated a higher mean BBB score than did the control group (P<0.001) and the sham-treated group (P<0.001). Our data provide evidence in support of the potential effects of aspirin in biochemical and neurobehavioral recovery after SCI. PMID:27217606

  12. Effects of external helmet accessories on biomechanical measures of head injury risk: An ATD study using the HYBRIDIII headform.

    PubMed

    Butz, Robert C; Knowles, Brooklynn M; Newman, James A; Dennison, Christopher R

    2015-11-01

    Competitive cycling is a popular activity in North America for which injuries to the head account for the majority of hospitalizations and fatalities. In cycling, use of helmet accessories (e.g. cameras) has become widespread. As a consequence, standards organizations and the popular media are discussing the role these accessories could play in altering helmet efficacy and head injury risk. We conducted impacts to a helmeted anthropomorphic headform, with and without camera accessories, at speeds of 4m/s and 6m/s, and measured head accelerations, forces on the head-form skull, and used the Simulated Injury Monitor to estimate brain tissue strain. The presence of the camera reduced peak linear head acceleration (51% - 4m/s impacts, 61% - 6m/s, p<0.05). Skull fracture risk based on kinematics was always less than 1%. For 4m/s impacts, peak angular accelerations were lower (47%, p<0.05), as were peak angular velocities (14%) with the velocity effect approaching significance (p=0.06), with the camera accessory. For 6m/s impacts, accelerations were on average higher (5%, p>0.05) as were velocities (77%, p<0.05). Skull forces were never greater than 443.2N, well below forces associated with fracture. Brain tissue strain, the cumulative strain damage measure at 25% (CSDM-25), was lower (56%, p<0.05) in 4m/s but higher (125%, p>0.05) in 6m/s impacts with the camera accessory. Based on CSDM-25 for 4m/s tests, the risk of severe concussion was reduced (p<0.05) from 25% (no camera) to 7% (camera). For 6m/s tests, risks were on average increased (p>0.05) from 18% (no camera) to 58% (camera). PMID:26477409

  13. Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model

    PubMed Central

    Barry, Erin S.; Bhomia, Manish; Hutchison, Mary Anne; Balakathiresan, Nagaraja S.; Grunberg, Neil E.; Maheshwari, Radha K.

    2014-01-01

    Wars in Iraq and Afghanistan have highlighted the problems of diagnosis and treatment of mild traumatic brain injury (mTBI). MTBI is a heterogeneous injury that may lead to the development of neurological and behavioral disorders. In the absence of specific diagnostic markers, mTBI is often unnoticed or misdiagnosed. In this study, mice were induced with increasing levels of mTBI and microRNA (miRNA) changes in the serum were determined. MTBI was induced by varying weight and fall height of the impactor rod resulting in four different severity grades of the mTBI. Injuries were characterized as mild by assessing with the neurobehavioral severity scale-revised (NSS-R) at day 1 post injury. Open field locomotion and acoustic startle response showed behavioral and sensory motor deficits in 3 of the 4 injury groups at day 1 post injury. All of the animals recovered after day 1 with no significant neurobehavioral alteration by day 30 post injury. Serum microRNA (miRNA) profiles clearly differentiated injured from uninjured animals. Overall, the number of miRNAs that were significantly modulated in injured animals over the sham controls increased with the severity of the injury. Thirteen miRNAs were found to identify mTBI regardless of its severity within the mild spectrum of injury. Bioinformatics analyses revealed that the more severe brain injuries were associated with a greater number of miRNAs involved in brain related functions. The evaluation of serum miRNA may help to identify the severity of brain injury and the risk of developing adverse effects after TBI. PMID:25379886

  14. Long-term outcomes of major trauma without head injury in the West of Scotland: pilot case-control study.

    PubMed

    Graham, Colin A; Gordon, Malcolm W G; Roy, Christopher W; Hanlon, Philip W

    2007-02-01

    The aim of this study was to identify the outcomes of survivors of blunt major trauma (without head injury) 2 years or more following injury. The study uses a case-control design, is set in the West of Scotland and includes trauma patients treated in Greater Glasgow NHS Board hospitals. Participants consisted of patients who had sustained major trauma (injury severity score >15) with little or no head injury at least 2 years before assessment, identified from the Scottish Trauma Audit Group database, and age and sex-matched controls nominated by the index case's general practitioner. Nineteen cases and seven controls completed the study from 223 potential cases and 39 potential controls. Participants and non-participants had comparable injury severity score, probability of survival (Ps) and length of stay. American Medical Association impairment scores show survivors were more impaired than controls (25.9 vs 7.4%, P=0.043). No differences were observed in Functional Independence Measure (FIM) or Community Integration Questionnaire (CIQ) scores, although a type II error is possible. Short-form 36 (SF36) Physical Component Summary (PCS) scores of survivors showed no difference compared with controls although survivors' PCS scores were below UK and US means (P=0.008). SF36 Mental Component Summary (MCS) scores of survivors were below those of controls (45.07 vs 56.65, P=0.004) and normal values of the UK population (P=0.036). No differences in work status were noted, but small sample sizes were used. Non-head-injured survivors of major trauma in the West of Scotland have poorer health status (SF36), physically and mentally, than the UK population. They have greater impairment, but have an employment status comparable to that of the controls. The lack of differences in FIM and CIQ scores between survivors and controls may be due to small sample sizes. PMID:17198324

  15. Cerebral blood flow and metabolism in children with severe head injuries. Part 2: Cerebrovascular resistance and its determinants.

    PubMed Central

    Sharples, P M; Matthews, D S; Eyre, J A

    1995-01-01

    It has been proposed that in children with severe head injuries the cerebral circulation does not respond appropriately to normal physiological control mechanisms, making children more susceptible than adults to low cerebrovascular resistance, increased cerebral blood flow (cerebral hyperaemia), and raised intracranial pressure. To investigate this issue, 122 serial measurements of cerebrovascular resistance in 17 children with severe head injuries have been performed and related to cerebral perfusion pressure, arterial CO2 (PaCO2), arterial oxygen content (AO2), and the cerebral metabolic rate of oxygen (CMRO2). Cerebrovascular resistance values (mean (SD) 1.54 (0.61) mm Hg.ml-1.100 g.min) were normal or raised in most cases; 71 values (58%) were within the normal range, 39 (32%) above the upper limit, and only 12 (10%) below the lower limit. There was a significant correlation between cerebral perfusion pressure and cerebrovascular resistance (r = 0.32, p = 0.0003), suggesting preservation of pressure autoregulation. This correlation was absent in four of the five children who died or survived with severe handicap. Analysis by multilevel modelling indicated that, as in normal subjects, CMRO2, CPP, AO2, PaCO2, and cerebrovenous pH were important independent determinants of cerebrovascular resistance. The results indicate that normal cerebrovascular reactivity is often preserved in children with severe head injuries but may be impaired in the most severely injured patients. PMID:7876844

  16. Angular Impact Mitigation system for bicycle helmets to reduce head acceleration and risk of traumatic brain injury.

    PubMed

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

    2013-10-01

    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 (p<0.001), a 34% reduction in peak angular acceleration (p<0.001), and a 22-32% reduction in neck loading (p<0.001). Computational results predicted that AIM helmets reduced the risk of concussion and DAI by 27% and 44%, respectively. In conclusion, these results demonstrated that AIM technology could effectively improve impact mitigation compared to a contemporary expanded polystyrene-based bicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required. PMID:23770518

  17. Angular Impact Mitigation System for Bicycle Helmets to Reduce Head Acceleration and Risk of Traumatic Brain Injury

    PubMed Central

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

    2013-01-01

    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 (p < 0.001), a 34% reduction in peak angular acceleration (p < 0.001), and a 22% to 32% reduction in neck loading (p < 0.001). Computational results predicted that AIM helmets reduced the risk of concussion and DAI by 27% and 44%, respectively. In conclusion, these results demonstrated that AIM technology could effectively improve impact mitigation compared to a contemporary expanded polystyrene-based bicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required. PMID:23770518

  18. Noninvasive assessment of hemodynamic and brain metabolism parameters following closed head injury in a mouse model by comparative diffuse optical reflectance approaches.

    PubMed

    Abookasis, David; Volkov, Boris; Shochat, Ariel; Kofman, Itamar

    2016-04-01

    Optical techniques have gained substantial interest over the past four decades for biomedical imaging due to their unique advantages, which may suggest their use as alternatives to conventional methodologies. Several optical techniques have been successfully adapted to clinical practice and biomedical research to monitor tissue structure and function in both humans and animal models. This paper reviews the analysis of the optical properties of brain tissue in the wavelength range between 500 and 1000 nm by three different diffuse optical reflectance methods: spatially modulated illumination, orthogonal diffuse light spectroscopy, and dual-wavelength laser speckle imaging, to monitor changes in brain tissue morphology, chromophore content, and metabolism following head injury. After induction of closed head injury upon anesthetized mice by weight-drop method, significant changes in hemoglobin oxygen saturation, blood flow, and metabolism were readily detectible by all three optical setups, up to 1 h post-trauma. Furthermore, the experimental results clearly demonstrate the feasibility and reliability of the three methodologies, and the differences between the system performances and capabilities are also discussed. The long-term goal of this line of study is to combine these optical systems to study brain pathophysiology in high spatiotemporal resolution using additional models of brain trauma. Such combined use of complementary algorithms should fill the gaps in each system's capabilities, toward the development of a noninvasive, quantitative tool to expand our knowledge of the principles underlying brain function following trauma, and to monitor the efficacy of therapeutic interventions in the clinic. PMID:27175372

  19. Comparison of PECARN, CATCH, and CHALICE Rules for Children with Minor Head Injury: A prospective cohort study

    PubMed Central

    Easter, Joshua S.; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S.

    2014-01-01

    Objective To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries (TBIs) in children with minor head injuries presenting to the emergency department (ED). Methods We prospectively enrolled children <18 years of age with minor head injury (Glasgow Coma Scale 13 – 15) presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (CATCH, CHALICE, PECARN) and 2 measures of physician judgment (estimated of <1% risk of TBI, actual CT ordering practice) to predict clinically important TBI, as defined by death from TBI, need for neurosurgery, intubation >24 hours for TBI, or hospital admission >2 nights for TBI. Results Among the 1,009 children, 21 (2%; 95% CI: 1% to 3%) had clinically important TBIs. Only physician practice and PECARN identified all clinically important TBIs, with ranked sensitivities as follows (95% CI): Physician practice and PECARN each 100% (84% to 100%), physician estimates 95% (76% to 100%), CATCH 91% (70% to 99%), and CHALICE 84% (60% to 97%). Ranked specificities were as follows: CHALICE 85% (82% to 87%), physician estimates 68% (65% to 71%), PECARN 62% (59% to 66%), physician practice 50% (47% to 53%), and CATCH 44% (41% to 47%). Conclusions Of the 5 modalities studied, only physician practice and PECARN identified all clinically important TBIs, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely sensitive and had the poorest specificity of all modalities. PMID:24635987

  20. Racemic ketamine in adult head injury patients: use in endotracheal suctioning

    PubMed Central

    2013-01-01

    Introduction Endotracheal suctioning (ETS) is essential for patient care in an ICU but may represent a cause of cerebral secondary injury. Ketamine has been historically contraindicated for its use in head injury patients, since an increase of intracranial pressure (ICP) was reported; nevertheless, its use was recently suggested in neurosurgical patients. In this prospective observational study we investigated the effect of ETS on ICP, cerebral perfusion pressure (CPP), jugular oxygen saturation (SjO2) and cerebral blood flow velocity (mVMCA) before and after the administration of ketamine. Methods In the control phase, ETS was performed on patients sedated with propofol and remifentanil in continuous infusion. If a cough was present, patients were assigned to the intervention phase, and 100 γ/kg/min of racemic ketamine for 10 minutes was added before ETS. Results In the control group ETS stimulated the cough reflex, with a median cough score of 2 (interquartile range (IQR) 1 to 2). Furthermore, it caused an increase in mean arterial pressure (MAP) (from 89.0 ± 11.6 to 96.4 ± 13.1 mmHg; P <0.001), ICP (from 11.0 ± 6.7 to 18.5 ± 8.9 mmHg; P <0.001), SjO2 (from 82.3 ± 7.5 to 89.1 ± 5.4; P = 0.01) and mVMCA (from 76.8 ± 20.4 to 90.2 ± 30.2 cm/sec; P = 0.04). CPP did not vary with ETS. In the intervention group, no significant variation of MAP, CPP, mVMCA, and SjO2 were observed in any step; after ETS, ICP increased if compared with baseline (15.1 ± 9.4 vs. 11.0 ± 6.4 mmHg; P <0.05). Cough score was significantly reduced in comparison with controls (P <0.0001). Conclusions Ketamine did not induce any significant variation in cerebral and systemic parameters. After ETS, it maintained cerebral hemodynamics without changes in CPP, mVMCA and SjO2, and prevented cough reflex. Nevertheless, ketamine was not completely effective when used to control ICP increase after administration of 100 γ/kg/min for 10

  1. The Effect of Various Types of Motorcycle Helmets on Cervical Spine Injury in Head Injury Patients: A Multicenter Study in Taiwan

    PubMed Central

    Lin, Mau-Roung; Chu, Shu-Fen; Tsai, Shin-Han; Bai, Chyi-Huey; Chiu, Wen-Ta

    2015-01-01

    Introduction. The relationship between cervical spine injury (CSI) and helmet in head injury (HI) patients following motorcycle crashes is crucial. Controversy still exists; therefore we evaluated the effect of various types of helmets on CSI in HI patients following motorcycle crashes and researched the mechanism of this effect. Patients and Methods. A total of 5225 patients of motorcycle crashes between 2000 and 2009 were extracted from the Head Injury Registry in Taiwan. These patients were divided into case and control groups according to the presence of concomitant CSI. Helmet use and types were separately compared between the two groups and the odds ratio of CSI was obtained by using multiple logistic regression analysis. Results. We observed that 173 (3.3%) of the HI patients were associated with CSI. The HI patients using a helmet (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.19−0.49), full-coverage helmet (0.19, 0.10−0.36), and partial-coverage helmet (0.35, 0.21−0.56) exhibited a significantly decreased rate of CSI compared with those without a helmet. Conclusion. Wearing full-coverage and partial-coverage helmets significantly reduced the risk of CSI among HI patients following motorcycle crashes. This effect may be due to the smooth surface and hard padding materials of helmet. PMID:25705663

  2. [Case of primary central nervous system lymphoma after open head injury].

    PubMed

    Honma, Mari; Ota, Mamoru; Sato, Naoki; Ogawa, Kazuei; Sugino, Takashi; Yamamoto, Teiji

    2012-01-01

    A 65-year-old man had suffered contusion of the left frontal lobe of the brain with a skull base fracture, pneumocephalus, and cerebrospinal fluid (CSF) leakage. He was treated with ceftriaxone 4 g/day for 14 days, but after 1 month he developed multiple cranial nerve palsies (bilateral III-X). CSF contained increased levels of protein (96 mg/dl) and mononuclear cells (72 cells/mm³), and low glucose levels (40 mg/dl, blood sugar 120 mg/dl), but no malignant cells were detected. Magnetic resonance imaging (MRI) disclosed swelling in multiple cranial nerves with Gd enhancement. Anti-biotic and antifungal therapy remitted the facial, glossopharyngeal, and vagus nerve palsies and reduced the Gd-enhancement lesion, as detected by MRI. However, the eyes were bilaterally dilated and medially fixed, and hearing impairments persisted. After 3 months, follow-up MRIs revealed the presence of Gd-enhanced small masses at the ventral pontine base, medulla, and cervicomedullary junctions despite a lack of change in neurological symptoms. Those lesions subsided favorably upon treatment with intravenous and oral corticosteroids. After 1 year and 9 months, Gd-enhanced small cystic masses appeared on the medulla and cerebellum. An open biopsy of the cerebellar tonsillar lesions revealed diffuse large B cell lymphoma. Although the development of primary central nervous system lymphoma after open head injury and infection has not been reported to date, central nervous system lymphomas may mimic diverse neurological diseases. Brain biopsy remains the only definitive diagnosis, and thus should be pursued if blood and CSF markers appear normal. PMID:22688112

  3. Alterations in brain protein kinase C after experimental brain injury.

    PubMed

    Padmaperuma, B; Mark, R; Dhillon, H S; Mattson, M P; Prasad, M R

    1996-04-01

    Regional activities and levels of protein kinase C were measured after lateral fluid percussion brain injury in rats. At 5 min and 20 min after injury, neither cofactor-dependent nor -independent PKC activities in the cytosol and membrane fractions changed in the injured and contralateral cortices or in the ipsilateral hippocampus. Western blot analysis revealed decreases in the levels of cytosolic PKC alpha and PKC beta in the injured cortex after brain injury. In the same site, a significant increase in the levels of membrane PKC alpha and PKC beta was observed after injury. Although the level of PKC alpha did not change and that of PKC beta decreased in the cytosol of the ipsilateral hippocampus, these levels did not increase in the membrane fraction after injury. The levels of PKC gamma were generally unchanged in the cytosol and the membrane, except for its decrease in the cytosol of the hippocampus. There were no changes in the levels of any PKC isoform in either the cytosol or the membrane of the contralateral cortex after injury. The present results suggest a translocation of PKC alpha and PKC beta from the cytosol to the membrane in the injured cortex after brain injury. The observation that such a translocation occurs only in the brain regions that undergo substantial neuronal loss suggests that membrane PKC may play a role in neuronal damage after brain injury. PMID:8861605

  4. The predicted risk of head injury from fall-related impacts on to third-generation artificial turf and grass soccer surfaces: a comparative biomechanical analysis.

    PubMed

    Theobald, Peter; Whitelegg, Liam; Nokes, Leonard D M; Jones, Michael D

    2010-03-01

    The risk of soccer players sustaining mild traumatic brain injury (MTBI) following head impact with a playing surface is unclear. This study investigates MTBI by performing headform impact tests from varying heights onto a range of third-generation artificial turf surfaces. Each turf was prepared as per manufacturers specifications within a laboratory, before being tested immediately following installation and then again after a bedding-in period. Each turf was tested dry and when wetted to saturation. Data from the laboratory tests were compared to an in situ third-generation surface and a professional grass surface. The surface performance threshold was set at a head impact criterion (HIC) = 400, which equates to a 10% risk of the head impact causing MTBI. All six third-generation surfaces had a > 10% risk of MTBI from a fall > 0.77 m; the inferior surfaces required a fall from just 0.46 m to have a 10% MTBI risk. Wetting the artificial turf did not produce a statistically significant improvement (P > 0.01). The in situ third-generation playing surface produced HIC values within the range of bedded-in experimental values. However, the natural turf pitch was the superior performer--necessitating fall heights exceeding those achievable during games to achieve HIC = 400. PMID:20446637

  5. Experimental measurement of human head motion for high-resolution computed tomography system design

    NASA Astrophysics Data System (ADS)

    Li, Liang; Chen, Zhiqiang; Jin, Xin; Yu, Hengyong; Wang, Ge

    2010-06-01

    Human head motion has been experimentally measured for high-resolution computed tomography (CT) design using a Canon digital camera. Our goal is to identify the minimal movements of the human head under ideal conditions without rigid fixation. In our experiments, all the 19 healthy volunteers were lying down with strict self-control. All of them were asked to be calm without pressures. Our results showed that the mean absolute value of the measured translation excursion was about 0.35 mm, which was much less than the measurements on real patients. Furthermore, the head motions in different directions were correlated. These results are useful for the design of the new instant CT system for in vivo high-resolution imaging (about 40 μm).

  6. Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria

    PubMed Central

    Olabinri, Eunice O.; Ogbole, Godwin I.; Adeleye, Amos O.; Dairo, David M.; Malomo, Adefolarin O.; Ogunseyinde, Ayotunde O.

    2015-01-01

    Background: Basal skull fractures (BSF) in head injury may be missed clinically. Early detection ensures prompt treatment and prevention of complications We compared the clinical and Computed Tomography (CT) features of basal skull fractures in head injured patients in a southwestern Nigerian hospital. Materials and Methods: Head injury patients who had cranial CT at a Southwestern Nigerian hospital were selected. CT images were acquired with a 64-slice Toshiba Aquillion CT scanner using a standard head protocol. The images were evaluated for evidence of skull fractures, and associated complications. The clinical data and CT findings were analyzed. Results: One hundred and thirty patients were evaluated, including 103 (79.2%) males. Their ages ranged between 7 months and 81 years, mean 35 years (SD, 20.3). In 59 patients (45.4%, 59/130) BSF was detected on CT, while 71 (54.6%) had no evidence BSF. Forty-two (71.2%) of the 59 patients detected on CT had clinical suspicion of BSF (P < 0.001) while the remaining 17 (28.8%) were not clinically diagnosed. This equaled a sensitivity of 71.2% and, specificity of 90.1% for clinical determination of BSF in this study. There was no statistically significant difference between clinical and CT diagnosis (P > 0.05). The commonest observed clinical feature in patients with confirmed BSF was otorrhagia (45.8%) and the petrous temporal bone (45.8%) was the most commonly fractured bone. The BSF was caused most commonly by motor bike accidents in 53 (40.8%). The most common associated intracranial injuries were intracerebral haemorrhage (34.6%) and subdural (17.3%) Conclusion: It appears that neurosurgical evaluation is comparatively reliable in evaluating basal skull fractures in this study area even as they are consistently demonstrated by high resolution CT scanners. A clinical suspicion of BSF should warrant a closer detailed CT evaluation and reporting by radiologists. PMID:25883468

  7. Cold Heading of Cylindrical PVC Billets: An Experimental and Theoretical Investigation

    NASA Astrophysics Data System (ADS)

    Alves, L. M.; Martins, P. A. F.

    2010-12-01

    The design of upset forged metal parts by cold heading is presently well established. Major operating parameters are identified and the typical modes of deformation that may occur during the process are fully characterized. In contrast to metals, there is no research work and no practical design rules in the specialized literature concerning the cold heading of polymer parts. This paper is concerned with the abovementioned lack of knowledge and is a contribution toward the application of cold heading to polymers. The experimental research work makes use of polyvinyl chloride (PVC) and the overall findings are interpreted in the light of an innovative extension of the flow formulation that is capable of modeling cold forming of pressure-sensitive materials under a nonassociated flow rule. Emphasis is placed on the deformation mechanics of cold heading applied to PVC and on the influence of the major operating parameters on the overall formability limits of the process. Results show that cold heading of PVC can be successfully utilized for producing upset forged parts.

  8. Odontocete suction feeding: Experimental analysis of water flow and head shape.

    PubMed

    Werth, Alexander J

    2006-12-01

    The role of cranial morphology in the generation of intraoral and oropharyngeal suction pressures in odontocetes was investigated by manipulating the jaw and hyolingual apparatus of submerged heads of three species presenting varied shapes. Hyoid and gular muscles were manually employed to depress and retract the tongue. Pressures were recorded at three locations in the oral cavity, as gape and site, speed, and force of pull were varied. A biomechanical model was also developed to evaluate pressure data. The species with the shortest, bluntest head and smallest mouth opening generated greater negative pressures. Suction generation diminished sharply as gape increased. Greatest negative pressures attained were around -45 mmHg (-6,000 Pa), a magnitude deemed suitable for capture of small live prey. Odontocetes utilizing this bidirectional flow system should profit by evolution of a rounder mouth opening through progressive shortening and widening of the rostrum and jaws, a trend evident in cranial measurements from fossil and recent odontocetes. Blunt heads correlate with anatomical, ecological, and behavioral traits associated with suction feeding. Small-gape suction (with minimally opened jaws) could be used by odontocetes of all head and oral shapes to draw prey sufficiently close to the mouth for suction ingestion or grasping via dentition. Principal limitations of the experimental and mathematical simulations include assumption of a stationary odontocete with static (open or closed) jaws and potential scaling issues with differently sized heads and gapes. PMID:17103391

  9. Injury to the diaphragm: Our experience in Union Head quarters Hospital

    PubMed Central

    Radjou, Angeline Neetha; Balliga, Dillip Kumar; Uthrapathy, Muthandavan; Pal, Ranabir; Mahajan, Preetam

    2013-01-01

    Background: Diaphragmatic injury is a global diagnostic and therapeutic challenge. Objectives: The study was to identify the variations in the risk factors, diagnosis, management, and outcome between blunt and penetrating injuries of the diaphragm. Materials and Methods: A prospective study was conducted on patients who were diagnosed with injury to diaphragm during preoperative, intraoperative, or postmortem period. The risk correlates and the trail of events following injury, interventions, and outcomes were studied. Results: Of the 25 cases, blunt injury was experienced by 10. Road traffic injury was the most common cause in blunt trauma and assault with knife in penetrating trauma. Acute presentation was the most common mechanism. X-rays were positive in 52% cases. The most common reason for false negative X-rays was massive effusion/hemothorax. Computed tomography (CT) improved the positivity rate to 62.5%. A total of 25% of diaphragmatic injuries were diagnosed during surgery for hemodynamic instability irrespective of initial X-rays findings. Laprotomy alone was sufficient in majority of cases. The defects were largely in the left side; mean defect size was more in blunt trauma. Associated injuries were noted in 92%. Stomach was most affected in penetrating injuries and spleen in blunt trauma. Empeyma was the most common morbidity. Mortality rate of 13% in penetrating injury was far lower than 60% in blunt injury. Mean Injury Severity Score (ISS) was significantly related to the fatal outcomes irrespective of mechanism. Diagnostic laparoscopy for asymptomatic low velocity junctional penetrating wounds revealed diaphragmatic injury in 20%. Conclusions: The incidence of multisystem injuries at our trauma center is on the rise. A high index of suspicion is needed for diagnosis of diaphragmatic injury. The need for thorough exploratory laprotomy is essential. In resource stretched setting like ours, the need for routine diagnostic laparoscopy in asymptomatic

  10. Emergency department-reported head injuries from skiing and snowboarding among children and adolescents, 1996-2010

    PubMed Central

    Graves, Janessa M; Whitehill, Jennifer M; Stream, Joshua O; Vavilala, Monica S; Rivara, Frederick P

    2013-01-01

    Objectives To evaluate the incidence of snow-sports-related head injuries among children and adolescents reported to emergency departments (EDs), and to examine the trend from 1996 to 2010 in ED visits for snow-sports-related traumatic brain injury (TBI) among children and adolescents. Methods A retrospective, population-based cohort study was conducted using data from the National Electronic Injury Surveillance System for patients (aged ≤17 years) treated in EDs in the USA from 1996 to 2010, for TBIs associated with snow sports (defined as skiing or snowboarding). National estimates of snow sports participation were obtained from the National Ski Area Association and utilised to calculate incidence rates. Analyses were conducted separately for children (aged 4–12 years) and adolescents (aged 13–17 years). Results An estimated number of 78 538 (95% CI 66 350 to 90 727) snow sports-related head injuries among children and adolescents were treated in EDs during the 14-year study period. Among these, 77.2% were TBIs (intracranial injury, concussion or fracture). The annual average incidence rate of TBI was 2.24 per 10 000 resort visits for children compared with 3.13 per 10 000 visits for adolescents. The incidence of TBI increased from 1996 to 2010 among adolescents (p<0.003). Conclusions Given the increasing incidence of TBI among adolescents and the increased recognition of the importance of concussions, greater awareness efforts may be needed to ensure safety, especially helmet use, as youth engage in snow sports. PMID:23513009

  11. Experimental Creep Life Assessment for the Advanced Stirling Convertor Heater Head

    NASA Technical Reports Server (NTRS)

    Krause, David L.; Kalluri, Sreeramesh; Shah, Ashwin R.; Korovaichuk, Igor

    2010-01-01

    includes direct benchmark experimental creep assessment. This element provides high-fidelity creep testing of prototypical heater head test articles to investigate the relevant material issues and multiaxial stress state. Benchmark testing provides required data to evaluate the complex life assessment methodology and to validate that analysis. Results from current benchmark heater head tests and newly developed experimental methods are presented. In the concluding remarks, the test results are shown to compare favorably with the creep strain predictions and are the first experimental evidence for a robust ASC heater head creep life.

  12. Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review

    PubMed Central

    Munusamy, Thangaraj; Dinesh, Shree Kumar

    2015-01-01

    Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature. PMID:26251817

  13. Pattern of cerebrospinal immediate early gene c-fos expression in an ovine model of non-accidental head injury.

    PubMed

    Finnie, J W; Blumbergs, P C; Manavis, J; Vink, R

    2013-12-01

    Expression of the immediate early gene, c-fos, was examined in a large animal model of non-accidental head injury ("shaken baby syndrome"). Lambs were used because they have a relatively large gyrencephalic brain and weak neck muscles resembling a human infant. Neonatal lambs were manually shaken in a manner similar to that believed to occur with most abused human infants, but there was no head impact. The most striking c-fos expression was in meningothelial cells of the cranial cervical spinal cord and, to a lesser degree, in hemispheric, cerebellar, and brainstem meninges. Vascular endothelial cells also frequently showed c-fos immunopositivity in the meninges and hemispheric white matter. It was hypothesised that this c-fos immunoreactivity was due to mechanical stress induced by shaking, with differential movement of different craniospinal components. PMID:24035422

  14. The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: a rejoinder.

    PubMed

    Rissel, Chris

    2012-03-01

    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. PMID:22269491

  15. Cerebral correlates of disturbed executive function and memory in survivors of severe closed head injury: a SPECT study.

    PubMed Central

    Goldenberg, G; Oder, W; Spatt, J; Podreka, I

    1992-01-01

    Thirty six patients in the chronic stage after severe closed head injury were examined with tests of executive function, memory, intelligence, and functional capacities in daily living. Correlations were sought between test results and Tc-99m-HMPAO uptake of frontal, temporal, and thalamic regions assessed by SPECT. Neither the number of significant correlation coefficients between memory tests and regional uptake nor that between temporal uptake and tests exceeded chance. For the remaining tests, correlations to thalamic regions were stronger than those to the frontal regions, and those to right brain regions stronger than those to homologous left brain regions. Relationships of thalamic isotope uptake to neuropsychological performance may reflect the impact of diffuse brain damage and particularly of diffuse axonal injury on mental capacities. PMID:1602308

  16. A review of outcome after moderate and severe closed head injury with an introduction to life care planning.

    PubMed

    Sherer, M; Madison, C F; Hannay, H J

    2000-04-01

    Forensic consultation regarding moderate and severe closed head injury (CHI) generally focuses on determination of severity of residual deficits and the implications of these deficits for future health care needs, personal independence, and employment. This information can be used to develop a life care plan that describes the patient's needs for continued medical care, rehabilitation, and daily assistance or supervision and estimates the long-term costs for these services. This article provides brief reviews of CHI classification, epidemiology, residual deficits, expected outcomes, and factors predictive of outcome. An introduction to the process of developing a life care plan is presented. PMID:10739966

  17. S-100 B Concentrations Are a Predictor of Decreased Survival in Patients with Major Trauma, Independently of Head Injury

    PubMed Central

    Pfortmueller, Carmen Andrea; Drexel, Christian; Krähenmann-Müller, Simone; Leichtle, Alexander Benedikt; Fiedler, Georg Martin; Lindner, Gregor; Exadaktylos, Aristomenis Konstantinos

    2016-01-01

    Background Major trauma remains one of the principle causes of disability and death throughout the world. There is currently no satisfactory risk assessment to predict mortality in patients with major trauma. The aim of our study is to examine whether S-100 B protein concentrations correlate with injury severity and survival in patients with major trauma, with special emphasis on patients without head injury. Methods Our retrospective data analysis comprised adult patients admitted to our emergency department between 1.12. 2008 and 31.12 2010 with a suspected major trauma. S-100 B concentrations were routinely assessed in major trauma patients. Results A total of 27.7% (378) of all patients had major trauma. The median ISS was 24.6 (SD 8.4); 16.6% (63/378) of the patients died. S-100 B concentrations correlated overall with the ISS (p<0.0001). Patients who died had significantly higher S-100 B concentrations than survivors (8.2 μg/l versus 2.2 μg/l, p<0.0001). Polytraumatised patients with and without head trauma did not differ significantly with respect to S-100 B concentration (3.2 μg/l (SD 5.3) versus 2.9 μg/l (SD 3.8), respectively, p = 0.63) or with respect to Injury Severity Score (24.8 (SD 8.6) versus 24.2 (SD 8.1), respectively, p = 0.56). S-100 B concentrations correlated negatively with survival (p<0.0001) in all patients and in both subgroups (p = 0.001 and p = 0.006, respectively) Conclusions S-100 concentrations on admission correlate positively with greater injury severity and decreased survival in major trauma patients, independently of the presence of a head injury. S-100 B protein levels at admission in patients with major trauma may therefore be used to assess outcome in all polytraumatised patients. These measurements should be subject to further evaluation. PMID:27031106

  18. Head Start and Unintended Injury: The Use of the Family Map Interview to Document Risk

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  19. Laryngeal Adductor Function in Experimental Models of Recurrent Laryngeal Nerve Injury

    PubMed Central

    Paniello, Randal C.; Rich, Jason T.; Debnath, Nick L.

    2014-01-01

    Objectives/Hypothesis Most patients with unilateral vocal fold paralysis experience some degree of spontaneous reinnervation, which depends upon the type and severity of recurrent laryngeal nerve (RLN) injury. After partial recovery, the paretic vocal fold may or may not adduct adequately to allow glottic closure, which in turn affects phonatory and swallowing outcomes. This process was studied in a series of canine laryngeal nerve injury models. Study Design Animal (canine) experiments. Methods Maximum stimulable laryngeal adductor pressure (LAP) was measured pre-treatment (baseline) and at 6 months following experimental RLN injuries (total n=59). The 9 study groups were designed to simulate a range of severities of RLN injury. Results The greatest LAP recovery, at 108% of original baseline, was seen in a 50% transection model; the least recovery was seen when the RLN underwent complete transection with repair, at 56% with precise alignment and 50% with alignment reversed. Intermediate models (partial RLN injuries) gave intermediate results. Crush models recovered 105% of LAP, while a half-transection, half-crush injury recovered 72% and cautery injuries recovered 61%. Controls (complete transection without repair) had no measurable recovery. Conclusions The injured RLN has a strong tendency to recover. Restoration of adductor strength, as determined by the LAP, was predictably related to the severity of RLN injury. The model RLN injuries studied provide a range of expected outcomes that can be used for future experiments exploring interventions that may improve post-injury adductor function. PMID:25283381

  20. Experimental Variation of Head Start Curricula: A Comparison of Current Approaches. Annual Report, June 12, 1968-June 11, 1969.

    ERIC Educational Resources Information Center

    Miller, Louise B.

    In this study, investigators made an experimental comparison of four curricula for Head Start classes: (1) the official (or "traditional") Head Start program, emphasizing enrichment of experience, individual differences, a climate of freedom, and learning by doing, (2) the DARCEE program, emphasizing reinforcement of attitudes combined with…

  1. Monte Carlo and experimental internal radionuclide dosimetry in RANDO head phantom.

    PubMed

    Ghahraman Asl, Ruhollah; Nasseri, Shahrokh; Parach, Ali Asghar; Zakavi, Seyed Rasoul; Momennezhad, Mehdi; Davenport, David

    2015-09-01

    Monte Carlo techniques are widely employed in internal dosimetry to obtain better estimates of absorbed dose distributions from irradiation sources in medicine. Accurate 3D absorbed dosimetry would be useful for risk assessment of inducing deterministic and stochastic biological effects for both therapeutic and diagnostic radiopharmaceuticals in nuclear medicine. The goal of this study was to experimentally evaluate the use of Geant4 application for tomographic emission (GATE) Monte Carlo package for 3D internal dosimetry using the head portion of the RANDO phantom. GATE package (version 6.1) was used to create a voxel model of a human head phantom from computed tomography (CT) images. Matrix dimensions consisted of 319 × 216 × 30 voxels (0.7871 × 0.7871 × 5 mm(3)). Measurements were made using thermoluminescent dosimeters (TLD-100). One rod-shaped source with 94 MBq activity of (99m)Tc was positioned in the brain tissue of the posterior part of the human head phantom in slice number 2. The results of the simulation were compared with measured mean absorbed dose per cumulative activity (S value). Absorbed dose was also calculated for each slice of the digital model of the head phantom and dose volume histograms (DVHs) were computed to analyze the absolute and relative doses in each slice from the simulation data. The S-values calculated by GATE and TLD methods showed a significant correlation (correlation coefficient, r(2) ≥ 0.99, p < 0.05) with each other. The maximum relative percentage differences were ≤14% for most cases. DVHs demonstrated dose decrease along the direction of movement toward the lower slices of the head phantom. Based on the results obtained from GATE Monte Carlopackage it can be deduced that a complete dosimetry simulation study, from imaging to absorbed dose map calculation, is possible to execute in a single framework. PMID:26232251

  2. Finite element analysis vs experimental study of head firearm wound in pig.

    PubMed

    Xu, Chuan; Chen, Yubin; Li, Bingcang; Zhang, Liangchao; Wang, Jianmin; Kang, Jianyi; Chen, Zhiqiang; Li, Xiaoxia

    2015-01-01

    To establish a finite element (FE) model of the pig head for simulating firearm wounds. An experimental study was carried out by measuring impact load parameters from 17 fresh pig heads that were shot at the right part of cranium by a standard 7.62 mm M43 bullet. FE analysis was executed through the LS-DYNA code under impact loads similar to those obtained from the experimental study. The residual velocity, the transferred energy from the bullet to the cranium, and the surface area of the entrance showed no statistical differences between the FE simulation and the experimental study. However, the mean surface area of the exit wounds was significantly larger than that of the entrance wounds in the experimental and FE study. Although the results of FE analysis corresponded with the experiment study, FE analysis further revealed that the stress zones were mainly located at the impact region of the cranium, mainly located in occipital lobe, frontal lobe and skull base of brain, with a lower speed of stress distribution. The FE model was appropriate and conformed to the basic principles of wound ballistics. PMID:26410330

  3. The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics

    PubMed Central

    2013-01-01

    Background The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate. Methods This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised controlled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence intubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone. Results Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting from drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are discussed. Conclusion This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI. Trial Registration ClinicalTrials.gov: NCT00112398 PMID:24034628

  4. Pediatric head trauma

    PubMed Central

    Alexiou, George A; Sfakianos, George; Prodromou, Neofytos

    2011-01-01

    Head injury in children accounts for a large number of emergency department visits and hospital admissions. Falls are the most common type of injury, followed by motor-vehicle-related accidents. In the present study, we discuss the evaluation, neuroimaging and management of children with head trauma. Furthermore, we present the specific characteristics of each type of pediatric head injury. PMID:21887034

  5. [Prognostic evaluation of patients with severe head injury by motor evoked potentials induced by transcranial magnetic stimulation--combined analysis with brainstem auditory evoked potentials].

    PubMed

    Kaneko, M

    1995-05-01

    Prognostic evaluation of severe head injury was performed on the basis of transcranial magnetic motor evoked potentials (MEPs) and brainstem auditory evoked potentials (BAEPs). The subjects were 43 severe head injury patients with Glasgow Coma Scale Scores (GCS) of 9 or less. MEPs were recorded within 3 days after the injury. Patient outcome at 1, 6 and 12 months after the injury was correlated with the MEPs and BAEPs. Differences between MEP and BAEP findings in focal lesions and diffuse lesions also were analyzed. MEP wave latencies and inter-peak latencies between BAEP waves IV and V and between waves I and V were evaluated. There was a closer relationship between MEP latency and GOS, especially between the good recovery group and other outcome groups. At 1 month after the injury, there was a closer correlation between MEP latency and BAEP latency in those who died than in those who survived, and this tendency was more evident with regard to focal lesions. However, there was no significant correlation between MEP and patient outcome when the lesions were diffuse. There was no correlation between BAEP latencies and patient outcome, but there was a good, close correlation between prolonged MEP latency and unfavorable outcome at 1, 6, 12 months after injury. In conclusion, the combined use of BAEPs and MEPs induced by transcranial magnetic stimulation is useful in prognostic evaluation of acute head injury patients, especially when the brain lesions are focal. PMID:7786626

  6. Experimental- Analitical Procedure Of Definition Of Thermal Fluxes On The Head Fairing Of Launch Vehicles

    NASA Astrophysics Data System (ADS)

    Yurchenko, I.; Karakotin, I.; Kudinov, A.

    2011-05-01

    Minimization of head fairing heat protection shield weight during spacecraft injecting in atmosphere dense layers is a complicated task. The identification of heat transfer coefficient on heat protection shield surface during injection can be considered as a primary task to be solved with certain accuracy in order to minimize heat shield weight as well as meet reliability requirements. The height of the roughness around sound point on the head fairing spherical nose tip has a great influence on the heat transfer coefficient calculation. As it has found out during flight tests the height of the roughness makes possible to create boundary layer transition criterion on the head fairing in flight. Therefore the second task is an assessment how height of the roughness influences on the total incoming heat flux to the head fairing. And finally the third task is associated with correct implementation of the first task results, as there are changing boundary conditions during a flight such as bubbles within heat shield surface paint and thermal protection ablation for instance. In the article we have considered results of flight tests carried out using launch vehicles which allowed us to measure heat fluxes in flight and to estimate dispersions of heat transfer coefficient. The experimental-analytical procedure of defining heat fluxes on the LV head fairings has been presented. The procedure includes: - calculation of general-purpose dimensionless heat transfer coefficient - Nusselt number Nueff - based on the proposed effective temperature Teff method. The method allows calculate the Nusselt number values for cylindrical surfaces as well as dispersions of heat transfer coefficient; - universal criterion of turbulent-laminar transition for blunted head fairings - Reynolds number Reek = [ρеUеk/μе]TR = const , which gives the best correlation of all dates of flight experiment carried out per Reda procedure to define turbulent-laminar transition in boundary layer. The

  7. 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.

    PubMed

    Davis, Lauren; Hanson, Brenda; Gilliam, Sara

    2016-01-01

    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. PMID:26891636

  8. [Protective action of blumeatin against experimental liver injuries].

    PubMed

    Xu, S B; Chen, W F; Liang, H Q; Lin, Y C; Deng, Y J; Long, K H

    1993-07-01

    Blumeatin (Blu, 5,3',5'-trihydroxy-7-methoxy-dihydro-flavone) was first isolated from Blumea balsamifera DC by Department of Chemistry, Sunyatsen University of China. Blu ip inhibited the increase of serum alanine aminotransferase (AAT) and liver triglyceride and increased serum triglyceride, beta-lipoprotein, and liver glycogen content in CCl4-intoxicated rats. Histological lesions of liver were less severe than those of hepatic injury control. Blu ip 0.65 and 3.25 mg.kg-1 inhibited the increase of serum AAT and hepatic TG in thioacetamide (TAA)-intoxicated mice. Blu ip shortened the pentobarbital sleeping time in CCl4-intoxicated mice. It suggested that Blu could protect liver against injury induced by CCl4 and TAA. PMID:8249641

  9. Experimental blowgun injuries, ballistic aspects of modern blowguns.

    PubMed

    Karlssona, T; Ståhlingb, S

    2000-07-24

    Slender thin arrows blown through modern blowguns can cause serious injuries. In this paper we present some data regarding the terminal ballistics of such an arrow when blown by a young male who had no previous experience with the weapon. The penetration depth into wood was similar to that of an arrow fired from a pistol-crossbow. Further, the blowgun arrow could pass through more than 7 mm of porcine bone. The velocities at a distance of 2 m from the blowgun of three different types of arrows having weights of 1-1.6 g and diameters between 1 and 5 mm were between 22 and 32 m/s, giving an energy of 0.3 to 0.6 J. When blown from a blowgun, these slender modern arrows can thus penetrate human skin and even the cranial bone of a child and cause serious injury. PMID:10882831

  10. Cardioprotection against experimental myocardial ischemic injury using cornin.

    PubMed

    Xu, Y; Xu, Y; Luan, H; Jiang, Y; Tian, X; Zhang, S

    2016-02-01

    Phosphorylated-cyclic adenosine monophosphate response element-binding protein (Phospho-CREB) has an important role in the pathogenesis of myocardial ischemia. We isolated the iridoid glycoside cornin from the fruit of Verbena officinalis L, investigated its effects against myocardial ischemia and reperfusion (I/R) injury in vivo, and elucidated its potential mechanism in vitro. Effects of cornin on cell viability, as well as expression of phospho-CREB and phospho-Akt in hypoxic H9c2 cells in vitro, and myocardial I/R injury in vivo, were investigated. Cornin attenuated hypoxia-induced cytotoxicity significantly in H9c2 cells in a concentration-dependent manner. Treatment of H9c2 cells with cornin (10 µM) blocked the reduction of expression of phospho-CREB and phospho-Akt in a hypoxic condition. Treatment of rats with cornin (30 mg/kg, iv) protected them from myocardial I/R injury as indicated by a decrease in infarct volume, improvement in hemodynamics, and reduction of severity of myocardial damage. Cornin treatment also attenuated the reduction of expression of phospho-CREB and phospho-Akt in ischemic myocardial tissue. These data suggest that cornin exerts protective effects due to an increase in expression of phospho-CREB and phospho-Akt. PMID:26871971

  11. Cardioprotection against experimental myocardial ischemic injury using cornin

    PubMed Central

    Xu, Y.; Xu, Y.; Luan, H.; Jiang, Y.; Tian, X.; Zhang, S.

    2016-01-01

    Phosphorylated-cyclic adenosine monophosphate response element-binding protein (Phospho-CREB) has an important role in the pathogenesis of myocardial ischemia. We isolated the iridoid glycoside cornin from the fruit of Verbena officinalis L, investigated its effects against myocardial ischemia and reperfusion (I/R) injury in vivo, and elucidated its potential mechanism in vitro. Effects of cornin on cell viability, as well as expression of phospho-CREB and phospho-Akt in hypoxic H9c2 cells in vitro, and myocardial I/R injury in vivo, were investigated. Cornin attenuated hypoxia-induced cytotoxicity significantly in H9c2 cells in a concentration-dependent manner. Treatment of H9c2 cells with cornin (10 µM) blocked the reduction of expression of phospho-CREB and phospho-Akt in a hypoxic condition. Treatment of rats with cornin (30 mg/kg, iv) protected them from myocardial I/R injury as indicated by a decrease in infarct volume, improvement in hemodynamics, and reduction of severity of myocardial damage. Cornin treatment also attenuated the reduction of expression of phospho-CREB and phospho-Akt in ischemic myocardial tissue. These data suggest that cornin exerts protective effects due to an increase in expression of phospho-CREB and phospho-Akt. PMID:26871971

  12. Microglial Activation in Rat Experimental Spinal Cord Injury Model

    PubMed Central

    Abdanipour, Alireza; Tiraihi, Taki; Taheri, Taher; Kazemi, Hadi

    2013-01-01

    Background: The present study was designed to evaluate the secondary microglial activation processes after spinal cord injury (SCI). Methods: A quantitative histological study was performed to determine ED-1 positive cells, glial cell density, and cavitation size in untreated SCI rats at days 1, 2, and 4, and weeks 1, 2, 3, and 4. Results: The results of glial cell quantification along the 4900-µm long injured spinal cord showed a significant increase in glial cell density percentage at day 2 as compared to other days. Whereas the highest increase in ED-1 immunoreactive cells (monocyte/phagocyte marker in rats) was observed at day 2 (23.15%) post-injury. Evaluation of cavity percentage showed a significant difference between weeks 3 and 4 post-injury groups. Conclusions: This study provides a new insight into the multiphase immune response to SCI, including cellular inflammation, macrophages/microglia activation, glial cell density, and cavitation. Better understanding of the inflammatory processes associated with acute SCI would permit the development of better therapeutic strategies. PMID:23999718

  13. Low risk of late post-traumatic seizures following severe head injury: implications for clinical trials of prophylaxis.

    PubMed Central

    McQueen, J K; Blackwood, D H; Harris, P; Kalbag, R M; Johnson, A L

    1983-01-01

    A randomised, controlled, double-blind clinical trial designed to determine the effectiveness of phenytoin in preventing epilepsy in patients who had suffered a serious head injury is reported. One hundred and sixty-four patients were randomly assigned to treatment with phenytoin or placebo capsules for one year. Patients who had a fit within one week of injury were excluded. Drug levels were monitored throughout with appropriate dosage adjustment; however only 48% of the phenytoin group had plasma levels greater than 40 mumol/l. There were seven deaths during the study. Only 11 patients (six in the phenytoin group and five in the placebo group) developed post-traumatic epilepsy within one year; a further four patients developed seizures between 1 and 2 years after injury. This low incidence of post-traumatic epilepsy (7% (SE 2%) at one year and 10 (SE 2%) at two years) means that future clinical trials of prophylaxis will have to be much larger (at least six fold). PMID:6417279

  14. Influence of the front part of the vehicle and cyclist's sitting position on the severity of head injury in side collision.

    PubMed

    Fanta, Ondřej; Bouček, Jan; Hadraba, Dan; Jelen, Karel

    2013-01-01

    An injury of cyclists during a collision with a car is currently a neglected topic. Most research projects evaluate in detail the injury of pedestrians, but with an increasing number of cyclists it will be necessary to devote more attention to their safety. This study is focused on the most common type of collision and offers insights into the biomechanics of cyclist's head injury without the use of bicycle helmet. Initial mechanical and kinematic conditions that affect Head Injury Criterion (HIC) after a car hits a cyclist were determined using simulation software MADYMO. In relation to HIC, three different shapes of the front part of the car and three basic cyclist's positions were compared. PMID:23957302

  15. A Novel Closed-Head Model of Mild Traumatic Brain Injury Using Focal Primary Overpressure Blast to the Cranium in Mice.

    PubMed

    Guley, Natalie H; Rogers, Joshua T; Del Mar, Nobel A; Deng, Yunping; Islam, Rafiqul M; D'Surney, Lauren; Ferrell, Jessica; Deng, Bowei; Hines-Beard, Jessica; Bu, Wei; Ren, Huiling; Elberger, Andrea J; Marchetta, Jeffrey G; Rex, Tonia S; Honig, Marcia G; Reiner, Anton

    2016-02-15

    Mild traumatic brain injury (TBI) from focal head impact is the most common form of TBI in humans. Animal models, however, typically use direct impact to the exposed dura or skull, or blast to the entire head. We present a detailed characterization of a novel overpressure blast system to create focal closed-head mild TBI in mice. A high-pressure air pulse limited to a 7.5 mm diameter area on the left side of the head overlying the forebrain is delivered to anesthetized mice. The mouse eyes and ears are shielded, and its head and body are cushioned to minimize movement. This approach creates mild TBI by a pressure wave that acts on the brain, with minimal accompanying head acceleration-deceleration. A single 20-psi blast yields no functional deficits or brain injury, while a single 25-40 psi blast yields only slight motor deficits and brain damage. By contrast, a single 50-60 psi blast produces significant visual, motor, and neuropsychiatric impairments and axonal damage and microglial activation in major fiber tracts, but no contusive brain injury. This model thus reproduces the widespread axonal injury and functional impairments characteristic of closed-head mild TBI, without the complications of systemic or ocular blast effects or head acceleration that typically occur in other blast or impact models of closed-skull mild TBI. Accordingly, our model provides a simple way to examine the biomechanics, pathophysiology, and functional deficits that result from TBI and can serve as a reliable platform for testing therapies that reduce brain pathology and deficits. PMID:26414413

  16. Insurance status and admission to hospital for head injuries: are we part of a two-tiered medical system?

    PubMed

    Svenson, J E; Spurlock, C W

    2001-01-01

    Previous studies have shown an association between insurance status and use of resources for inpatient care. We sought to assess whether insurance status influences decisions regarding the evaluation and treatment of head injured patients in the emergency department (ED). Head injured patients were identified from ED data from 4 hospitals reporting to the Kentucky Emergency Medical Services Information System. Multiple regression analysis using admission, ED length of stay, and ED charges as outcome variables was then performed. From 216,137 ED visits there were 8,591 (4%) head injured patients identified from the database. Eliminating those with revisits, transfers to another hospital in the database, and isolated facial lacerations, there were 3,821 cases. Controlling for age, hospital, race, primary diagnosis, and indicators of severity of the injury, insurance status was significantly associated with hospital admission. Those uninsured were the least likely to be admitted (OR 0.41; 95% CI (0.31, 0.50), whereas those with public insurance had an intermediate probability (OR 0.50 95% CI (0.37, 0.68) as compared with those with private insurance. Similarly, ED charges were lower for Medicaid patients than insured patients ($880) and tended to be slightly lower for uninsured patients ($1,043) than insured patients ($1,141) (P =.001). Length of stay in the ED was shorter for publicly insured patients (179 minutes) than uninsured (186 minutes) and privately insured patients (192 minutes) (P =.001). The extent of evaluation and admission for head injured patients is associated with insurance status. This creates a dual standard of care for patients. Practitioners should work to standardize the evaluation of patients independent of paying status. PMID:11146011

  17. Blast From the Past: A Retrospective Analysis of Blast-induced Head Injury.

    PubMed

    Yu, Kristin E; Murphy, Justin M; Tsao, Jack W

    2016-03-01

    Because of the sharp increase in the number of military personnel exposed to explosive blasts in combat, research has been dedicated toward understanding the impact of explosions on the brain. It is important to consider that potential injuries that military personnel sustain may be both in the form of physical injury as well as "invisible" neuronal and psychological damage. Since the inception of the study of blast science in the Medieval and Renaissance eras, significant improvements have been made in the historical record keeping and biomedical analysis of blast injuries. This editorial comments on the evolution of blast science and the recognition of neurological sequelae from both the historical and scientific perspectives. PMID:26926849

  18. [An experimental study of chemical necrectomy in chemical injuries of the skin].

    PubMed

    Troshev, K; Markov, D; Skerlev, M

    1993-01-01

    The authors studied experimentally the morphological changes of injuries and the surrounding areas after a skin chemical injury caused by sodium hydroxide, sulphuric acid and chlorhydric acid under the influence of acidic necrolytics--40% benzoic acid and 40% salycilic acid in unguentus. The necrolytics are applied on the injured areas immediately upon getting the wound or on the 4th day thereafter, while the morphological study is carried out after getting off the necrosis. It has been established that the necrolysis in the case of sodium hydroxide was not effected by the 28th day. The processes in the tissues upon acidic injuries do not differ from the spontaneous healing process. PMID:8264193

  19. Mild traumatic brain injury in children: just another bump on the head?

    PubMed

    Cook, Rebecca S; Schweer, Lynn; Shebesta, Kaaren Fanta; Hartjes, Karen; Falcone, Richard A

    2006-01-01

    Mild traumatic brain injury (MTBI) is frequently encountered in pediatrics and challenges healthcare practitioners to provide safe, consistent, cost-effective care. Clinical management of children who sustain MTBI poses dilemmas for healthcare practitioners. This article will provide an overview of pediatric MTBI including definition, issues impacting diagnosis and management, risk factors for intracranial injury, indications for diagnostic imaging, disposition, and return to sports/activity. Knowledge and understanding of MTBI in children aid healthcare practitioners to make informed competent recommendations for care. Clinicians must have a thorough understanding and working knowledge of pediatric MTBI to aid clinical decisions and optimize patient outcomes. PMID:16884134

  20. Experimental Injury Biomechanics of the Pediatric Extremities and Pelvis

    NASA Astrophysics Data System (ADS)

    Ivarsson, Johan; Okamoto, Masayoshi; Takahashi, Yukou

    The paucity of pediatric postmortem human subjects (PMHS) for biomechanical research has led to the development of biofidelity requirements and injury assessment reference values (IARVs) for pediatric anthropomorphic test devices (ATDs) through geometrical scaling of adult PMHS data. Geometrical scaling relies on the assumption of geometrical similarity between the adult and child and does not account for any differences in tissue material properties. Attempts have been made to improve the accuracy of the scaled responses and IARVs by also accounting for the difference in Young's modulus between adult and pediatric bone (Irwin and Mertz 1997; van Ratingen et al. 1997; Mertz et al. 2001; Ivarsson et al. 2004a, b). However, the development of more biofidelic pediatric ATDs and accurate IARVs requires access to validation data that do not rely on the assumptions and simplifications associated with scaling. Access to accurate data from testing of pediatric tissues and anatomical structures would also facilitate the development of computational models for simulation of the response and injury of pediatric subjects in various loading situations.

  1. Corilagin Attenuates Aerosol Bleomycin-Induced Experimental Lung Injury

    PubMed Central

    Wang, Zheng; Guo, Qiong-Ya; Zhang, Xiao-Ju; Li, Xiao; Li, Wen-Ting; Ma, Xi-Tao; Ma, Li-Jun

    2014-01-01

    Idiopathic pulmonary fibrosis (IPF) is a progressing lethal disease with few clinically effective therapies. Corilagin is a tannin derivative which shows anti-inflammatory and antifibrotics properties and is potentiated in treating IPF. Here, we investigated the effect of corilagin on lung injury following bleomycin exposure in an animal model of pulmonary fibrosis. Corilagin abrogated bleomycin-induced lung fibrosis as assessed by H&E; Masson’s trichrome staining and lung hydroxyproline content in lung tissue. Corilagin reduced the number of apoptotic lung cells and prevented lung epithelial cells from membrane breakdown, effluence of lamellar bodies and thickening of the respiratory membrane. Bleomycin exposure induced expression of MDA, IKKα, phosphorylated IKKα (p-IKKα), NF-κB P65, TNF-α and IL-1β, and reduced I-κB expression in mice lung tissue or in BALF. These changes were reversed by high-dose corilagin (100 mg/kg i.p) more dramatically than by low dose (10 mg/kg i.p). Last, corilagin inhibits TGF-β1 production and α-SMA expression in lung tissue samples. Taken together, these findings confirmed that corilagin attenuates bleomycin-induced epithelial injury and fibrosis via inactivation of oxidative stress, proinflammatory cytokine release and NF-κB and TGF-β1 signaling. Corilagin may serve as a promising therapeutic agent for pulmonary fibrosis. PMID:24886817

  2. Discriminating Neuropsychological Sequelae of Head Injury from Alcohol-Abuse-Induced Deficits: A Review and Analysis.

    ERIC Educational Resources Information Center

    Mearns, Jack; Lees-Haley, Paul R.

    1993-01-01

    Alcohol abuse is linked strongly with neuropsychological deficits that may resemble deficits seen in head-injured individuals. Heavy daily drinking appears more damaging than episodic abusive consumption. Cognitive deficits associated with alcohol include abstraction, perceptuospatial, and problem-solving skills. For alcoholics younger than 40,…

  3. Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

    PubMed Central

    Shindle, Michael K.; Buly, Robert L.; Kelly, Bryan T.; Lorich, Dean G.

    2010-01-01

    The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1 year and greater than 5 years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface. PMID:21886541

  4. Head injury mortality in a geriatric population: differentiating an "edge" age group with better potential for benefit than older poor-prognosis patients.

    PubMed

    Bouras, Triantafyllos; Stranjalis, George; Korfias, Stefanos; Andrianakis, Ilias; Pitaridis, Marianos; Sakas, Damianos E

    2007-08-01

    A comparison of outcomes between different modes of head-injury treatment in the elderly has important bearing on questions of cost-effectiveness and medical ethics. Here, we have examined rates of mortality in elderly head-trauma victims to determine whether it is valid to differentiate an "edge" age group of younger elderly patients, 65-74 years of age, from older elderly patients, considering possible benefit from intensive treatment and surgical intervention. We collected data from 1926 cases of head trauma and separated them into three age groups: 14-64 years, 65-74 years, and 75 years or older. We then compared these groups with respect to cause of injury, severity of injury, and whether or not treatment included either admission to an Intensive Care Unit (ICU) or surgical intervention. We found that road traffic accidents were the major cause of head injury in the younger age group, whereas in the elderly falls predominated. Mortality was higher in the elderly in all the head injury severity subgroups. Young subjects with a Glasgow Coma Scale (GCS) score of less than or equal to 8 tended to benefit from ICU treatment whereas patients 75 and over did not, regardless of their severity of injury. For these patients who were in the 65-74 age group, the data suggested that some benefit was likely. Patients 75 and older were significantly less likely to survive surgical intervention than younger patients. We conclude that it is valid to treat patients in the age group 65-74 years as a separate group from those patients 75 and older. Patients in this younger subset of the elderly may benefit from ICU treatment or surgical intervention. However, the patients in our older subset of elderly patients clearly did not, and they had a significantly higher risk of surgical mortality. PMID:17711397

  5. Intellectual Performance and Reading Skills after Localized Head Injury in Childhood.

    ERIC Educational Resources Information Center

    Chadwick, Oliver; And Others

    1981-01-01

    Ninety-seven school-age children who had previously sustained a unilateral compound depressed fracture of the skull were studied using tests of intelligence and reading attainment. Intellectual impairment was significantly associated with overall severity of brain trauma. Neither the child's age at injury nor the brain hemisphere damaged had…

  6. Closed Head Injury in Infants and Preschool Children: Research and Practice Issues.

    ERIC Educational Resources Information Center

    Bagnato, Stephen J.; Feldman, Heidi

    1989-01-01

    The article examines the sparse literature on acquired brain injury in infants and preschoolers, including epidemiology, neuropathology, neurodevelopmental outcome, and treatment efficacy. It suggests blending applied research and clinical practice, emphasizing team approaches, focusing on family involvement, integrating assessment and treatment…

  7. A Spanish Language Narrative Simulation to Prevent Horseback Riding Head Injury among Rural Youth

    ERIC Educational Resources Information Center

    Arrowsmith, Heather E.; Cole, Henry P.; Mazur, Joan M.

    2009-01-01

    Objective: A Spanish language version of an exercise about adolescent horseback riders' exposure to traumatic brain injuries was integrated into the Spanish curriculum in a rural Kentucky high school. Design: An exploratory case study design with two groups of students. Setting and Method: Thirty-eight students, enrolled in intermediate Spanish IV…

  8. [Emergency indications of EEG in the situation of a head injury in children and adults].

    PubMed

    Farnarier, G

    1998-05-01

    After initial loss of consciousness following brain injury, background EEG may show slowing and posterior slow waves are observed, consistent with the existence of commotio cerebri, particularly in children. However, discrepancies between cerebral electrogenesis and the clinical condition may also persist for several weeks. As EEG is correlated with the stage of posttraumatic coma, its reactivity to stimuli is of value. While important EEG impairment with paroxysmal abnormalities is frequent in children, the patients' outcome is poorly correlated with initial EEG record. In intensive care units, the use of continuous digitized EEG techniques has opened new avenues. Though in case of mild risks, EEG and clinical follow-up may be sufficient after brain injury, EEG recording is recommended when computerized tomography (CT-scan) is normal in case of severe risks. When consciousness impairment is unexplained by the importance of the brain injury, emergency CT-scan is recommended, searching for intracranial hematoma. If CT-scan proves to be normal EEG should then be recorded, searching for local injury. EEG may uncover non-convulsive status epilepticus, mainly in elderly patients. In case of early seizures, EEG recording should be done within the first 24 hours following brain injury. In the post-ictal period, EEG should be recorded in emergency in case of confusional state lasting more than 30 minutes, as potential non-convulsive status epilepticus should not be underestimated. EEG is not of good predictive value for posttraumatic epilepsy; however, the existence of paroxysmal, local abnormalities is a risk factor. Recording of abnormalities may be useful for the medico-legal expert. PMID:9622805

  9. Clinical and Experimental Advances in Regeneration of Spinal Cord Injury

    PubMed Central

    Hyun, Jung Keun; Kim, Hae-Won

    2010-01-01

    Spinal cord injury (SCI) is one of the major disabilities dealt with in clinical rehabilitation settings and is multifactorial in that the patients suffer from motor and sensory impairments as well as many other complications throughout their lifetimes. Many clinical trials have been documented during the last two decades to restore damaged spinal cords. However, only a few pharmacological therapies used in clinical settings which still have only limited effects on the regeneration, recovery speed, or retraining of the spinal cord. In this paper, we will introduce recent clinical trials, which performed pharmacological treatments and cell transplantations for patients with SCI, and evaluate recent in vivo studies for the regeneration of injured spinal cord, including stem-cell transplantation, application of neurotrophic factors and suppressor of inhibiting factors, development of biomaterial scaffolds and delivery systems, rehabilitation, and the combinations of these therapies to evaluate what can be appropriately applied in the future to the patients with SCI. PMID:21350645

  10. The impact of compulsory helmet legislation on cyclist head injuries in New South Wales, Australia: a response.

    PubMed

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

    2013-03-01

    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. PMID:23339779

  11. A new minimally invasive experimental spinal cord injury model in rabbits.

    PubMed

    Baydin, A; Cokluk, C; Aydin, K

    2007-06-01

    The aim of this experimental study was to evaluate the effectivity of epidural microballoon inflation into the unroofed spinal column for the creation of a new experimental spinal cord injury model in rabbits. 10 New Zealand white rabbits were used for this study. Before operation and after anasthesia with 50 mg/kg ketamine and 8 mg/kg xylazine, spinal evoked potentials (SEP) were recorded in all rabbits. A midline skin incision was done on the lomber skin at the level of L1-L4. Paravertebral muscles were dissected bilaterally. A microhemilaminotomy was done in the right L3 lamina close to the midline by using Midas-rex micro-diamond drill instruments. The ligamentum flavum was opened and removed with microscissors. A microballoon was inserted into the spinal column between the bone and dura mater to the level of T12. The microballoon was inflated by using a pressure- and volume-controlled microballoon inflation device. Pre-injury and post-injury SEPs were recorded. The microballoon was deflated 15 minutes later and removed completely from the epidural space. 24 hours later the SEP study was repeated. Following microballoon inflation the SEP waves dropped to the basal level. All rabbits were paraplegic after the operation. In conclusion, this experimental study demonstrated that the microballoon inflation technique is a very successful method for the evaluation of spinal cord injury in rabbits. Unroofing of the spinal column is extremely important because decompression may be an effective treatment in spinal cord injury. Also the traumatic effect of aneurysm clips represents a different type of injury to the spinal cord. This new model may be used in experimental studies of spinal cord injury in rabbits. PMID:17882754

  12. Analytic Approximation with Experimental Data of the Head-Tail Phase Difference from Continuous Transverse Excitation for Measuring Chromaticity

    SciTech Connect

    Tan, C.Y.; Ranjbar, V.H.; /Tech-X, Boulder

    2007-11-01

    We will explore a method for measuring chromaticity by continuously kicking the beam transversely. This is called the continuous head-tail method for measuring chromaticity. The complete analytic approximation in terms of trigonometric functions is derived for zero transverse emittance beam. A simple formula for calculating chromaticity from experimental data is also shown. Finally the theory is compared with experimental data.

  13. Second-Impact Syndrome and a Small Subdural Hematoma: An Uncommon Catastrophic Result of Repetitive Head Injury with a Characteristic Imaging Appearance

    PubMed Central

    Gean, Alisa D.

    2010-01-01

    Abstract There have been a handful of previously published cases of athletes who were still symptomatic from a prior head injury, and then suffered a second injury in which a thin, acute subdural hematoma (SDH) with unilateral hemisphere vascular engorgement was demonstrated on CT scan. In those cases, the cause of the brain swelling/dysautoregulation was ascribed to the presence of the acute SDH rather than to the acceleration/deceleration forces that caused the SDH. We believe that the brain swelling is due to “second-impact dysautoregulation,” rather than due to the effect of the SDH on the underlying hemisphere. To support our hypothesis, we present 10 additional cases of acute hemispheric swelling in association with small SDHs in athletes who received a second head injury while still symptomatic from a previous head injury. The clinical history and the unique neuroimaging features of this entity on CT are described and illustrated in detail. The CT findings included an engorged cerebral hemisphere with initial preservation of grey-white matter differentiation, and abnormal mass effect and midline shift that appeared disproportionately greater than the size of the SDH. In addition, the imaging similarities between our patients and those with non-accidental head trauma (shaken-baby syndrome) will be discussed. PMID:20536318

  14. The Long-Term Effects of Mild Head Injury on Short-Term Memory for Visual Form, Spatial Location, and Their Conjunction in Well-Functioning University Students

    ERIC Educational Resources Information Center

    Chuah, Y.M.L.; Maybery, M.T.; Fox, A.M.

    2004-01-01

    Research has suggested the presence of subtle long-term cognitive changes in otherwise well-functioning individuals who have previously sustained a mild head injury (MHI). This paper investigated the long-term effects of MHI on visual, spatial, and visual-spatial short-term memory in well-functioning university students. Sixteen students who…

  15. Static Blood Flow Autoregulation in the Optic Nerve Head in Normal and Experimental Glaucoma

    PubMed Central

    Wang, Lin; Burgoyne, Claude F.; Cull, Grant; Thompson, Simon; Fortune, Brad

    2014-01-01

    Purpose. To characterize the static blood flow autoregulation in the optic nerve head (ONH), and to investigate its role in hemodynamic changes in experimental glaucoma (EG). Methods. Unilateral elevation of intraocular pressure (IOP) was induced in 15 adult rhesus macaques by laser treatment to the trabecular meshwork. Prior to and after laser treatment, retinal nerve fiber layer thickness (RNFLT) was assessed, biweekly, by spectral-domain optical coherence tomography. Optic nerve head static autoregulation was assessed by determining the percentage blood flow (BF) change after the IOP was acutely increased from 10 to 30, 40, or 50 mm Hg manometrically, utilizing a laser speckle flowgraphy device. Results. Postlaser IOP (measured during average 7.7 ± 2.6 months) was 20.2 ± 5.9 mm Hg in EG eyes and 12.3 ± 2.6 mm Hg in control eyes (P < 0.0001). Retinal nerve fiber layer thickness was reduced by 33 ± 22% of the baseline values (P < 0.001) on average in EG eyes and by 0.4 ± 2.3% in control eyes (P > 0.05). The ONH BF remained at a constant level within a range of ocular perfusion pressure (OPP), 41 mm Hg and above. The autoregulation curves, created by all 723 tests in control and 352 tests in EG, were not significantly different (P = 0.71). Conclusions. Optic nerve head BF in normal nonhuman primate (NHP) eyes is effectively regulated within a range of OPP approximately 41 mm Hg and above. Chronic IOP elevation causes no remarkable change to the static autoregulation within the ONH of EG eyes. PMID:24436190

  16. Impact of Mild Head Injury on Neuropsychological Performance in Healthy Older Adults: Longitudinal Assessment in the AIBL Cohort.

    PubMed

    Albrecht, Matthew A; Masters, Colin L; Ames, David; Foster, Jonathan K

    2016-01-01

    Traumatic brain injury (TBI) is suggested to be a significant risk factor for dementia. However, little research has been conducted into long-term neuropsychological outcomes after head trauma. Participants from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL) who had recovered after sustaining a mild TBI involving loss of consciousness more than 5 years previously were compared with matched controls across a 3-year period. Bayesian nested-domain modeling was used to estimate the effect of TBI on neuropsychological performance. There was no evidence for a chronic effect of mild TBI on any neuropsychological domain compared to controls. Within the TBI group, there was some evidence suggesting that the age that the head trauma occurred and the duration of unconsciousness were modulators of episodic memory. However, these findings were not robust. Taken together, these findings indicate that adults who have sustained a TBI resulting in loss of consciousness, but who recover to a healthy level of cognitive functioning, do not experience frank deficits in cognitive ability. PMID:27242516

  17. Impact of Mild Head Injury on Neuropsychological Performance in Healthy Older Adults: Longitudinal Assessment in the AIBL Cohort

    PubMed Central

    Albrecht, Matthew A.; Masters, Colin L.; Ames, David; Foster, Jonathan K.

    2016-01-01

    Traumatic brain injury (TBI) is suggested to be a significant risk factor for dementia. However, little research has been conducted into long-term neuropsychological outcomes after head trauma. Participants from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL) who had recovered after sustaining a mild TBI involving loss of consciousness more than 5 years previously were compared with matched controls across a 3-year period. Bayesian nested-domain modeling was used to estimate the effect of TBI on neuropsychological performance. There was no evidence for a chronic effect of mild TBI on any neuropsychological domain compared to controls. Within the TBI group, there was some evidence suggesting that the age that the head trauma occurred and the duration of unconsciousness were modulators of episodic memory. However, these findings were not robust. Taken together, these findings indicate that adults who have sustained a TBI resulting in loss of consciousness, but who recover to a healthy level of cognitive functioning, do not experience frank deficits in cognitive ability. PMID:27242516

  18. The head that wears the crown: Henry VIII and traumatic brain injury.

    PubMed

    Ikram, Muhammad Qaiser; Sajjad, Fazle Hakim; Salardini, Arash

    2016-06-01

    Henry VIII of England is one of the most controversial figures in European history. He was born on 28 June 1491 as the second son of Henry VII and Elizabeth of York and became the heir to the English throne after his elder brother died prematurely. A contradictory picture of Henry's character emerges from history: the young Henry was a vigorous, generous and intelligent king who saw early military and naval successes. In contrast, in his later years he became cruel, petty and tyrannical. His political paranoia and military misjudgements are in direct contrast to his earlier successes and promise. Several hypotheses have been put forward regarding his transformation from a renaissance king to a later medieval tyrant, including endocrinopathies, psychiatric illnesses and traumatic brain injury. In this paper we examine the historical evidence linking the change in Henry's personality and health problems to traumatic brain injury. To our knowledge this is the first systematic neurological study of traumatic brain injury in Henry VIII. PMID:26857293

  19. Monitoring closed head injury induced changes in brain physiology with orthogonal diffuse near-infrared reflectance spectroscopy

    NASA Astrophysics Data System (ADS)

    Abookasis, David; Shochat, Ariel; Mathews, Marlon S.

    2014-03-01

    We applied an orthogonal diffuse reflectance spectroscopy (o-DRS) to assess brain physiology following closed head injury (CHI). CHI was induced in anesthetized male mice by weight-drop device using ~50gram cylindrical metal falling from a height of 90 cm onto the intact scalp. A total of twenty-six mice were used in the experiments divided randomly into three groups as follows: Group 1 (n=11) consisted of injured mice monitored for 1 hour every 10 minutes. Group 2 (n=10) were the control mice not experience CHI. Group 3 (n=5) consisted of injured mice monitored every minute up to 20 minutes. Measurement of optical quantities of brain tissue (absorption and reduced scattering coefficients) in the near-infrared window from 650 to 1000 nm were carried out by employing different source-detector distances and locations to provide depth sensitivity. With respect to baseline, we found difference in brain hemodynamic properties following injury. In addition, o-DRS successfully evaluate the structural variations likely from evolving cerebral edema throughout exploring the scattering spectral shape.

  20. Event related potentials from closed head injury patients in an auditory "oddball" task: evidence of dysfunction in stimulus categorisation.

    PubMed Central

    Rugg, M D; Cowan, C P; Nagy, M E; Milner, A D; Jacobson, I; Brooks, D N

    1988-01-01

    Event-related potentials (ERPs) were recorded from 19 closed head injury (CHI) patients, at least 6 months after injury, and an equal number of control subjects, during a task requiring the covert counting of rare auditory "target" stimuli against a background of frequent "non-targets". In both groups, ERPs to targets contained enhanced frontal N2 and parietal P3 components. N2 was larger in amplitude in the CHI patients than in the controls, and its peak latency was delayed. P3 amplitude was smaller in the patients, but its latency was not significantly different from that of the control group. The delay in N2 latency is interpreted as evidence of an increase in the time needed to achieve stimulus categorisation in CHI patients. The larger N2s in this group are thought to reflect the additional cognitive effort required after CHI to cope with the task. The negative findings with respect to P3 latency suggest that this may be a less sensitive measure of information-processing efficiency in this task than the latency of N2. PMID:3404166

  1. Citicoline protects brain against closed head injury in rats through suppressing oxidative stress and calpain over-activation.

    PubMed

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

    2014-07-01

    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. PMID:24691765

  2. Dual-wavelength laser speckle imaging for monitoring brain metabolic and hemodynamic response to closed head traumatic brain injury in mice

    NASA Astrophysics Data System (ADS)

    Kofman, Itamar; Abookasis, David

    2015-10-01

    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

  3. Experimental investigations of aeration efficiency in high-head gated circular conduits.

    PubMed

    Cihat Tuna, M; Ozkan, Fahri; Baylar, Ahmet

    2014-01-01

    The primary purpose of water aeration is to increase the oxygen saturation of the water. This can be achieved by using hydraulic structures because of substantial air bubble entrainment at these structures. Closed conduit aeration is a particular instance of this. While there has been a great deal of research on air-demand ratio within closed conduit, very little research has specifically addressed aeration efficiency of closed conduit. In the present work an experimental study was conducted to investigate the aeration efficiency of high-head gated circular conduits. Results showed that high-head gated circular conduits were effective for oxygen transfer. The effects of Froude number and ratio of the water cross-sectional flow area to the conduit cross-sectional area on aeration efficiency were particularly significant, whereas the effect of conduit length was only moderate. Further, a design formula for the aeration efficiency was presented relating the aeration efficiency to ratio of water cross-sectional flow area to conduit cross-sectional area and Froude number. The obtained results will be useful in future modeling processes and aid the practicing engineer in predicting aeration efficiency for design purposes. PMID:24647194

  4. Experimental Injury Biomechanics of the Pediatric Thorax and Abdomen

    NASA Astrophysics Data System (ADS)

    Kent, Richard; Ivarsson, Johan; Maltese, Matthew R.

    Motor vehicle crashes are the leading cause of death and injury for children in the United States. Pediatric anthropomorphic test devices (ATD) and computational models are important tools for the evaluation and optimization of automotive restraint systems for child occupants. The thorax interacts with the restraints within the vehicle, and any thoracic model must mimic this interaction in a biofidelic manner to ensure that restraint designs protect humans as intended. To define thoracic biofidelity for adults, Kroell et al. (1974) conducted blunt impacts to the thoraces of adult postmortem human subjects (PMHS), which have formed the basis for biofidelity standards for modern adult ATD thoraces (Mertz et al. 1989). The paucity of pediatric PMHS for impact research led to the development of pediatric model biofidelity requirements through scaling. Geometric scale factors and elastic moduli of skull and long bone have been used to scale the adult thoracic biofidelity responses to the 3-, 6-, and 10-year-old child (Irwin and Mertz 1997; Mertz et al. 2001; van Ratingen et al. 1997). There is currently a need for data that apply to the child without scaling, both for validation of scaling methods used in the past and to confirm the validity of the specifications currently used to develop models of the child.

  5. Gastric dysreflexia after acute experimental spinal cord injury in rats

    PubMed Central

    Tong, M.; Holmes, G. M.

    2009-01-01

    Gastric reflexes are mediated mainly by vago-vagal reflex circuits in the caudal medulla. Despite the fact that brainstem vago-vagal circuitry remains intact after spinal cord injury (SCI), patients with SCI at the cervical level most often present gastric stasis with an increased risk of reflux and aspiration of gastric contents. Using a miniature strain gauge sutured to the gastric surface; we tested gastric motility and reflexive gastric relaxation following oesophageal distension (oesophageal-gastric relaxation reflex) in animals 3 days after a severe spinal contusion at either the third or ninth thoracic spinal segment (acute T3- or T9 SCI, respectively). Both basal gastric motility and the oesophageal-gastric relaxation reflex were significantly diminished in animals with T3 SCI. Conversely, both basal gastric motility and the oesophageal-gastric relaxation reflex were not significantly reduced in T9 SCI animals compared to controls. The reduced gastric motility and oesophageal-gastric reflex in T3 SCI rats was not ameliorated by celiac sympathectomy. Our results show that gastric stasis following acute SCI is independent of altered spinal sympathetic input to the stomach caudal to the lesion. Our data suggest that SCI may alter the sensitivity of vagal reflex function, perhaps by interrupting ascending spinosolitary input to brainstem vagal nuclei. PMID:19126185

  6. The Pathophysiology of Repetitive Concussive Traumatic Brain Injury in Experimental Models; New Developments and Open Questions

    PubMed Central

    Brody, David L; Benetatos, Joseph; Bennett, Rachel E; Klemenhagen, Kristen C; Donald, Christine L Mac

    2015-01-01

    In recent years, there has been an increasing interest in the pathophysiology of repetitive concussive traumatic brain injury (rcTBI) in large part due to the association with dramatic cases of progressive neurological deterioration in professional athletes, military personnel, and others. However, our understanding of the pathophysiology of rcTBI is less advanced than for more severe brain injuries. Most prominently, the mechanisms underlying traumatic axonal injury, microglial activation, amyloid-beta accumulation, and progressive tau pathology are not yet known. In addition, the role of injury to dendritic spine cytoskeletal structures, vascular reactivity impairments, and microthrombi are intriguing and subjects of ongoing inquiry. Methods for quantitative analysis of axonal injury, dendritic injury, and synaptic loss need to be refined for the field to move forward in a rigorous fashion. We and others are attempting to develop translational approaches to assess these specific pathophysiological events in both animals and humans to facilitate clinically relevant pharmacodynamic assessments of candidate therapeutics. In this article, we review and discuss several of the recent experimental results from our lab and others. We include new initial data describing the difficulty in modeling progressive tau pathology in experimental rcTBI, and results demonstrating that sertraline can alleviate social interaction deficits and depressive-like behaviors following experimental rcTBI plus foot shock stress. Furthermore, we propose a discrete set of open, experimentally tractable questions that may serve as a framework for future investigations. In addition, we also raise several important questions that are less experimentally tractable at this time, in hopes that they may stimulate future methodological developments to address them. PMID:25684677

  7. Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal

    PubMed Central

    Bajracharya, A; Agrawal, A; Yam, BR; Agrawal, CS; Lewis, Owen

    2010-01-01

    Background: Trauma is one of the common surgical emergencies presenting at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal, a tertiary referral center catering to the needs of the population of Eastern Nepal and nearby districts of India. Objective: The objective of this study is to analyze the magnitude, epidemiological, clinical profile and outcome of trauma at B P Koirala Institute of Health Sciences. Materials and Methods: This descriptive case series study includes all patients with history of trauma coming to BPKIHS emergency and referred to the surgery department. We noted the detailed clinical history and examination, demographics, mechanism of injury, nature of injury, time of reporting in emergency, treatment offered (operative or non operative management) and analyzed details of operative procedure (i.e. laparotomy, thoracotomy, craniotomy etc.), average length of hospital stay, morbidity and outcome (according to Glasgow outcome scale). Collected data were analyzed using EpiInfo 2000 statistical software. Results: There were 1848 patients eligible to be included in the study. The mean age of the patients was 28.9 ± 19.3 years. Majority of the patients (38%) belonged to the age group of 21 - 40 years and the male to female ratio was 2.7:1. Most of the trauma victims were students (30%) followed by laborers (27%) and farmers (22%) respectively. The commonest causes of injury were fall from height (39%), road traffic accident (38%) and physical assault (18%); 78% of the patients were managed conservatively and 22% underwent operative management. Postoperative complications were seen in 18%. Wound infection 7.5%, neurological deficit including cerebrospinal fluid (CSF) otrorrhea was seen in 2.2% patients. Good recovery was seen in 84%, moderate disability in 5.2% patients and severe disability in 1.4% patients. The mortally was 6.3% and most of the deaths were related to traumatic brain injuries. Conclusions: In Nepal, trauma-related injury

  8. Retinal Ganglion Cell Damage in an Experimental Rodent Model of Blast-Mediated Traumatic Brain Injury

    PubMed Central

    Mohan, Kabhilan; Kecova, Helga; Hernandez-Merino, Elena; Kardon, Randy H.; Harper, Matthew M.

    2013-01-01

    Purpose. To evaluate retina and optic nerve damage following experimental blast injury. Methods. Healthy adult mice were exposed to an overpressure blast wave using a custom-built blast chamber. The effects of blast exposure on retina and optic nerve function and structure were evaluated using the pattern electroretinogram (pERG), spectral domain optical coherence tomography (OCT), and the chromatic pupil light reflex. Results. Assessment of the pupil response to light demonstrated decreased maximum pupil constriction diameter in blast-injured mice using red light or blue light stimuli 24 hours after injury compared with baseline in the eye exposed to direct blast injury. A decrease in the pupil light reflex was not observed chronically following blast exposure. We observed a biphasic pERG decrease with the acute injury recovering by 24 hours postblast and the chronic injury appearing at 4 months postblast injury. Furthermore, at 3 months following injury, a significant decrease in the retinal nerve fiber layer was observed using OCT compared with controls. Histologic analysis of the retina and optic nerve revealed punctate regions of reduced cellularity in the ganglion cell layer and damage to optic nerves. Additionally, a significant upregulation of proteins associated with oxidative stress was observed acutely following blast exposure compared with control mice. Conclusions. Our study demonstrates that decrements in retinal ganglion cell responses can be detected after blast injury using noninvasive functional and structural tests. These objective responses may serve as surrogate tests for higher CNS functions following traumatic brain injury that are difficult to quantify. PMID:23620426

  9. Animal Models of Head Trauma

    PubMed Central

    Cernak, Ibolja

    2005-01-01

    Summary: Animal models of traumatic brain injury (TBI) are used to elucidate primary and secondary sequelae underlying human head injury in an effort to identify potential neuroprotective therapies for developing and adult brains. The choice of experimental model depends upon both the research goal and underlying objectives. The intrinsic ability to study injury-induced changes in behavior, physiology, metabolism, the blood/tissue interface, the blood brain barrier, and/or inflammatory- and immune-mediated responses, makes in vivo TBI models essential for neurotrauma research. Whereas human TBI is a highly complex multifactorial disorder, animal trauma models tend to replicate only single factors involved in the pathobiology of head injury using genetically well-defined inbred animals of a single sex. Although such an experimental approach is helpful to delineate key injury mechanisms, the simplicity and hence inability of animal models to reflect the complexity of clinical head injury may underlie the discrepancy between preclinical and clinical trials of neuroprotective therapeutics. Thus, a search continues for new animal models, which would more closely mimic the highly heterogeneous nature of human TBI, and address key factors in treatment optimization. PMID:16389305

  10. Assessment of an experimental rodent model of pediatric mild traumatic brain injury.

    PubMed

    Mychasiuk, Richelle; Farran, Allyson; Esser, Michael J

    2014-04-15

    Childhood is one the highest risk periods for experiencing a mild traumatic brain injury (mTBI) from sports-related concussions, motor vehicle accidents, and falls. In addition, many children experience lingering symptomology (post-concussion syndrome) from these closed head injuries. Although the negative sequel of mTBI has been described, a clinically reliable animal model of mild pediatric brain injury has not. The purpose of this study was to examine the validity of a modified weight-drop technique as a model for the induction of mTBI/concussion in juvenile rats following a single impact. Male and female rats (P30) were exposed to a single mTBI or a sham injury followed by a behavioral test battery. Juvenile rats who experienced a single mTBI displayed significant motor/balance impairments when tested on the beam walking task and in the open field, as well as deficits of executive functioning as measured with the novel context mismatch task and the probe trial of the Morris water task. In addition, both male and female rats showed depression-like behavior in the forced swim task, with male rats also exhibiting decreased anxiety-related behaviors in the elevated plus maze. The results from this study suggest that the modified weight-drop technique induces a clinically relevant behavioral phenotype in juvenile rats, and may provide researchers with a reliable animal model of mTBI/concussion from which clinical therapeutic strategies could be developed. PMID:24283269

  11. Does distracting pain justify performing brain computed tomography in multiple traumas with mild head injury?

    PubMed

    Sadeghian, Homa; Motiei-Langroudi, Rouzbeh

    2016-06-01

    Traumatic brain injury (TBI) is a significant health concern classified as mild, moderate, and severe. Although the indications to perform brain computed tomography (CT) are clear in moderate and severe cases, there still exists controversy in mild TBI (mTBI). We designed the study to evaluate the significance of distracting pain in patients with mTBI. The study population included patients with mild traumatic brain injury (GCS ≥13). Moderate and high risk factors including age <18 months or ≥60 years, moderate to severe or progressive headache, ≥2 episodes of vomiting, loss of consciousness (LOC), post-traumatic amnesia, seizure or prior antiepileptic use, alcohol intoxication, previous neurosurgical procedures, uncontrolled hypertension, anticoagulant use, presence of focal neurologic deficits, deformities in craniofacial region, and penetrating injuries were excluded. The patients were then grouped based on presence (DP+) or absence (DP-) of another organ fracture with severe pain (based on VAS). The primary outcome was any abnormal findings on brain CT scans; 330 patients were enrolled (184 DP+ and 146 DP-). Overall, two DP+ and one DP- patients had mild cerebral edema in brain CT (p > 0.99). No patients had any neurologic symptoms or signs in follow-up. Our results show that in the absence of any other risk factors, distracting pain from other organs (limbs, pelvis, and non-cervical spine) cannot be regarded as a brain CT indication in patients with mild TBI, as it is never associated with significant intracranial lesions. PMID:26931118

  12. 'It's the hearing that is last to go': a case of traumatic head injury.

    PubMed

    Tapson, Kate; Sierotowicz, Wanda; Marks-Maran, Di; Thompson, Trish Morris

    This article explores the literature related to acquired brain injury (ABI) and is followed by a case study of one patient with ABI, which reflects how the evidence, when implemented by a team of health professionals, can have a positive impact on recovery. Gregor is a middle-aged Polish man who suffered traumatic ABI when knocked down by a car. He spent a number of years in a specialist neurosurgical unit, then a rehabilitation unit, and for the past several years has been cared for in a care home. For most of this time he was in a coma. He began to come out of his coma and during his time in the care home received intensive physiotherapy and speech therapy. At the time of his brain injury Gregor could speak no English yet years later, when he began to regain consciousness, he was able to speak and understand English, a fact that might be attributed in part to 6 years of nurses talking to him in English as part of caring for him. Nurses are always told that hearing is the last of the senses to be lost when a person is unconscious or has a brain injury (Sisson, 1990). The case study presented in this article demonstrates the potential power of talking to a patient when providing care, even when that patient is in a coma, and the impact this may have had on Gregor. It also demonstrates the importance of the need for evidence-based neuro-rehabilitation, including multi-professional working by a team of specialist physiotherapists, nurses, speech therapists, continence specialist nurse and nutritionist. PMID:25757582

  13. Assessing the socioeconomic impact of improved treatment of head and spinal cord injuries.

    PubMed

    Berkowitz, M

    1993-01-01

    Assessment of improved treatment of neurotrauma presents two basic challenges: 1) measurement of the medical effects of treatment, and 2) evaluation of these effects in socioeconomic terms. A nationwide survey was conducted in 1988 to estimate the prevalence of persons in the United States who suffered traumatic spinal cord injury and to calculate its economic consequences. Seven hundred fifty-eight persons weighted to be representative of the spinal cord injury population were interviewed. The prevalence rate was found to be 721 cases per million people. Conservative calculations for 1988 showed that the average direct costs per person were $103,000 for hospitalization and home modifications during the first 2 years postinjury and $14,000 per year thereafter for medical care. Losses in earnings and homemaker services averaged $12,726 per year. Total aggregate costs for 1 year were estimated at $5.6 billion. Lifetime costs for a representative person with complete paraplegia injured at age 33 were estimated to be $500,000. For a representative person with complete quadriplegia injured at age 27, these costs amounted to $1 million. These data can be used to estimate cost savings related to decreased disability resulting from improved treatment. PMID:8445206

  14. Ultrafine particles in the airway aggravated experimental lung injury through impairment in Treg function.

    PubMed

    Li, Guanggang; Cao, Yinghua; Sun, Yue; Xu, Ruxiang; Zheng, Zhendong; Song, Haihan

    2016-09-01

    Acute lung injury (ALI) is a life-threatening condition characterized by rapid-onset alveolar-capillary damage mediated by pathogenic proinflammatory immune responses. Since exposure to airway particulate matter (PM) could significantly change the inflammatory status of the individual, we investigated whether PM instillation in the airway could alter the course of ALI, using a murine model with experimental lung injury induced by intratracheal LPS challenge. We found that PM-treated mice presented significantly aggravated lung injury, which was characterized by further reductions in body weight, increased protein concentration in the bronchoalveolar lavage (BAL), and higher mortality rate, compared to control saline-treated mice. The PM-treated mice also presented elevated lung and systemic type 1 T helper cell (Th1) frequency as well as reduced lung regulatory T cell (Treg) frequency, which was associated with severity of lung injury. Further examinations revealed that the Treg function was impaired in PM-treated mice, characterized by significantly repressed transforming growth factor beta production. Adoptive transfer of functional Tregs from control mice to PM-treated mice significantly improved their prognosis after intratracheal LPS challenge. Together, these results demonstrated that first, PM in the airway aggravated lung injury; second, severity of lung injury was associated with T cell subset imbalance in PM-treated mice; and third, PM treatment induced quantitative as well as qualitative changes in the Tregs. PMID:27179778

  15. Vitamins and nutrients as primary treatments in experimental brain injury: Clinical implications for nutraceutical therapies.

    PubMed

    Vonder Haar, Cole; Peterson, Todd C; Martens, Kris M; Hoane, Michael R

    2016-06-01

    With the numerous failures of pharmaceuticals to treat traumatic brain injury in humans, more researchers have become interested in combination therapies. This is largely due to the multimodal nature of damage from injury, which causes excitotoxicity, oxidative stress, edema, neuroinflammation and cell death. Polydrug treatments have the potential to target multiple aspects of the secondary injury cascade, while many previous therapies focused on one particular aspect. Of specific note are vitamins, minerals and nutrients that can be utilized to supplement other therapies. Many of these have low toxicity, are already FDA approved and have minimal interactions with other drugs, making them attractive targets for therapeutics. Over the past 20 years, interest in supplementation and supraphysiologic dosing of nutrients for brain injury has increased and indeed many vitamins and nutrients now have a considerable body of the literature backing their use. Here, we review several of the prominent therapies in the category of nutraceutical treatment for brain injury in experimental models, including vitamins (B2, B3, B6, B9, C, D, E), herbs and traditional medicines (ginseng, Gingko biloba), flavonoids, and other nutrients (magnesium, zinc, carnitine, omega-3 fatty acids). While there is still much work to be done, several of these have strong potential for clinical therapies, particularly with regard to polydrug regimens. This article is part of a Special Issue entitled SI:Brain injury and recovery. PMID:26723564

  16. Spinal injury

    MedlinePlus

    ... head. Alternative Names Spinal cord injury; SCI Images Skeletal spine Vertebra, cervical (neck) Vertebra, lumbar (low back) Vertebra, thoracic (mid back) Vertebral column Central nervous system Spinal cord injury Spinal anatomy Two person roll - ...

  17. Head injuries in children: a chronicle of a quarter of a century.

    PubMed

    Berney, J; Favier, J; Rilliet, B

    1995-05-01

    Children aged 0-15 years hospitalized in Geneva for head trauma during the last quarter of a century are reviewed. More than half of the severely injured children were not from Geneva area. New methods of management have been introduced progressively. The cases are divided in four successive time periods and classified according to their pathology. A continuous improvement in mortality is obvious, decreasing from 29.4% to 2.2%, but climbing again to 15.2% in the last period, probably due to more severe pathologies. For the Geneva area the mortality decreased progressively from 10.4/100,000 to 3.5/100,000 annually, due to better organization and management, but also to a drop in the incidence of severe cases from 35.5-13.5/100,000 per year. A decrease in the number of traffic accidents is responsible for this. However, the number of handicapped children has not changed. PMID:7648565

  18. The first concussion crisis: head injury and evidence in early American football.

    PubMed

    Harrison, Emily A

    2014-05-01

    In the early 21st century, sports concussion has become a prominent public health problem, popularly labeled "The Concussion Crisis." Football-related concussion contributes much of the epidemiological burden and inspires much of the public awareness. Though often cast as a recent phenomenon, the crisis in fact began more than a century ago, as concussions were identified among footballers in the game's first decades. This early concussion crisis subsided-allowing the problem to proliferate-because work was done by football's supporters to reshape public acceptance of risk. They appealed to an American culture that permitted violence, shifted attention to reforms addressing more visible injuries, and legitimized football within morally reputable institutions. Meanwhile, changing demands on the medical profession made practitioners reluctant to take a definitive stance. Drawing on scientific journals, public newspapers, and personal letters of players and coaches, this history of the early crisis raises critical questions about solutions being negotiated at present. PMID:24625171

  19. Is erythropoietin a worthy candidate for traumatic brain injury or are we heading the wrong way?

    PubMed Central

    Grasso, Giovanni; Alafaci, Concetta; Ghezzi, Pietro

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in the modern society. Although primary prevention is the only strategy that can counteract the primary brain damage, numerous preclinical studies have been accumulated in order to find therapeutic strategies against the secondary damage. In this scenario erythropoietin (EPO) has been shown to be a promising candidate as neuroprotective agent. A recent clinical trial, however, has shown that EPO has not an overall effect on outcomes following TBI thus renewing old concerns.  However, the results of a prespecified sensitivity analysis indicate that the effect of EPO on mortality remains still unclear. In the light of these observations, further investigations are needed to resolve doubts on EPO effectiveness in order to provide a more solid base for tailoring conclusive clinical trials. PMID:27239280

  20. Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks.

    PubMed

    Kunz, S N; Zinka, B; Peschel, O; Fieseler, S

    2011-07-15

    A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device. PMID:21570222

  1. Electromagnetic Head-And-Neck Hyperthermia Applicator: Experimental Phantom Verification and FDTD Model

    SciTech Connect

    Paulides, Margarethus M. . E-mail: M.Paulides@ErasmusMC.nl; Bakker, Jurriaan F.; Rhoon, Gerard C. van

    2007-06-01

    Purpose: To experimentally verify the feasibility of focused heating in the neck region by an array of two rings of six electromagnetic antennas. We also measured the dynamic specific absorption rate (SAR) steering possibilities of this setup and compared these SAR patterns to simulations. Methods and Materials: Using a specially constructed laboratory prototype head-and-neck applicator, including a neck-mimicking cylindrical muscle phantom, we performed SAR measurements by electric field, Schottky-diode sheet measurements and, using the power-pulse technique, by fiberoptic thermometry and infrared thermography. Using phase steering, we also steered the SAR distribution in radial and axial directions. All measured distributions were compared with the predictions by a finite-difference time-domain-based electromagnetic simulator. Results: A central 50% iso-SAR focus of 35 {+-} 3 mm in diameter and about 100 {+-} 15 mm in length was obtained for all investigated settings. Furthermore, this SAR focus could be steered toward the desired location in the radial and axial directions with an accuracy of {approx}5 mm. The SAR distributions as measured by all three experimental methods were well predicted by the simulations. Conclusion: The results of our study have shown that focused heating in the neck is feasible and that this focus can be effectively steered in the radial and axial directions. For quality assurance measurements, we believe that the Schottky-diode sheet provides the best compromise among effort, speed, and accuracy, although a more specific and improved design is warranted.

  2. What Is a Plume: An Experimental Perspective on Heads, Tails and Entrainment

    NASA Astrophysics Data System (ADS)

    Lithgow-Bertelloni, C. R.; Newsome, W.; Davies, D.; Cotel, A. J.; Hart, S. R.; Whitehead, J. A.

    2010-12-01

    The concept of mantle plumes has had a significant impact on our ideas about mantle geochemical heterogeneity and evolution. And yet many aspects remain controversial from their geochemical signature, excess temperature and seismic detectability to their very existence. We take an experimental approach not to tackle the question of plume survival in the mantle, but rather to characterize quantitatively the temperature and velocity structure of a single thermal plume and hence define unambiguously and objectively the structure of the plume (head, conduit and source material) and the degree of entrainment. We have developed an automated Stereoscopic Particle Image Velocimetry and Thermometry (SPIVeT) non-invasive visualization system to measure the 3-D velocity and temperature structure of thermal plumes in very viscous fluids. We augmented existing techniques of velocimetry by developing a hybrid particle tracking/particle image velocimetry method for better removal of spurious vectors. Thermochromic liquid crystals were used to extract temperature, but because of their limited color play, a finite volume numerical model using the SPIV velocities as inputs aided in the reconstruction of the temperature field, although only one contour is truly reliable. We performed a series of experiments in a cubic tank (30 cm on the side) with corn syrup and a circular heater 2 cm in diameter, set to temperatures ranging from 38-80 C. We analyze the results using the concepts of dynamical systems analysis and in particular Lagrangian Coherent Structures (LCS). We found the unstable manifold to define the boundary of the head with respect to the surrounding fluid, but did not locate in our experiments the stable manifold that would encircle all material to be entrained. We determine, by advecting tracers with the experimentally measured velocities mass maps that show the radial and vertical origin of plume material. We have developed a stretching metric that quantifies the shape

  3. [Interest of S100B protein blood level determination in severe or moderate head injury].

    PubMed

    Bouvier, Damien

    2013-01-01

    S100B, a suffering brain marker, exhibits a different interest in traumatic brain injury (TBI) as the trauma is severe (sTBI) or mild (mTBI). Our works presented for the attribution of the SFBC 2012 price talked about both aspects. Firstly, the extent of S100B elevation has been found to be useful in predicting clinical outcome after sTBI. However, few studies were realized with jugular venous blood samples. After comparing the interest between jugular venous and arterial blood concentrations evaluation of serum S100B protein in patients with sTBI, determination of S100B concentration in jugular blood samples appears to be better than in arterial ones to predict clinical outcome after brain injury. Secondly, it's difficult to determine the indication of cranial computed tomography (CCT) for patients with mTBI. Actually, 90% of patients with mTBI have unnecessary CCT or short hospitalization for observation. Serum concentrations of S100B were found to provide useful information. We have investigated in 2 studies (1 for adult, 1 for children) whether S100B concentrations in patients with mTBI could provide additional information to improve indication of the need for an initial CCT scan or for a short hospitalization. Patients with intracerebral lesions on the CCT scan (CCT+) or with bad clinical evolution were identified with a sensitivity level of 100% and a specificity level of 30%. Adding the measurement of S-100B serum concentration to the clinical decision rules for a CCT scan or hospitalization in patients with mTBI could allow a 30% reduction in scans and in hospitalization for clinical observation. PMID:23587577

  4. Backspatter from experimental close-range shots to the head. I. Macrobackspatter.

    PubMed

    Karger, B; Nüsse, R; Schroeder, G; Wüstenbecker, S; Brinkmann, B

    1996-01-01

    Backspatter is the ejection of biological material from a gunshot entrance wound against the line of fire. This phenomenon was investigated experimentally in transverse gunshots to the heads of calves (n = 9) using two types of 9 mm Parabellum ammunition from shooting distances of 0-10 cm. The resulting bloodstains were documented on white paper placed horizontally 60 cm below the impact site. In this report the analysis was restricted to stains with a diameter > 0.5 mm. Backspatter was documented after every gunshot. The number of stains varied from 31-324 per gunshot and appeared to be independent of the shooting distance. The maximum distance droplets travelled varied from 72-119 cm. The majority of droplets accumulated between 0 and 50 cm. The number of droplets and the distances travelled should be higher in man for anatomical reasons. The direction a single droplet can take comprises every possible angle between the most tangential ones to the skin surface. This resulted in a semi-circle of 180 degrees covered with stains. Skin ruptures of the entrance wound were not observed. The succession of events was documented on high speed film and started with the recoil of the firearm, immediately followed by a blow-out effect of the skin. Large droplets exited approximately 0.7-4 ms after the bullet impacted the skin. The calculated minimum initial velocity of these droplets was 13-61 m/s. Backspatter from gunshots to the head likely is caused by the hot gases expanding subcutaneously and by cavitation-related intracranial overpressure and tail splashing. In three out of nine gunshots, secondary backspatter additionally occurred as a result of droplets produced by a stream of blood from the entrance wound impacting the paper surface. PMID:8912050

  5. SCI-Base: an open-source spinal cord injury animal experimentation database.

    PubMed

    Weeks, Jeffrey; Hart, Ronald P

    2004-03-01

    To capture all pertinent data during spinal cord injury animal experimentation, the authors have designed and implemented a database that is available for use under a public license. Their goals were to record all daily medical care of paraplegic animals, including unexpected complications; to store all injury parameters and/or therapeutic procedures; to track locomotor scores and other measures of functional recovery; to allow planning and management of experiments; and to serve as an externally linkable, SQL-queryable data mining source. Ultimately, the use of databases such as this will allow multiple neurotrauma laboratories to compare animal data through web meta-analysis. PMID:15235627

  6. A brief report on MRI investigation of experimental traumatic brain injury

    PubMed Central

    Duong, Timothy Q.; Watts, Lora T.

    2016-01-01

    Traumatic brain injury is a major cause of death and disability. This is a brief report based on a symposium presentation to the 2014 Chinese Neurotrauma Association Meeting in San Francisco, USA. It covers the work from our laboratory in applying multimodal MRI to study experimental traumatic brain injury in rats with comparisons made to behavioral tests and histology. MRI protocols include structural, perfusion, manganese-enhanced, diffusion-tensor MRI, and MRI of blood-brain barrier integrity and cerebrovascular reactivity. PMID:26981069

  7. [Glutamate receptor-mediated retinal neuronal injury in experimental glaucoma].

    PubMed

    Wang, Zhong-Feng; Yang, Xiong-Li

    2016-08-25

    Glaucoma, the second leading cause of blindness, is a neurodegenerative disease characterized by optic nerve degeneration related to apoptotic death of retinal ganglion cells (RGCs). In the pathogenesis of RGC death following the onset of glaucoma, functional changes of glutamate receptors are commonly regarded as important risk factors. During the past several years, we have explored the mechanisms underlying RGC apoptosis and retinal Müller cell reactivation (gliosis) in a rat chronic ocular hypertension (COH) model. We demonstrated that elevated intraocular pressure in COH rats may induce changes of various signaling pathways, which are involved in RGC apoptosis by modulating glutamate NMDA and AMPA receptors. Moreover, we also demonstrated that over-activation of group I metabotropic glutamate receptors (mGluR I) by excessive extracellular glutamate in COH rats could contribute to Müller cell gliosis by suppressing Kir4.1 channels. In this review, incorporating our results, we discuss glutamate receptor- mediated RGC apoptosis and Müller cell gliosis in experimental glaucoma. PMID:27546508

  8. An Experimental and Computational Study of Blunt Carotid Artery Injury

    PubMed Central

    Gayzik, F. Scott; Bostrom, Ola; Örtenwall, Per; Duma, Stefan M.; Stitzel, Joel D.

    2006-01-01

    A carotid artery dissection begins as a tear or defect of the intimal lining of the artery, and can lead to luminal occlusion and ultimately cerebral ischemia. Our aim is to conduct an organ level validation of a finite element model of the carotid artery using an experiment designed to elicit internal layer failure within fluid-filled carotid artery samples. A 2.4-kg beveled guillotine is dropped from three heights (0.3, 0.5 and 0.7 m) onto fluid-filled porcine carotid arteries and resulting damage is recorded. These events are modeled using finite element analysis. Stress, strain and strain rate are correlated to experimental outcome. Internal layer damage is reported in half of the experiments, with damage occurring with 100% frequency at a drop height of 0.7 m. Simulations of this experiment result in maximum principal stress and strain values of 1.43 MPa and 46.2% respectively. The strain level predicted by the model for this impact scenario approaches the strain to intimal failure level for porcine arteries found in the literature. The results of this study represent an important step in validating this finite element carotid artery model at the organ level. PMID:16968627

  9. Behavioural and psychosocial sequelae of severe closed head injury and regional cerebral blood flow: a SPECT study.

    PubMed Central

    Oder, W; Goldenberg, G; Spatt, J; Podreka, I; Binder, H; Deecke, L

    1992-01-01

    Thirty six patients (31 male, 5 female) who had suffered severe closed head injury were re-examined at an average of 39.3 (SD 12.8, range 7-66) months after the injury. Behavioural symptoms were measured using the Giessen test. The relatives' reports were used for data analysis to ensure that results were valid. The neurophysical impairment subscale of the Glasgow assessment schedule was completed by two neurologists, and the number connection test was completed by each patient. The adjective mood scale was completed by each relative. All patients were investigated by single photon emission computerised tomography (SPECT). Exploratory factor analysis using the principal components method was carried out separately for SPECT results and psychological measures and correlations were sought between the resulting factors. Factor analysis of the data from the Giessen test identified social isolation, disinhibition, and aggressive behaviour as major components of post-traumatic personality changes; it indicates that these behavioural features are independent of the level of neurological and neuropsychological impairment, which loaded on a single independent factor. Relatives' psychic health seemed to be relatively resistant to physical and cognitive disability and was mainly affected by disinhibitive behaviour. The highest correlation was between frontal flow indices and disinhibitive behaviour (p less than 0.01): the severity of disinhibition increased with lower frontal flow rates. There was a significant but somewhat weaker correlation (p less than 0.05) between flow indices of the left cerebral hemisphere and social isolation. Low flow values of the right brain regions were related to aggressive behaviour (p less than 0.05). Neurological and cognitive impairment correlated negatively with the thalamus; worse neurological and cognitive performance indicate by raised scores on the neurophysical scale and on the number connection test was associated with low thalamic

  10. Dural sinus obstruction following head injury: a diagnostic and clinical study.

    PubMed

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

    2016-09-01

    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. [Hand injuries by pyrotechnic articles--case report and reconstructive experimental investigations].

    PubMed

    Schröder, Ann Sophie; Jahnke, Philipp; Hessler, Christian; Lockemann, Ute

    2014-01-01

    Injuries caused by explosions of fireworks often involve people's hands. The case of a young man who suffered severe hand injuries as well as damage to both eardrums and one eye is described. Reconstructive experimental investigations of the explosive effect of six different pyrotechnic articles were carried out using human hands from body donors. With the most powerful firecrackers that used to be legally available in Germany ("Super-Böller A", "Kanonenschlag") and a self-made one with 36 g gunpowder only blackening of the skin occurred. Three pyrotechnic articles not allowed in Germany ("La Bomba", "Color salute" and "Vogelschreck") caused serious injury to the hand's soft tissue and bones. PMID:25122993

  12. Outlet biceps tenodesis: a new technique for treatment of biceps long head tendon injury.

    PubMed

    Lemos, David; Esquivel, Amanda; Duncan, Douglas; Marsh, Stephanie; Lemos, Stephen

    2013-05-01

    Degeneration and tearing of the long head of the biceps brachii tendon (LHBT) are common intra-articular findings, and surgical intervention including tenodesis or tenotomy is beneficial. A new arthroscopic shoulder technique may be performed through an anterior portal while one is viewing from a posterior portal: (1) Visualize the intra-articular biceps tendon. (2) Identify the segment of the LHBT to be enlarged. (3) Use a tissue modulation wand to enlarge the tendon. (4) Evaluate the diameter of the enlarged segment. It should be twice the original diameter. (5) Cut the biceps tendon at the proximal end of the enlarged segment. (6) View the tendon within the tunnel. (7) Identify and cut the remaining stump of the biceps tendon. Seventeen cadaveric shoulders were used to compare the pullout force, stiffness, and displacement of outlet tenodesis versus tenotomy. There was a significant increase in pullout force for the outlet tenodesis group when compared with tenotomy. This technique is used to operatively treat LHBT intra-articular pathology in patients who would benefit from tenotomy and traditional biceps tenodesis and may minimize the retraction of the biceps tendon distally. PMID:23875155

  13. The First Concussion Crisis: Head Injury and Evidence in Early American Football

    PubMed Central

    2014-01-01

    In the early 21st century, sports concussion has become a prominent public health problem, popularly labeled “The Concussion Crisis.” Football-related concussion contributes much of the epidemiological burden and inspires much of the public awareness. Though often cast as a recent phenomenon, the crisis in fact began more than a century ago, as concussions were identified among footballers in the game’s first decades. This early concussion crisis subsided—allowing the problem to proliferate—because work was done by football’s supporters to reshape public acceptance of risk. They appealed to an American culture that permitted violence, shifted attention to reforms addressing more visible injuries, and legitimized football within morally reputable institutions. Meanwhile, changing demands on the medical profession made practitioners reluctant to take a definitive stance. Drawing on scientific journals, public newspapers, and personal letters of players and coaches, this history of the early crisis raises critical questions about solutions being negotiated at present. PMID:24625171

  14. Teardrop fracture following head-first impact in an ice hockey player: Case report and analysis of injury mechanisms

    PubMed Central

    Yue, James J.; Scott, David L.

    2016-01-01

    Background We report a case of a young male athlete who sustained a three column displaced teardrop fracture of the C5 vertebra due to a head-first impact in hockey, suffered neurapraxia, yet made full neurological recovery. This full recovery was in sharp contrast to multiple case series which reported permanent quadriplegia in the vast majority of teardrop fracture patients. We investigate the etiology and biomechanical mechanisms of injury. Methods Admission imaging revealed the teardrop fracture which consisted of: a frontal plane fracture which separated an anterior quadrilateral-shaped fragment from the posterior vertebral body; a vertical fracture of the posterior vertebral body in the sagittal plane; and incomplete fractures of the neural arch that initiated superiorly at the anterior aspect of the spinous process and left lamina adjacent to the superior facet. Epidural hematoma in the region of the C5 vertebra was observed in addition to disc and ligamentous disruptions at C4-5 and C5-6. Our patient was ultimately treated surgically with anterior fusion from C4 through C6 and subsequently with bilateral posterior fusion at C5-6. Results The injuries were caused by high-energy axial compression with the neck in a pre-flexed posture. The first fracture event consisted of the anterior vertebral body fragment being sheared off of the posterior fragment under the compression load due in part to the sagittal plane concavity of the C5 inferior endplate. The etiology of the vertical fracture of the posterior vertebral body fragment in the sagittal plane was consistent with a previously described hypothesis of the mechanistic injury events. First, the C4-5 disc height decreased under load which increased its hoop stress. Next, this increased hoop stress transferred lateral forces to the C5 uncinate processes which caused their outward expansion. Finally, the outward expansion of the uncinate processes caused the left and right sides of the vertebral body to split

  15. Strain-Related Differences after Experimental Traumatic Brain Injury in Rats

    PubMed Central

    Rolfe, Andrew; Register, David; Levasseur, Joseph E.; Churn, Severn B.; Sun, Dong

    2010-01-01

    Abstract The present study directly compares the effects of experimental brain injury in two commonly used rat strains: Fisher 344 and Sprague-Dawley. We previously found that Fisher rats have a higher mortality rate and more frequent seizure attacks at the same injury level than Sprague-Dawley rats. Although strain differences in rats are commonly accepted as contributing to variability among studies, there is a paucity of literature addressing strain influence in experimental neurotrauma. Therefore this study compares outcome measures in two rat strains following lateral fluid percussion injury. Fisher 344 and Sprague-Dawley rats were monitored for changes in physiological measurements, intracranial pressure, and electroencephalographic activity. We further analyzed neuronal degeneration and cell death in the injured brain using Fluoro-Jade-B (FJB) histochemistry and caspase-3 immunostaining. Behavioral studies using the beam walk and Morris water maze were conducted to characterize strain differences in both motor and cognitive functional recovery following injury. We found that Fisher rats had significantly higher intracranial pressure, prolonged seizure activity, increased FJB-positive staining in the injured cortex and thalamus, and increased caspase-3 expression than Sprague-Dawley rats. On average, Fisher rats displayed a greater amount of total recording time in seizure activity and had longer ictal durations. The Fisher rats also had increased motor deficits, correlating with the above results. In spite of these results, Fisher rats performed better on cognitive tests following injury. The results demonstrate that different rat strains respond to injury differently, and thus in preclinical neurotrauma studies strain influence is an important consideration when evaluating outcomes. PMID:20392137

  16. Prevention of Axonal Injury using Calpain Inhibitor in Chronic Progressive Experimental Autoimmune Encephalomyelitis

    PubMed Central

    Hassen, Getaw Worku; Feliberti, Jason; Kesner, Leo; Stracher, Alfred; Mokhtarian, Foroozan

    2011-01-01

    Axonal injury is the major correlate of permanent disability in neurodegenerative diseases such as multiple sclerosis (MS), especially in secondary-progressive MS following relapsing-remitting disease course. Proteolytic enzyme, calpain, is a potential candidate for causing axonal injury. Most current treatment options only target the inflammatory component of MS. Previous work using calpain inhibitor CYLA in our laboratory showed significant reduction in clinical sign, demyelination and tissue calpain content in acute experimental autoimmune encephalomyelitis (EAE). Here we evaluated markers of axonal injury (amyloid precursor protein, Nav1.6 channels), neuronal calpain content and the effect of CYLA on axonal protection using histological methods in chronic EAE [myelin oligodendrocyte glycoprotein (MOG) – induced disease model of MS]. Intraperitoneal application of CYLA (2mg/mouse/day) significantly reduced the clinical signs, tissue calpain content, demyelination and inflammatory infiltration of EAE. Similarly, markers for axonal injury were barely detectable in the treated mice. Thus, this novel drug, which markedly suppresses the disease course, axonal injury and its progression, is a candidate for the treatment of a neurodegenerative disease such as multiple sclerosis. PMID:18725211

  17. The mental health sequelae of traumatic head injury in South Vietnamese ex-political detainees who survived torture.

    PubMed

    Mollica, Richard F; Chernoff, Miriam C; Megan Berthold, S; Lavelle, James; Lyoo, In Kyoon; Renshaw, Perry

    2014-10-01

    Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture. PMID:24962448

  18. The Mental Health Sequelae of Traumatic Head Injury in South Vietnamese Ex-Political Detainees Who Survived Torture

    PubMed Central

    Mollica, Richard F.; Chernoff, Miriam C.; Berthold, S. Megan; Lavelle, James; Lyoo, In Kyoon; Renshaw, Perry

    2014-01-01

    Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. 78% of the ex-political detainees had experienced THI. 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture. PMID:24962448

  19. The Current State of Knowledge of Hepatic Ischemia-Reperfusion Injury Based on Its Study in Experimental Models

    PubMed Central

    Mendes-Braz, M.; Elias-Miró, M.; Jiménez-Castro, M. B.; Casillas-Ramírez, A.; Ramalho, F. S.; Peralta, C.

    2012-01-01

    The present review focuses on the numerous experimental models used to study the complexity of hepatic ischemia/reperfusion (I/R) injury. Although experimental models of hepatic I/R injury represent a compromise between the clinical reality and experimental simplification, the clinical transfer of experimental results is problematic because of anatomical and physiological differences and the inevitable simplification of experimental work. In this review, the strengths and limitations of the various models of hepatic I/R are discussed. Several strategies to protect the liver from I/R injury have been developed in animal models and, some of these, might find their way into clinical practice. We also attempt to highlight the fact that the mechanisms responsible for hepatic I/R injury depend on the experimental model used, and therefore the therapeutic strategies also differ according to the model used. Thus, the choice of model must therefore be adapted to the clinical question being answered. PMID:22649277

  20. Patterns of Behavioral Deficits in Rodents Following Brain Injury Across Species, Gender, and Experimental Model.

    PubMed

    Hartman, Richard E; Thorndyke, Earl C

    2016-01-01

    Behavioral data were collected from several hundred mice and rats using a variety of experimental models of brain injury. The use of consistent protocols allowed compilation of these data, facilitating analyses of animal behaviors across experimental models, species, and gender. Spatial learning and sensorimotor/coordination data are presented, suggesting that, in general, rats performed better than mice both in the water maze and on the rotarod. Compared with females, males performed slightly better in the water maze and slightly worse on the rotarod. However, gender by species interactions accounted for both of these differences. Male rats performed better in the water maze than female rats, male mice, and female mice, which did not differ. Male mice performed worse on the rotarod than female mice, male rats, and female rats, which performed similarly. Furthermore, animals with subcortical injury were impaired in the water maze, but performed better than animals with cortical injuries. However, only animals with cortical injuries were impaired on the rotarod. Additional covariates, such as edema and lesion size, may further clarify these phenotypes. Overall, we provide evidence that abbreviated test batteries can be specifically designed to test deficits, depending on the species, gender, and model. PMID:26463925

  1. [An Extremely Rare Case of Penetrating Head Injury Caused by a Nasal Implant Made of an Ivory Chip and a Review of the Literature].

    PubMed

    Miyahara, Makiko; Okamoto, Koichiro; Tamai, Yuta; Aishima, Kaoru; Inoue, Masato; Ohno, Hiroyasu; Hara, Tetsuo; Matsubayashi, Shigemi

    2016-06-01

    Although penetrating head injuries are very rare in Japan, an extremely rare case is reported in which an ivory chip, embedded in the subcutaneous tissue by a cosmetic rhinoplasty, penetrated the cranium. A 69-year-old woman with a psychiatric disorder suddenly jumped down from a window and bruised her face. The ivory chip went into her left frontal lobe via the frontal sinus. At surgery, it was completely removed via the nasion. There were no postoperative complications after adequate frontal sinus repair and closure of dura mater with a piece of pericranium. The literature dealing with Japanese penetrating head injuries was also reviewed. (Received May 27, 2015; Accepted December 1, 2015; Published June 1, 2016). PMID:27279165

  2. Backspatter on the firearm and hand in experimental close-range gunshots to the head.

    PubMed

    Karger, Bernd; Nüsse, Roland; Bajanowski, Thomas

    2002-09-01

    The deposition of backspatter on the firearm or person shooting can greatly assist the reconstruction of shooting incidents. Backspatter was investigated in experimental transverse gunshots (9-mm Luger) to the heads of calves (n = 9) from shooting distances of 0 to 10 cm. The firearms were examined with a magnifying glass; the surgical gloves and the right sleeve worn by the person shooting were examined with a stereomicroscope. On the firearms, backspatter of blood was found in five of the nine cases, and one or both gloves showed bloodspatter deposits in six and the right sleeves in four cases. Most droplets were 1 to 3 mm and circular or elongated. In addition, a fine spray of tiny blood deposits was present on the firearm and textiles in four cases. The distribution of the droplets on the firearms varied: the areas included regions shielded by prominent parts, and the droplets were predominantly located on the extensor side of the fingers and the radial aspect of the hands and sleeves. Backspatter of tiny bone fragments was recovered from the firearm and sleeve in only one case, but tissue (bone, fat, muscle, skin) was present on the ground in front of the entrance wound in seven cases. A careful investigation, including appropriate lightning and magnification, is necessary for reliable statements concerning the absence of backspatter or the extent of backspatter present. PMID:12198343

  3. Comparison of Mortality Following Hospitalisation for Isolated Head Injury in England and Wales, and Victoria, Australia

    PubMed Central

    Gabbe, Belinda J.; Lyons, Ronan A.; Lecky, Fiona E.; Bouamra, Omar; Woodford, Maralyn; Coats, Timothy J.; Cameron, Peter A.

    2011-01-01

    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

  4. Experimental study on cheng zai wan for treatment of necrosis of the femoral head.

    PubMed

    Chen, Yanping; Huang, Keqin; Lang, Fengping; Huang, Yongxun; Huang, Hui; Huang, Hong; Zhou, Chongguang; Zhang, Wanqiang

    2003-12-01

    Cheng Zai Wan ([symbol: see text]), a Chinese herbal preparation was administrated in the two-leg rat model of aseptic necrosis of the femoral head established by taking prednisone acetate for a long period and the osteoporosis model rat by castration in order to explore the effects of the prescription on necrosis of the femoral head. The results showed that after treatment, the pitting on the surface of the femoral head disappeared, the reticular structure with filling cells was restored; the fat droplets in bone cells or cartilage cells of the femoral head were significantly reduced; sparse capillaries were improved, density and width of the bone trabecula were increased somewhat; bone mineral density, bone weight, bone strength and rigidity were significantly increased; and the low level of estrin was improved. It is suggested that Cheng Zai Wan has definite therapeutic effects on aseptic necrosis of the femoral head. PMID:14719304

  5. An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast.

    PubMed

    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

    2009-06-01

    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). PMID:19215189

  6. Electromagnetic Controlled Cortical Impact Device for Precise, Graded Experimental Traumatic Brain Injury

    PubMed Central

    BRODY, DAVID L.; DONALD, CHRISTINE Mac; KESSENS, CHAD C.; YUEDE, CARLA; PARSADANIAN, MAIA; SPINNER, MIKE; KIM, EDDIE; SCHWETYE, KATHERINE E.; HOLTZMAN, DAVID M.; BAYLY, PHILIP V.

    2008-01-01

    Genetically modified mice represent useful tools for traumatic brain injury (TBI) research and attractive preclinical models for the development of novel therapeutics. Experimental methods that minimize the number of mice needed may increase the pace of discovery. With this in mind, we developed and characterized a prototype electromagnetic (EM) controlled cortical impact device along with refined surgical and behavioral testing techniques. By varying the depth of impact between 1.0 and 3.0 mm, we found that the EM device was capable of producing a broad range of injury severities. Histologically, 2.0-mm impact depth injuries produced by the EM device were similar to 1.0-mm impact depth injuries produced by a commercially available pneumatic device. Behaviorally, 2.0-, 2.5-, and 3.0-mm impacts impaired hidden platform and probe trial water maze performance, whereas 1.5-mm impacts did not. Rotorod and visible platform water maze deficits were also found following 2.5- and 3.0-mm impacts. No impairment of conditioned fear performance was detected. No differences were found between sexes of mice. Inter-operator reliability was very good. Behaviorally, we found that we could statistically distinguish between injury depths differing by 0.5 mm using 12 mice per group and between injury depths differing by 1.0 mm with 7-8 mice per group. Thus, the EM impactor and refined surgical and behavioral testing techniques may offer a reliable and convenient framework for preclinical TBI research involving mice. PMID:17439349

  7. Understanding Edward Muybridge: historical review of behavioral alterations after a 19th-century head injury and their multifactorial influence on human life and culture.

    PubMed

    Manjila, Sunil; Singh, Gagandeep; Alkhachroum, Ayham M; Ramos-Estebanez, Ciro

    2015-07-01

    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. PMID:26126403

  8. [A detailed examination of injuries to the head and neck caused by bullfighting, and of their surgical treatment; the role of the cervico-facial surgeon].

    PubMed

    Chambres, O; Giraud, C; Gouffrant, J M; Debry, C

    2003-01-01

    Bullfighting (corrida) dates back to the 13th century in France, especially in the Camargue and the South-West, even if this fight between man and wild bull had been described before in other countries. The current modern bullfight, as an artistic interpretation, was codified in Spain during the 18th century into 3 tercios (parts): the tercio of the lance, of the bandillera, and of the muletta, which end with the death of the bull. Celebrated by our Spanish neighbours as a national fiesta, the corrida represents a confrontation between the intelligence of man and the power of the bull. Injuries are the heavy cost of this art paid by each bullfighter. Most of them have been injured seriously, or even gored to death inside the bullring. Goring is a single injury, a mix of wound, burn, contusion and infection. Its treatment calls for an expert, which makes this type of surgery highly specialised. Head and neck trauma represents 16% of the total wounds in bullfighting. Its not very often that this type of injury happens, but each time it is serious. This study is based on 1450 case reports, deals with causes and accident circumstances, together with the type of injuries and their early management in the bullring's infirmary. The seriousness of these wounds would justify a head and neck surgeon being part of the medical staff during the corrida. PMID:15038564

  9. Safe management of paediatric penetrating head injury without a CT scanner: A strategy for humanitarian surgeons based on experience in southern Afghanistan.

    PubMed

    Mathew, P; Nott, D M; Gentleman, D

    2016-03-01

    Introduction In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. Methods All cases of children aged under 16 years with penetrating head injury who were treated in a trauma unit in southern Afghanistan by a single neurosurgeon between 2008 and 2010 were reviewed. Based on a previously published retrospective review, a clinical strategy aimed specifically at generalist surgeons is proposed for selecting children who can benefit from surgical intervention in environments with no access to CT scanners. Results Fourteen patients were reviewed, of whom three had a tangential wound, 10 had a penetrating wound with retained fragments and one had a perforating injury. Two operations for generalist surgeons are described in detail: limited wound excision; and simple decompression of the intra-cranial compartment without brain resection or dural repair. Conclusions In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury. PMID:26890836

  10. Experimental Test of Spatial Updating Models for Monkey Eye-Head Gaze Shifts

    PubMed Central

    Van Grootel, Tom J.; Van der Willigen, Robert F.; Van Opstal, A. John

    2012-01-01

    How the brain maintains an accurate and stable representation of visual target locations despite the occurrence of saccadic gaze shifts is a classical problem in oculomotor research. Here we test and dissociate the predictions of different conceptual models for head-unrestrained gaze-localization behavior of macaque monkeys. We adopted the double-step paradigm with rapid eye-head gaze shifts to measure localization accuracy in response to flashed visual stimuli in darkness. We presented the second target flash either before (static), or during (dynamic) the first gaze displacement. In the dynamic case the brief visual flash induced a small retinal streak of up to about 20 deg at an unpredictable moment and retinal location during the eye-head gaze shift, which provides serious challenges for the gaze-control system. However, for both stimulus conditions, monkeys localized the flashed targets with accurate gaze shifts, which rules out several models of visuomotor control. First, these findings exclude the possibility that gaze-shift programming relies on retinal inputs only. Instead, they support the notion that accurate eye-head motor feedback updates the gaze-saccade coordinates. Second, in dynamic trials the visuomotor system cannot rely on the coordinates of the planned first eye-head saccade either, which rules out remapping on the basis of a predictive corollary gaze-displacement signal. Finally, because gaze-related head movements were also goal-directed, requiring continuous access to eye-in-head position, we propose that our results best support a dynamic feedback scheme for spatial updating in which visuomotor control incorporates accurate signals about instantaneous eye- and head positions rather than relative eye- and head displacements. PMID:23118883

  11. Oxidative tissue injury in multiple sclerosis is only partly reflected in experimental disease models.

    PubMed

    Schuh, Cornelia; Wimmer, Isabella; Hametner, Simon; Haider, Lukas; Van Dam, Anne-Marie; Liblau, Roland S; Smith, Ken J; Probert, Lesley; Binder, Christoph J; Bauer, Jan; Bradl, Monika; Mahad, Don; Lassmann, Hans

    2014-08-01

    Recent data suggest that oxidative injury may play an important role in demyelination and neurodegeneration in multiple sclerosis (MS). We compared the extent of oxidative injury in MS lesions with that in experimental models driven by different inflammatory mechanisms. It was only in a model of coronavirus-induced demyelinating encephalomyelitis that we detected an accumulation of oxidised phospholipids, which was comparable in extent to that in MS. In both, MS and coronavirus-induced encephalomyelitis, this was associated with massive microglial and macrophage activation, accompanied by the expression of the NADPH oxidase subunit p22phox but only sparse expression of inducible nitric oxide synthase (iNOS). Acute and chronic CD4(+) T cell-mediated experimental autoimmune encephalomyelitis lesions showed transient expression of p22phox and iNOS associated with inflammation. Macrophages in chronic lesions of antibody-mediated demyelinating encephalomyelitis showed lysosomal activity but very little p22phox or iNOS expressions. Active inflammatory demyelinating lesions induced by CD8(+) T cells or by innate immunity showed macrophage and microglial activation together with the expression of p22phox, but low or absent iNOS reactivity. We corroborated the differences between acute CD4(+) T cell-mediated experimental autoimmune encephalomyelitis and acute MS lesions via gene expression studies. Furthermore, age-dependent iron accumulation and lesion-associated iron liberation, as occurring in the human brain, were only minor in rodent brains. Our study shows that oxidative injury and its triggering mechanisms diverge in different models of rodent central nervous system inflammation. The amplification of oxidative injury, which has been suggested in MS, is only reflected to a limited degree in the studied rodent models. PMID:24622774

  12. Evidence of apoptotic cell death after experimental traumatic brain injury in the rat.

    PubMed Central

    Rink, A.; Fung, K. M.; Trojanowski, J. Q.; Lee, V. M.; Neugebauer, E.; McIntosh, T. K.

    1995-01-01

    Apoptosis plays an important role in many developmental and pathological processes of the central nervous system. However, the role of apoptosis in traumatic brain injury has not been determined. Using the terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end labeling (TUNEL) method, we detected many cells with extensive DNA fragmentation in different regions of the brains of rats subjected to experimental traumatic brain injury. Two types of TUNEL-positive cells were demonstrated by light and electron microscopy, including type I cells that displayed morphological features of necrotic cell death and type II cells that displayed morphological features of classic apoptotic cell death. TUNEL-positive cells were detectable for up to 72 hours after the initial injury. Gel electrophoresis of DNA extracted from affected areas of the injured brain containing both type I and II cells revealed only internucleosomal fragmentation at 185-bp intervals, a feature originally described in apoptotic cell death. These data suggest that apoptosis, in addition to necrotic cell death, occurs after traumatic brain injury, and that internucleosomal fragmentation of DNA may be associated with certain types of necrotic cell death. Images Figure 1 Figure 2 Figure 4 PMID:7495282

  13. An experimental spinal cord injury rat model using customized impact device: A cost-effective approach

    PubMed Central

    Vijayaprakash, K.M.; Sridharan, N.

    2013-01-01

    Till date, NYU MASCIS (New York University, Multicenter Animal Spinal Cord Injury Study) impactor and Ohio State University electromagnetic spinal cord injury device impactor were under use for simulating an experimental spinal cord injury in rodents; functional recovery being assessed through Basso, Beattie and Bresnahan (BBB) scoring method which is an open field behavior based scoring system. Although, the cited impactors are state-of-art devices, affordability to scientists in developing and under developed countries is questionable. Since the acquisition of these impact devices are expensive, we designed a customized impact device based on the requirement, satisfying all the parameters to withstand a standard animal model for contusion type of spinal cord injury at the thoracic level without compromising the lesion reproducibility. Here, a spinal cord contusion is created using a blunt-force impactor in male Wistar rats. Our method gave consistent lesion effects as evaluated by behavior scoring methods. All the animals showed equal degree of performance in tests like narrow beam, inclined plane and horizontal ladder and in BBB scores (open field locomotor test). The aim of presenting our experience is to reinstate the fact that lack of affordability to get sophisticated instrumentation need not be a hurdle in the pursuit of science. PMID:23960429

  14. Connecting clinical and experimental investigations of awareness in traumatic brain injury.

    PubMed

    Dockree, Paul M; O'Connell, Redmond G; Robertson, Ian H

    2015-01-01

    Questionnaire-based demonstrations of impaired self-awareness (SA) after traumatic brain injury (TBI) are not always supported by experimental studies of in-the-moment or online awareness. This chapter begins by describing the clinical phenomenon of impaired SA, how it is measured, and why its interdependency with mechanisms of online awareness may provide the scaffolding from which appraisals of cognitive functioning can be accurately revised following a brain injury. We review research that has measured unawareness of errors in routine action in TBI patients and propose more rigorous methodological approaches to studying the emergent properties of awareness with greater clarity in the laboratory. We discuss how neuropsychological and electrophysiologic studies are beginning to inform our understanding of impaired error processing in TBI patients and we highlight recent theory proposing that online metacognitive processes accumulate evidence of erroneous responses in a graded fashion. Neural signals with amplitudes that scale with the strength of accruing evidence and peak latencies that mark the threshold at which awareness emerges represent important neural mechanisms to examine the breakdown of error awareness after brain injury. We also discuss how errors can be investigated in relation to different sources of evidence that contribute to aware experiences after brain injury. Finally, we explore conditions beyond error signaling, and how different "objects of insight" that require retrospective and prospective judgments of confidence need to be examined in relation to the clinical phenomenon of impaired SA. PMID:25701904

  15. Experimental rat model for alcohol-induced osteonecrosis of the femoral head

    PubMed Central

    Okazaki, Shunichiro; Nagoya, Satoshi; Tateda, Kenji; Katada, Ryuichi; Mizuo, Keisuke; Watanabe, Satoshi; Yamashita, Toshihiko; Matsumoto, Hiroshi

    2013-01-01

    Alcohol-induced osteonecrosis of the femoral head (ONFH) is observed in alcohol abusers and patients with alcoholic fatty liver disease. It has been reported that Toll-like receptor 4 (TLR4) signalling plays a crucial role in the pathogenesis of alcoholic fatty liver disease. We previously reported a corticosteroid-induced ONFH rat model, and suggested that TLR4 signalling contributes to the pathogenesis of ONFH. Thus, it is thought that the pathogenesis of alcohol-induced ONFH is probably similar to that of corticosteroid-induced ONFH. The aim of this study was to develop a new animal model for alcohol-induced ONFH and to evaluate the relationship between the pro-inflammatory response via TLRs and the development of ONFH in rats. Male Wistar rats were fed a Lieber–DeCarli liquid diet containing 5% ethanol (experimental group) or dextran (control group) for 1–24 weeks. Histopathological and biochemical analyses were performed. Feeding the ethanol-containing liquid diet resulted in the development of ONFH with hepatic steatosis, hepatic dysfunction and hyperlipidaemia, whereas feeding the dextran-containing diet did not cause ONFH. However, we could not recognize any relationship between the pro-inflammatory response via TLR4 and the development of alcohol-induced ONFH. Thus in this study we have developed a new rat model for alcohol-induced ONFH based on the feeding of an ethanol liquid diet. ONFH was observed within seven days from the start of feeding with 5% ethanol-containing liquid diet. Although this was linked to hepatic steatosis, a TLR4 association was not a feature of this model. PMID:24020403

  16. Longitudinal Hemodynamic Changes Within the Optic Nerve Head in Experimental Glaucoma

    PubMed Central

    Cull, Grant; Burgoyne, Claude F.; Fortune, Brad; Wang, Lin

    2013-01-01

    Purpose. To characterize longitudinal changes in basal blood flow (BF) of the optic nerve head (ONH) during progression of structural damage in experimental glaucoma (EG). Methods. Unilateral elevation of IOP was induced in 15 adult rhesus macaques by laser treatment to the trabecular meshwork. Prior to and after laser, retinal nerve fiber layer thickness (RNFLT) and ONH BF were measured biweekly by spectral-domain optical coherence tomography and a laser speckle flowgraphy device (LSFG), respectively. Results. Average postlaser IOP was 20.2 ± 5.9 mm Hg in EG eyes and 12.3 ± 2.6 mm Hg in control eyes (P < 0.0001). Longitudinal changes in basal ONH BF were strongly associated with changes in RNFLT as EG progressed from early through moderately advanced stages of damage, with Pearson correlation coefficients ranging from 0.64 to 0.97 (average = 0.81) and an average slope of 1.0. During early stage (RNFLT loss < 10%), basal ONH BF was mildly increased (9% ± 10%, P = 0.004) relative to baseline and compared with fellow controls (P = 0.02). Basal ONH BF declined continuously throughout subsequent stages in EG eyes reaching 25.0% ± 9.6% (P < 0.0001) below baseline at the final stage studied (RNFLT loss > 40%). In fellow control eyes, there was no significant change in basal ONH BF over time (P = 0.27). Conclusions. In EG based on chronic mild-to-moderate IOP elevation, a two-phase pattern of ONH BF alteration was observed. ONH BF increased during the earliest stage (while RNFLT was within 10% of baseline) followed by a linear decline that was strongly correlated with loss of RNFLT. PMID:23737471

  17. Longitudinal Alterations in the Dynamic Autoregulation of Optic Nerve Head Blood Flow Revealed in Experimental Glaucoma

    PubMed Central

    Wang, Lin; Cull, Grant; Burgoyne, Claude F.; Thompson, Simon; Fortune, Brad

    2014-01-01

    Purpose. To use a novel dynamic autoregulation analysis (dAR) to test the hypothesis that the optic nerve head (ONH) blood flow (BF) autoregulation is disrupted during early stages of experimental glaucoma (EG) in nonhuman primates. Methods. Retinal nerve fiber layer thickness (RNFLT, assessed by optical coherence tomography) and ONH BF (assessed by laser speckle imaging technique) were measured biweekly before and after unilateral laser treatment to the trabecular meshwork. Each nonhuman primate was followed until reaching either an early stage of damage (RNFLT loss < 20%, n = 6) or moderate to advanced stages of damage (RNFLT loss > 20%, n = 9). At each test, dAR was assessed by characterizing ONH BF changes during the first minute of rapid manometrical intraocular pressure (IOP) elevation from 10 to 40 mm Hg. The dAR analysis extracted the following parameters: baseline BF, average BF 10 seconds before IOP elevation; BFΔmax, maximum BF change from baseline BF; Tr, time from baseline BF to the BFΔmax; Kr, average descending BF rate. Results. Mean postlaser IOP was 20.2 ± 5.9 and 12.3 ± 2.6 mm Hg in EG and control eyes, respectively (P < 0.0001). Compared with prelaser values, baseline BF was higher in early EG, but lower in moderate to advanced EG (P = 0.01). Tr was increased and Kr was reduced in both stages (P < 0.01). BFΔmax was smaller in the early EG (P = 0.05) and remained low in the moderate to advanced EG (P = 0.15). No changes in the parameters were observed in control eyes. Conclusions. Chronic IOP elevation causes ONH autoregulation dysfunction in the early stage of EG, characterized by a disrupted BF response and delayed Tr, revealed by dAR analysis. PMID:24812551

  18. Brain Injury After Proton Therapy or Carbon Ion Therapy for Head-and-Neck Cancer and Skull Base Tumors

    SciTech Connect

    Miyawaki, Daisuke Murakami, Masao; Demizu, Yusuke; Sasaki, Ryohei; Niwa, Yasue; Terashima, Kazuki; Nishimura, Hideki; Hishikawa, Yoshio; Sugimura, Kazuro

    2009-10-01

    Purpose: To assess the incidence of early delayed or late morbidity of Brain after particle therapy for skull base tumors and head-and-neck cancers. Methods and Materials: Between May 2001 and December 2005, 59 patients with cancerous invasion of the skull base were treated with proton or carbon ion therapy at the Hyogo Ion Beam Medical Center. Adverse events were assessed according to the magnetic resonance imaging findings (late effects of normal tissue-subjective, objective, management, analytic [LENT-SOMA]) and symptoms (Common Terminology Criteria for Adverse Events [CTCAE], version 3.0). Dose-volume histograms were used to analyze the relationship between the dose and volume of the irradiated brain and the occurrence of brain injury. The median follow-up time was 33 months. Results: Of the 48 patients treated with proton therapy and 11 patients treated with carbon ion radiotherapy, 8 (17%) and 7 (64%), respectively, developed radiation-induced brain changes (RIBCs) on magnetic resonance imaging (LENT-SOMA Grade 1-3). Four patients (7%) had some clinical symptoms, such as vertigo and headache (CTCAE Grade 2) or epilepsy (CTCAE Grade 3). The actuarial occurrence rate of RIBCs at 2 and 3 years was 20% and 39%, respectively, with a significant difference in the incidence between the proton and carbon ion radiotherapy groups. The dose-volume histogram analyses revealed significant differences between Brain lobes with and without RIBCs in the actuarial volume of brain lobes receiving high doses. Conclusion: Particle therapies produced minimal symptomatic brain toxicities, but sequential evaluation with magnetic resonance imaging detected a greater incidence of RIBCs. Significant differences were observed in the irradiated brain volume between Brain lobes with and without RIBCs.

  19. Objective Functional Assessment After a Head Injury Using Movement and Activity in Physical Space Scores: A Case Report

    PubMed Central

    Farnsworth, James L.; McElhiney, Danielle; David, Shannon; Sinha, Gaurav; Ragan, Brian G.

    2014-01-01

    Objective: To describe the potential benefit of using a global positioning system (GPS) and accelerometry as an objective functional-activity measure after concussion by creating Movement and Activity in Physical Space (MAPS) scores. Background: A 21-year-old female soccer player suffered a blow to the back of the head from an opponent's shoulder during an away match. No athletic trainer was present. She played the remainder of the match and reported to the athletic training facility the next day for evaluation. Differential Diagnosis: Concussion. Treatment: The athlete was removed from all athletic activities. Her symptoms were monitored based on the Zurich guidelines. She was also instructed to wear an accelerometer on her hip and to carry an on-person GPS receiver at all times for 10 days. Her total symptom scores for the 4 symptomatic days were 82, 39, 49, and 36. Her mean MAPS functional score for symptomatic days 3 through 5 was 900.9 and for asymptomatic days 6 through 11 was 2734.9. Uniqueness: We monitored the patient's function during the concussion-recovery process using an on-person GPS receiver and accelerometer to calculate personalized MAPS scores. This novel approach to measuring function after injury may provide a useful complementary tool to help with return-to-play decisions. Conclusions: An on-person GPS receiver and accelerometer were used to observe the patient's physical activity in a free-living environment, allowing for an objective measure of function during recovery. Her MAPS scores were low while she was symptomatic and increased as she became asymptomatic. We saw the expected inverse relationship between symptoms and function. In situations where accuracy of reported symptoms may be a concern, this measure may provide a way to verify the validity of, or raise doubts about, self-reported symptoms. PMID:24840582

  20. Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study

    PubMed Central

    Khan, A.; Prince, M.; Brayne, C.; Prina, A. M.

    2015-01-01

    Introduction 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. Methods 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. Results 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. Discussion 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. PMID:26146992

  1. Monitoring hemodynamic and morphologic responses to closed head injury in a mouse model using orthogonal diffuse near-infrared light reflectance spectroscopy

    NASA Astrophysics Data System (ADS)

    Abookasis, David; Shochat, Ariel; Mathews, Marlon S.

    2013-04-01

    The authors' aim is to assess and quantitatively measure brain hemodynamic and morphological variations during closed-head injury (CHI) in mice using orthogonal diffuse near-infrared reflectance spectroscopy (o-DRS). CHI is a type of injury to the head that does not penetrate the skull. Usually, it is caused by mechanical blows to the head and frequently occurs in traffic accidents, falls, and assaults. Measurements of brain optical properties, namely absorption and reduced scattering coefficients in the wavelength range from 650 to 1000 nm were carried out by employing different source-detector distance and locations to provide depth sensitivity on an intact scalp over the duration of the whole experiment. Furthermore, alteration in both cortical hemodynamics and morphologic markers, i.e., scattering power and amplitude properties were derived. CHI was induced in anesthetized male mice by a weight-drop model using ˜50 g cylindrical metal falling from a height of 90 cm onto the intact scalp producing an impact of 4500 g cm. With respect to baseline, difference in brain physiological properties was observed following injury up to 1 h post-trauma. Additionally, the reduced scattering spectral shapes followed Mie scattering theory was quantified and clearly shows changes in both scattering amplitude and power from baseline indicating structural variations likely from evolving cerebral edema during CHI. We further demonstrate high correlation between scattering amplitude and scattering power, with more than 20% difference in slope in comparison to preinjury. This result indicates the possibility of using the slope also as a marker for detection of structural changes. Finally, experiments investigating brain function during the first 20 min postinjury were conducted and changes in chromophore concentrations and scattering were observed. Overall, our experiments demonstrate the potential of using the proposed technique as a valuable quantitative noninvasive tool for

  2. An Ultrasonic-Adaptive Beamforming Method and Its Application for Trans-skull Imaging of Certain Types of Head Injuries; Part I: Transmission Mode.

    PubMed

    Shapoori, Kiyanoosh; Sadler, Jeff; Wydra, Adrian; Malyarenko, Eugene V; Sinclair, Anthony N; Maev, Roman Gr

    2015-05-01

    A new adaptive beamforming algorithm for imaging via small-aperture 1-D ultrasonic-phased arrays through composite layered structures is reported. Such structures cause acoustic phase aberration and wave refraction at undulating interfaces and can lead to significant distortion of an ultrasonic field pattern produced by conventional beamforming techniques. This distortion takes the form of defocusing the ultrasonic field transmitted through the barrier and causes loss of resolution and overall degradation of image quality. To compensate for the phase aberration and the refractional effects, we developed and examined an adaptive beamforming algorithm for small-aperture linear-phased arrays. After accurately assessing the barrier's local geometry and sound speed, the method calculates a new timing scheme to refocus the distorted beam at its original location. As a tentative application, implementation of this method for trans-skull imaging of certain types of head injuries through human skull is discussed. Simulation and laboratory results of applying the method on skull-mimicking phantoms are presented. Correction of up to 2.5 cm focal point displacement at up to 10 cm depth under our skull phantom is demonstrated. Quantitative assessment of the method in a variety of temporal focusing scenarios is also reported. Overall temporal deviation on the order of a few nanoseconds was observed between the simulated and experimental results. The single-point adaptive focusing results demonstrate strong potential of our approach for diagnostic imaging through intact human skull. The algorithms were implemented on an ultrasound advanced open-platform controlling 64 active elements on a 128-element phased array. PMID:25423646

  3. Reduced neuronal cell death after experimental brain injury in mice lacking a functional alternative pathway of complement activation

    PubMed Central

    Leinhase, Iris; Holers, V Michael; Thurman, Joshua M; Harhausen, Denise; Schmidt, Oliver I; Pietzcker, Malte; Taha, Mohy E; Rittirsch, Daniel; Huber-Lang, Markus; Smith, Wade R; Ward, Peter A; Stahel, Philip F

    2006-01-01

    Background Neuroprotective strategies for prevention of the neuropathological sequelae of traumatic brain injury (TBI) have largely failed in translation to clinical treatment. Thus, there is a substantial need for further understanding the molecular mechanisms and pathways which lead to secondary neuronal cell death in the injured brain. The intracerebral activation of the complement cascade was shown to mediate inflammation and tissue destruction after TBI. However, the exact pathways of complement activation involved in the induction of posttraumatic neurodegeneration have not yet been assessed. In the present study, we investigated the role of the alternative complement activation pathway in contributing to neuronal cell death, based on a standardized TBI model in mice with targeted deletion of the factor B gene (fB-/-), a "key" component required for activation of the alternative complement pathway. Results After experimental TBI in wild-type (fB+/+) mice, there was a massive time-dependent systemic complement activation, as determined by enhanced C5a serum levels for up to 7 days. In contrast, the extent of systemic complement activation was significantly attenuated in fB-/- mice (P < 0.05,fB-/- vs. fB+/+; t = 4 h, 24 h, and 7 days after TBI). TUNEL histochemistry experiments revealed that posttraumatic neuronal cell death was clearly reduced for up to 7 days in the injured brain hemispheres of fB-/- mice, compared to fB+/+ littermates. Furthermore, a strong upregulation of the anti-apoptotic mediator Bcl-2 and downregulation of the pro-apoptotic Fas receptor was detected in brain homogenates of head-injured fB-/- vs. fB+/+ mice by Western blot analysis. Conclusion The alternative pathway of complement activation appears to play a more crucial role in the pathophysiology of TBI than previously appreciated. This notion is based on the findings of (a) the significant attenuation of overall complement activation in head-injured fB-/- mice, as determined by a

  4. Pyruvate treatment attenuates cerebral metabolic depression and neuronal loss after experimental traumatic brain injury.

    PubMed

    Moro, Nobuhiro; Ghavim, Sima S; Harris, Neil G; Hovda, David A; Sutton, Richard L

    2016-07-01

    Experimental traumatic brain injury (TBI) is known to produce an acute increase in cerebral glucose utilization, followed rapidly by a generalized cerebral metabolic depression. The current studies determined effects of single or multiple treatments with sodium pyruvate (SP; 1000mg/kg, i.p.) or ethyl pyruvate (EP; 40mg/kg, i.p.) on cerebral glucose metabolism and neuronal injury in rats with unilateral controlled cortical impact (CCI) injury. In Experiment 1 a single treatment was given immediately after CCI. SP significantly improved glucose metabolism in 3 of 13 brain regions while EP improved metabolism in 7 regions compared to saline-treated controls at 24h post-injury. Both SP and EP produced equivalent and significant reductions in dead/dying neurons in cortex and hippocampus at 24h post-CCI. In Experiment 2 SP or EP were administered immediately (time 0) and at 1, 3 and 6h post-CCI. Multiple SP treatments also significantly attenuated TBI-induced reductions in cerebral glucose metabolism (in 4 brain regions) 24h post-CCI, as did multiple injections of EP (in 4 regions). The four pyruvate treatments produced significant neuroprotection in cortex and hippocampus 1day after CCI, similar to that found with a single SP or EP treatment. Thus, early administration of pyruvate compounds enhanced cerebral glucose metabolism and neuronal survival, with 40mg/kg of EP being as effective as 1000mg/kg of SP, and multiple treatments within 6h of injury did not improve upon outcomes seen following a single treatment. PMID:27059390

  5. Resolvin D1 protects against inflammation in experimental acute pancreatitis and associated lung injury.

    PubMed

    Liu, Yong; Zhou, Dan; Long, Fei-Wu; Chen, Ke-Ling; Yang, Hong-Wei; Lv, Zhao-Yin; Zhou, Bin; Peng, Zhi-Hai; Sun, Xiao-Feng; Li, Yuan; Zhou, Zong-Guang

    2016-03-01

    Acute pancreatitis is an inflammatory condition that may lead to multisystemic organ failure with considerable mortality. Recently, resolvin D1 (RvD1) as an endogenous anti-inflammatory lipid mediator has been confirmed to protect against many inflammatory diseases. This study was designed to investigate the effects of RvD1 in acute pancreatitis and associated lung injury. Acute pancreatitis varying from mild to severe was induced by cerulein or cerulein combined with LPS, respectively. Mice were pretreated with RvD1 at a dose of 300 ng/mouse 30 min before the first injection of cerulein. Severity of AP was assessed by biochemical markers and histology. Serum cytokines and myeloperoxidase (MPO) levels in pancreas and lung were determined for assessing the extent of inflammatory response. NF-κB activation was determined by Western blotting. The injection of cerulein or cerulein combined with LPS resulted in local injury in the pancreas and corresponding systemic inflammatory changes with pronounced severity in the cerulein and LPS group. Pretreated RvD1 significantly reduced the degree of amylase, lipase, TNF-α, and IL-6 serum levels; the MPO activities in the pancreas and the lungs; the pancreatic NF-κB activation; and the severity of pancreatic injury and associated lung injury, especially in the severe acute pancreatitis model. These results suggest that RvD1 is capable of improving injury of pancreas and lung and exerting anti-inflammatory effects through the inhibition of NF-κB activation in experimental acute pancreatitis, with more notable protective effect in severe acute pancreatitis. These findings indicate that RvD1 may constitute a novel therapeutic strategy in the management of severe acute pancreatitis. PMID:26702138

  6. Lumbar spine endplate fractures: Biomechanical evaluation and clinical considerations through experimental induction of injury.

    PubMed

    Curry, William H; Pintar, Frank A; Doan, Ninh B; Nguyen, Ha Son; Eckardt, Gerald; Baisden, Jamie L; Maiman, Dennis J; Paskoff, Glenn R; Shender, Barry S; Stemper, Brian D

    2016-06-01

    Lumbar endplate fractures were investigated in different experimental scenarios, however the biomechanical effect of segmental alignment was not outlined. The objectives of this study were to quantify effects of spinal orientation on lumbar spine injuries during single-cycle compressive loads and understand lumbar spine endplate injury tolerance. Twenty lumbar motion segments were compressed to failure. Two methods were used in the preparation of the lumbar motion segments. Group 1 (n = 7) preparation maintained pre-test sagittal lordosis, whereas Group 2 (n = 13) specimens had a free-rotational end condition for the cranial vertebra, allowing sagittal rotation of the cranial vertebra to create parallel endplates. Five Group 1 specimens experienced posterior vertebral body fracture prior to endplate fracture, whereas two sustained endplate fracture only. Group 2 specimens sustained isolated endplate fractures. Group 2 fractures occurred at approximately 41% of the axial force required for Group 1 fracture (p < 0.05). Imaging and specimen dissection indicate endplate injury consistently took place within the confines of the endplate boundaries, away from the vertebral periphery. These findings indicate that spinal alignment during compressive loading influences the resulting injury pattern. This investigation identified the specific mechanical conditions under which an endplate breach will take place. Development of endplate injuries has significant clinical implication as previous research identified internal disc disruption (IDD) and degenerative disc disease (DDD) as long-term consequences of the axial load-shift that occurs following a breach of the endplate. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1084-1091, 2016. PMID:26610067

  7. Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

    PubMed Central

    Grinsell, D.; Keating, C. P.

    2014-01-01

    Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery. PMID:25276813

  8. D-cycloserine improves functional recovery and reinstates long-term potentiation (LTP) in a mouse model of closed head injury.

    PubMed

    Yaka, Rami; Biegon, Anat; Grigoriadis, Nikolaos; Simeonidou, Constantina; Grigoriadis, Savvas; Alexandrovich, Alexander G; Matzner, Henri; Schumann, Johanna; Trembovler, Victoria; Tsenter, Jeanna; Shohami, Esther

    2007-07-01

    Traumatic brain injury triggers a massive glutamate efflux, activation of NMDA receptor channels, and cell death. Recently, we reported that NMDA receptors in mice are down-regulated from hours to days following closed head injury (CHI), and treatment with NMDA improved recovery of motor and cognitive functions up to 14 d post-injury. Here we show that a single injection of a low dose of D-cycloserine (DCS), a partial NMDA receptor agonist, in CHI mice 24 h post-injury, resulted in a faster and greater recovery of motor and memory functions as assessed by neurological severity score and object recognition tests, respectively. Moreover, DCS treatment of CHI mice led to a significant improvement of hippocampal long-term potentiation (LTP) in the CA1 region that was completely blunted in CHI control mice. However, DCS did not improve CHI-induced impairment in synaptic glutamate release measured by paired pulse facilitation (PPF) ratio in hippocampal CA1 region. Finally, CHI-induced reduction of brain-derived neurotrophic factor (BDNF) was fully restored following DCS treatment. Since DCS is in clinical use for other indications, the present study offers a novel approach to treat human brain injury. PMID:17351125

  9. Effects of zileuton and montelukast in mouse experimental spinal cord injury

    PubMed Central

    Genovese, T; Rossi, A; Mazzon, E; Di Paola, R; Muià, C; Caminiti, R; Bramanti, P; Sautebin, L; Cuzzocrea, S

    2007-01-01

    Background and purpose: 5-lipoxygenase (5-LO) is the key enzyme in leukotriene (LT) biosynthesis from arachidonic acid (AA). Here, we examined the role of the 5-LO-product, cysteinyl-LT (Cys-LT), with a 5-LO inhibitor (zileuton) and a Cys-LT, receptor antagonist (montelukast), in the inflammatory response and tissue injury associated with spinal cord injury (SCI). Experimental approach: SCI was induced in mice by the application of vascular clips to the dura via a two-level T6 to T7 laminectomy for 1 min. Cord inflammation was assessed histologically and by measuring inflammatory mediators (ELISA) and apoptosis by annexin V, TUNEL, Fas ligand staining and Bax and Bcl-2 expression (immunohistochemistry and western blots). Motor function in hindlimbs was assessed by a locomotor rating scale, for 10 days after cord injury. Key results: SCI in mice resulted in tissue damage, oedema, neutrophil infiltration, apoptosis, tumour necrosis-α (TNF-α) and cyclooxygenase-2 (COX-2) expression, prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) production, and extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation in injured tissue. Treatment of the mice with zileuton or montelukast reduced the spinal cord inflammation and tissue injury, neutrophil infiltration, TNF-α, COX-2 and pERK1/2 expression, PGE2 and LTB4 production, and apoptosis. In separate experiments, zileuton or montelukast significantly improved the recovery of limb function over 10 days. Conclusions and implications: Zileuton and montelukast produced a substantial reduction of inflammatory events associated with experimental SCI. Our data underline the important role of 5-LO and Cys-LT in neurotrauma. PMID:18059327

  10. Modified Citrus Pectin Reduces Galectin-3 Expression and Disease Severity in Experimental Acute Kidney Injury

    PubMed Central

    Kolatsi-Joannou, Maria; Price, Karen L.; Winyard, Paul J.; Long, David A.

    2011-01-01

    Galectin-3 is a β-galactoside binding lectin with roles in diverse processes including proliferation, apoptosis, inflammation and fibrosis which are dependent on different domains of the molecule and subcellular distribution. Although galectin-3 is known to be upregulated in acute kidney injury, the relative importance of its different domains and functions are poorly understood in the underlying pathogenesis. Therefore we experimentally modulated galectin-3 in folic acid (FA)-induced acute kidney injury utilising modified citrus pectin (MCP), a derivative of pectin which can bind to the galectin-3 carbohydrate recognition domain thereby predominantly antagonising functions linked to this role. Mice were pre-treated with normal or 1% MCP-supplemented drinking water one week before FA injection. During the initial injury phase, all FA-treated mice lost weight whilst their kidneys enlarged secondary to the renal insult; these gross changes were significantly lessened in the MCP group but this was not associated with significant changes in galectin-3 expression. At a histological level, MCP clearly reduced renal cell proliferation but did not affect apoptosis. Later, during the recovery phase at two weeks, MCP-treated mice demonstrated reduced galectin-3 in association with decreased renal fibrosis, macrophages, pro-inflammatory cytokine expression and apoptosis. Other renal galectins, galectin-1 and -9, were unchanged. Our data indicates that MCP is protective in experimental nephropathy with modulation of early proliferation and later galectin-3 expression, apoptosis and fibrosis. This raises the possibility that MCP may be a novel strategy to reduce renal injury in the long term, perhaps via carbohydrate binding-related functions of galectin-3. PMID:21494626

  11. An Experimental and Analytical Investigation of Stirling Space Power Converter Heater Head

    NASA Technical Reports Server (NTRS)

    Abdul-Aziz, Ali; Bartolotta, Paul; Tong, Mike; Allen, Gorden

    1995-01-01

    NASA has identified the Stirling power converter as a prime candidate for the next generation power system for space applications requiring 60000 hr of operation. To meet this long-term goal, several critical components of the power converter have been analyzed using advanced structural assessment methods. Perhaps the most critical component, because of its geometric complexity and operating environment, is the power converter's heater head. This report describes the life assessment of the heater head which includes the characterization of a viscoplastic material model, the thermal and structural analyses of the heater head, and the interpolation of fatigue and creep test results of a nickel-base superalloy, Udimet 720 LI (Low Inclusions), at several elevated temperatures for life prediction purposes.

  12. Traumatic Brain Injury

    MedlinePlus

    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 ...

  13. Head Injury without Laceration

    MedlinePlus

    ... decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. FreeMD.com is powered by a computer program that performs symptom triage. The goal of ...

  14. Mediators' Emotional Responses to Self-Injurious Behavior: An Experimental Study.

    ERIC Educational Resources Information Center

    Mossman, Dominique A.; Hastings, Richard P.; Brown, Tony

    2002-01-01

    Sixty mediators from British schools for children with mental retardation watched one of five matched videos depicting no self-injury, self-injury maintained by positive reinforcement, self-injury maintained by negative reinforcement, and self-injury unrelated to social events. Self-injury maintained by negative reinforcement was associated with…

  15. Biosensor for Hepatocellular Injury Corresponds to Experimental Scoring of Hepatosplenic Schistosomiasis in Mice

    PubMed Central

    Sombetzki, Martina; Koslowski, Nicole; Doss, Sandra; Loebermann, Micha; Trauner, Michael; Reisinger, Emil C.; Sauer, Martin

    2016-01-01

    Severe hepatosplenic injury of mansonian schistosomiasis is caused by Th2 mediated granulomatous response against parasite eggs entrapped within the periportal tissue. Subsequent fibrotic scarring and deformation/sclerosing of intrahepatic portal veins lead to portal hypertension, ascites, and oesophageal varices. The murine model of Schistosoma mansoni (S. mansoni) infection is suitable to establish the severe hepatosplenic injury of disease within a reasonable time scale for the development of novel antifibrotic or anti-infective strategies against S. mansoni infection. The drawback of the murine model is that the material prepared for complex analysis of egg burden, granuloma size, hepatic inflammation, and fibrosis is limited due to small amounts of liver tissue and blood samples. The objective of our study was the implementation of a macroscopic scoring system for mice livers to determine infection-related organ alterations of S. mansoni infection. In addition, an in vitro biosensor system based on the detection of hepatocellular injury in HepG2/C3A cells following incubation with serum of moderately (50 S. mansoni cercariae) and heavily (100 S. mansoni cercariae) infected mice affirmed the value of our scoring system. Therefore, our score represents a valuable tool in experimental schistosomiasis to assess severity of hepatosplenic schistosomiasis and reduce animal numbers by saving precious tissue samples. PMID:27376078

  16. OMA1 mediates OPA1 proteolysis and mitochondrial fragmentation in experimental models of ischemic kidne