OBJECTIVE: To show the effect of dual monitoring including cardiac output (CO) and intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI) patiens. We hypothesized that meticulous treatment using dual monitoring is effective to sustain maintain minimal intensive care unit (ICU) complications and maintain optimal ICP and cerebral perfusion pressure (CPP) for severe TBI patiens. METHODS: We included severe TBI, below Glasgow Coma Scale (GCS) 8 and head abbreviation injury scale (AIS) >4 and performed decompressive craniectomy at trauma ICU of our hospital. We collected the demographic data, head AIS, injury severity score (ISS), initial GCS, ICU stay, sedation duration, fluid therapy related complications, Glasgow Outcome Scale (GOS) at 3 months and variable parameters of ICP and CO monitor. RESULTS: Thirty patients with severe TBI were initially selected. Thirteen patients were excluded because 10 patients had fixed pupillary reflexes and 3 patients had uncontrolled ICP due to severe brain edema. Overall 17 patients had head AIS 5 except 2 patients and 10 patients (58.8%) had multiple traumas as mean ISS 29.1. Overall complication rate of the patients was 64.7%. Among the parameters of CO monitoring, high stroke volume variation is associated with fluid therapy related complications (p=0.043) and low cardiac contractibility is associated with these complications (p=0.009) statistically. CONCLUSION: Combined use of CO and ICP monitors in severe TBI patients who could be necessary to decompressive craniectomy and postoperative sedation is good alternative methods to maintain an adequate ICP and CPP and reduce fluid therapy related complications during postoperative ICU care.
Brain Edema ; Brain Injuries* ; Cardiac Output* ; Cerebrovascular Circulation* ; Decompressive Craniectomy ; Fluid Therapy ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head ; Humans ; Injury Severity Score ; Intensive Care Units ; Intracranial Pressure* ; Monitoring, Physiologic ; Multiple Trauma ; Reflex, Pupillary ; Stroke Volume

OBJECTIVE: Head injury is the main cause of death and severe disability in bicycle-related injuries. The purpose of this study was to compare the demographic characteristics and injury mechanisms of bicycle-related head injuries according to the severity and outcome and determine the main risk factors and common types of accompanying injuries. METHODS: A total of 205 patients who were admitted to the neurosurgery department of our hospital for bicycle-related head injuries between 2007 and 2016 were analyzed. We categorized the patients into two groups according to severity and outcome of head injury, and then identified the differences in age, sex, and cause of injury between the two groups. RESULTS: Collisions with a motor vehicle increased the risk of severe head injury (p=0.011), resulted in poor outcomes (Glasgow Outcome Scale [GOS] ≤3; p=0.022), and caused more accompanying chest/abdominal (p<0.001) and pelvic/lower extremity injuries (p=0.001) than other mechanisms. Older age and high grade of head injury severity resulted in poor outcomes (p=0.028 and p<0.001, respectively), and caused more accompanying chest/abdominal injuries (p<0.032 and p<0.001, respectively) compared with younger age and low grade of head injury severity. CONCLUSION: In bicycle-related head injuries, collision with motor vehicle is one of the most important risk factor for high grade of head injury severity and outcome. In addition, bicycle-related head injuries are often accompanied by injuries of other parts of the body.
Cause of Death ; Craniocerebral Trauma* ; Epidemiology* ; Extremities ; Head* ; Humans ; Motor Vehicles ; Neurosurgery ; Risk Factors*

OBJECTIVE: Recently, the number of patients who fell or jumped from bridges over Han River has rapidly increased. However, the injury patterns and outcomes of these patients have been poorly characterized. The aim of this study was to determine the injury characteristics of these patients. METHODS: We reviewed the medical records of all patients who were transferred to the Emergency Room due to jumping or falling from bridges over Han River between 2011 and 2015. RESULTS: A total of 203 patients were included. Among them, 14 (6.9%) patients were dead on arrival, 51 (25.1%) patients were expired in the hospital, and 138 (70%) patients were discharged alive, including a patient who had severe neurologic sequelae after resuscitation. Skeletal and internal organ injuries were identified based on radiologic images. The most injured organ was thorax (58.1%), followed by spine (23.1%), abdomen (11.1%), extremity (7.7%), and cranium (5.2%). Chest tubing for pneumothorax or hemothorax was performed in four (2.9%) patients. Surgical intervention was needed for four patients (2.9%). CONCLUSION: Trauma patterns were concentrating on the thorax and spine regions. Therefore, complete radiographic evaluation should be performed for these patients.
Abdomen ; Accidental Falls* ; Drowning* ; Emergency Service, Hospital ; Extremities ; Hemothorax ; Humans ; Medical Records ; Pneumothorax ; Resuscitation ; Rivers* ; Skull ; Spinal Fractures ; Spine ; Thoracic Injuries ; Thorax ; Trauma Severity Indices

OBJECTIVE: Traumatic brain injury causes tissue damage, breakdown of cerebral blood flow and metabolic regulation. This study aims to investigate the protective influence of antioxidant Ganoderma lucidum (G. lucidum) polysaccharides (GLPs) on brain injury in brain-traumatized rats. METHODS: Sprague-Dawley conducted a head-traumatized method on rats by dropping off 300 g weight from 1 m height. Groups were categorized as control, G. lucidum, trauma, trauma+ G. lucidum (20 mL/kg per day via gastric gavage). Brain tissues were dissected from anesthetized rats 7 days after injury. For biochemical analysis, malondialdehyde, glutathione and myeloperoxidase values were measured. RESULTS: In histopathological examination, neuronal damage in brain cortex and changes in blood brain barrier were observed. In the analysis of immunohistochemical and western blot, p38 mitogen-activated protein kinase, vascular endothelial growth factor and cluster of differentiation 68 expression levels were shown. These analyzes demonstrated the beneficial effects of GLPs on brain injury. CONCLUSION: We propose that GLPs treatment after brain injury could be an alternative treatment to decraseing inflammation and edema, preventing neuronal and glial cells degeneration if given in appropriate dosage and in particular time intervals.
Animals ; Blood-Brain Barrier ; Blotting, Western ; Brain Injuries ; Brain* ; Cerebrovascular Circulation ; Edema ; Ganoderma* ; Glutathione ; Inflammation ; Malondialdehyde ; Methods ; Neuroglia ; Neurons ; Oxidative Stress* ; Peroxidase ; Polysaccharides ; Protein Kinases ; Rats* ; Rats, Sprague-Dawley ; Reishi* ; Vascular Endothelial Growth Factor A

OBJECTIVE: Aquaporin (AQP) is a recently discovered protein that regulates water homeostasis. The present study examines changes in AQP 1 and 4 in kaolin induced experimental hydrocephalic rats to elucidate the pathophysiology of water homeostasis in the disease. METHODS: Hydrocephalus was induced by percutaneous intracisternal injection of kaolin. The brain parenchyma and choroid plexus were obtained at 3, 7, 14 and 30 days after injection. Protein expressions of AQP 1 and 4 were measured by western blot, immunohistochemistry (IHC) and immunofluorescence (IF) stains. RESULTS: In the choroid plexus of the kaolin-induced hydrocephalus group, AQP 1 expression identified by western blot exhibited sharp decrease in the early stage (55% by the 3rd day and 22% by the 7th day), but indicated a 2.2-fold increase in the later stage (30th day) in comparison with control groups. In the parenchyma, a quantitative measurement of AQP 4 expression revealed variable results on the 3rd and 7th days, but indicated expression 2.1 times higher than the control in the later stage (30th day). In addition, the IHC and IF findings supported the patterns of expression of AQP 1 in the choroid plexus and AQP 4 in the parenchyma. CONCLUSION: Expression of AQP 1 decreased sharply in the choroid plexus of acute hydrocephalus rats and increased at later stages. Expression of AQP 4 in the brain parenchyma was variable in the early stage in the hydrocephalus group, but was higher than in the control in the later stage. These findings suggest a compensating role of AQPs in water physiology in hydrocephalus.
Animals ; Aquaporin 1* ; Aquaporins ; Blotting, Western ; Brain* ; Choroid Plexus* ; Choroid* ; Coloring Agents ; Fluorescent Antibody Technique ; Homeostasis ; Hydrocephalus ; Immunohistochemistry ; Kaolin ; Physiology ; Rats* ; Water

Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). The risks of CSF leaks can be detrimental to the outcomes of the patients. Early diagnosis and proper management is imperative for it is strongly associated with a better long-term prognosis of the patients. Diagnostic tools for CSF leaks are still under debate. Nevertheless, many reports of successful treatments for CSF leaks have been published with introduction of various repair techniques for leakage sites even though it is surgically challenging. Hereby, we review about the pathophysiology, manifestations as well as the update of the clinical diagnosis and current management of CSF leaks.
Brain Injuries ; Cerebrospinal Fluid Leak* ; Cerebrospinal Fluid* ; Diagnosis ; Early Diagnosis ; Humans ; Meningitis ; Prognosis

A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
Adult ; Aged ; Arachnoid* ; Cerebrospinal Fluid ; Consensus ; Epidural Space ; Female ; Fenestration, Labyrinth ; Follow-Up Studies ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Recurrence ; Subarachnoid Space

We present a case of retro-odontoid pseudotumor (ROP) without rheumatoid arthritis (RA) or atlantoaxial subluxation (AAS). A 76-year-old woman presented with paresthesia and weakness of both lower and upper extremities. She had no laboratory or physical findings of RA. Dynamic X-ray showed no AAS and magnetic resonance imaging (MRI) showed a retro-odontoid mass compressing the spinal cord. Transdural mass debulking and biopsy were performed via minimal left suboccipital craniectomy and C1 hemilaminectomy. Two months after surgery, her symptoms were aggravated. Follow-up MRI visualized mass re-growth and spinal cord compression due to the mass and AAS. Posterior C1-2 fixation was performed without further decompression. Twelve months after posterior fixation, no symptoms were apparent and follow-up MRI showed complete resolution of the ROP with C1-2 bony fusion. The ROP with C1-2 instability might be completely resolved only C1-2 fusion without decompression. Furthermore, we speculated that osteoarthritis of C1-2 itself causes a partial tear or degradation of the transverse ligament, that induced formation of ROP.
Aged ; Arthritis, Rheumatoid ; Atlanto-Axial Joint ; Biopsy ; Decompression ; Female ; Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Odontoid Process ; Osteoarthritis ; Paresthesia ; Rheumatic Fever* ; Spinal Cord ; Spinal Cord Compression ; Tears ; Upper Extremity

Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.
Angiography, Digital Subtraction ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Middle Aged ; Multidetector Computed Tomography ; Neck Injuries ; Neck* ; Neurologic Manifestations ; Operating Rooms ; Vascular System Injuries ; Vital Signs ; Wounds, Penetrating

All iatrogenic vascular injury occurring during discectomy is a rare complication, but fatal if not immediately diagnosed. When a vascular injury is highly suspected during discectomy, immediate vascular evaluation is needed even vital signs are stable during and immediately after the operation. We describe a case of iatrogenic abdominal aortic injury that occurred during discectomy in a spondylodiscitis patient, which was treated by endovascular repair.
Discitis* ; Diskectomy* ; Humans ; Vascular System Injuries* ; Vital Signs