OBJECTIVETo study the influence of traumatic subarachnoid hemorrhage on secondary intracranial damage in GCS 13-15 head injuries and prognosis.

METHODSOne hundred and twenty-eight patients with mild head injury, including 64 with subarachnoid hemorrhage and 64 without subarachnoid hemorrhage, were selected and analyzed according to the changes of their conditions after injury.

RESULTSIntracranial abnormality was found in 14 patients (21.87%) with subarachnoid hemorrhage and only in 4 patients (6.25%) without subarachnoid hemorrhage (P<0.01). In the 14 patients, 4 were given surgical treatment. Mild disability was in 2 patients and 2 completely recovered. The rest were conservatively treated and achieved complete recovery at last.

CONCLUSIONSTraumatic subarachnoid hemorrhage, as a factor of intracranial complications in mild head injury should be given much attention. Early drainage of bloody cerebrospinal fluid by lumbar puncture is an effective method for prevention and treatment of complications in mild head injury.

Adolescent ; Adult ; Aged ; Brain Damage, Chronic ; etiology ; Craniocerebral Trauma ; complications ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Subarachnoid Hemorrhage ; etiology

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).
Brain Damage, Chronic/*etiology ; Child, Preschool ; Developmental Disabilities/etiology ; Humans ; Hypoglycemia/blood/*etiology ; Infant ; Infant, Newborn ; Insulin/*blood ; Male ; Pancreatic Diseases/complications/*diagnosis/therapy ; Postoperative Complications/epidemiology

Acute mountain sickness (AMS) occurs commonly in hikers who are rapidly exposed to high altitude environments. Despite the numerous reports of AMS, few studies have reported pallidal lesions associated with altitude sickness. A previously healthy 49-yr-old Korean patient, after ascent to 4,700 m, suffered symptoms consistent with AMS. After returning home, the patient showed changes in personality characterized by abulia, indifference, and indecisiveness. T2 weighted brain magnetic resonance imaging showed high signal lesions involving bilateral globus pallidus. Our case suggests that globus pallidus injury should be included in the differential diagnosis of patients with personality or cognitive change after recovery from AMS.
Altitude ; Altitude Sickness/*complications ; Behavior ; Brain/pathology ; Brain Damage, Chronic/*etiology/pathology ; Environment ; Globus Pallidus/*pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mountaineering

Brain Damage, Chronic ; diagnosis ; etiology ; pathology ; therapy ; Diffusion Magnetic Resonance Imaging ; Electroencephalography ; Humans ; Hypoglycemia ; complications ; Infant, Newborn ; Risk Factors ; Tomography, X-Ray Computed

OBJECTIVETo investigate the early diagnosis with MRI changes, MRI types and short-term neurodevelopmental outcome of preterm infants with punctate white matter damage (PWMD).

METHODThere were 44 preterm infants with PWMD (group A) from March 2009 to August 2010 at the neonatal ward of Shengjing Hospital of China Medical University, according to the number, shape and distribution of the lesions, group A was divided into dot injury group (A1), clusters group (A2) and linear group (A3), the first MRI and DWI scan of all cases were within 14 days after birth, and 17 subjects received re-examination with the MRI in the hospital. Twenty preterm infants with normal MRI (group B) received the follow-up, according to the age, 20 normal full-term infants were selected (group C) as the control group using paired design. Mental development index (MDI) and psychomotor development index (PDI) were determined using Bayley scales of infant development-II.

RESULTFirst MRI scan:in 44 infants with PWMD, group A1, A2, A3 separately had, 10, and 9 infants. MRI follow up in 17 cases showed that in 4 cases of A1 group the dot lesions disappeared; in 3 of 4 cases in clusters group who received re-examination, the lesions disappeared, 1 case had periventricular leukomalacia (PVL); in 5 of the 9 cases who had re-examination in linear group the lesions disappeared, while in 4 cases the lesions evolved into PVL. MDI and PDI: Group A [MDI (102.9 ± 15.5) , PDI (107.7 ± 17.5) ] was lower than that of group B[MDI (114.0 ± 13.1) , PDI (120.8 ± 9.4) ], group C [MDI (114.2 ± 12.2) , PDI (119.5 ± 10.7) ] (P < 0.05) . There were no significant differences between group B and group C. Group A1 [MDI (112.2 ± 8.1) , PDI (116.4 ± 8.5) ] had no significant differences compared with group B and group C. Group A2 [MDI (100.8 ± 12.5) , PDI (105.0 ± 12.1) ] showed significantly reduced values compared with group B, Group C, Group A1 (P < 0.05) ,Group A3 [MDI (75.8 ± 11.6) , PDI (79.1 ± 16.2) ] had lower values than group B, Group C, Group A1, and Group A2 (P < 0.05) .

CONCLUSIONPremature infants with PWMD mainly showed dot-like and clustered injury that are easy to be absorbed and disappear, but the linear lesions are likely to evolve into PVL. In addition, the cluster-like and linear injury have an influence on short-term cognition and motion development, especially the outcome of linear injury was the worst.

Brain ; pathology ; Brain Damage, Chronic ; diagnosis ; pathology ; Child, Preschool ; Developmental Disabilities ; diagnosis ; etiology ; pathology ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Premature ; physiology ; Infant, Premature, Diseases ; diagnosis ; pathology ; Leukomalacia, Periventricular ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Male ; Nervous System ; growth & development ; Neurologic Examination ; Retrospective Studies