We studied retrospectively 1,112 mild head injury patients visited during a 2-year period to Dankuk University Medical Center to determine the clinical value of routine computerized tomography(CT) of the head and the indication of early discharge in patients with mild head injury(Glasgow coma scale score>or=13) at emergency room. Routine urgent cranial CT scans were obtained on all patients. Variables reviewed were mental status, symptom & sign of head trauma(brief loss of consciousness(LOC), amnesia, nausea and vomiting, headache). skull fracture on skull radiology, intracranial lesions, and operation. Patients with 13-14 Glasgow coma scale(GCS) or skull fracture have a significantly higher incidence of intracranial lesions and operation. Thus we suggest classifing patients with a GCS of 13-14 or skull fracture into "moderate" rather than "mild" in severity and recommend performing CT in all those patients. The patients with normal mental status(GCS score of 15) and no skull fracture have a rate of abnormal CT finding of 8.5% in the subgroup with history of LOC/amnesia and symptoms of head injury, but no patient in the subgroup without LOC/amnesia and symptoms of head injury. There was a few occurrence of delayed intracranial hematoma in normal mental status, but no patient required surgical intervention. We conclude that routine CT of the head in patients with GCS score of 13-14, skull fracture, and history of LOC/amnesia or symptoms of head injury in clear mental status is indicated. If the results of CT scan are normal, these patients may be safely discharged. But if there is no history of LOC/amnesia or symtoms of head injury in normal mental status, an immediate CT scan is not indicated and these patients may also be safely discharged.
Academic Medical Centers ; Amnesia ; Coma ; Craniocerebral Trauma* ; Emergencies* ; Emergency Service, Hospital* ; Head* ; Hematoma ; Humans ; Incidence ; Nausea ; Retrospective Studies ; Skull ; Skull Fractures ; Tomography, X-Ray Computed* ; Vomiting

BACKGROUND: Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation far febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. METHODS: This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. RESULTS: The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symptoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67 mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria (91.6%), and hematuria (83.3%). CONCLUSION: As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory finding of thrombocytopenia, and renal dysfunction were suggestive of HFRS.
Azotemia ; Bilirubin ; Cough ; Diagnosis ; Exanthema ; Fever ; Flank Pain ; Headache ; Hematuria ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospirosis ; Leukocytosis ; Myalgia ; Occupations ; Proteinuria ; Retrospective Studies ; Rural Population* ; Scrub Typhus ; Skin ; Sputum ; Thorax ; Thrombocytopenia

This report describes five cases of cerebrospinal fluid(CSF) rhinorrhea which were caused by head injury in four cases and developed after surgical removal of brain tumor in one case. Intrathecally-enhanced brain computerized tomography(CT) with metrizamide, in addition to isotope cisternography, was helpful in localization of the CSF leakage site. All five cases which could not be managed conservatively were successfully repaired by surgical means using biological fibrin glue.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Craniocerebral Trauma ; Fibrin Tissue Adhesive ; Metrizamide

Acute Disease ; Diagnosis ; Enterotoxins ; Exanthema ; Fever ; Hypotension ; Shock ; Shock, Septic ; Staphylococcus aureus

Raeder's syndrome, or Raeder's paratrigeminal syndrome, is a painful Horner's syndrome characterized by unilateral head pain, oculosympathetic paralysis (miosis, ptosis) and anhydrosis over the forehead with otherwise normal facial sweating. We report two cases of Raeder's syndrome whose cause had not been found despite of intensive investigation and one case associated with nasopharyngeal tumor. The first case had a headache, miosis, ptosis but had not cranial nerve palsy. The second case had a unilateral facial headache, oculosympathetic paralysis, aoydrosis of forehead and sensory change in the ipsilateral ophthalmic division of the trigeminal nerve. The third case had a headache, miosis, ptosis, anhydrosis of forehead and sensory change in the whole territory of the trigeminal nerve.
Cranial Nerve Diseases ; Forehead ; Headache ; Horner Syndrome ; Miosis ; Paralysis ; Sweat ; Sweating ; Trigeminal Nerve

The case of an 33-year-old man with an intradural and extramedullary enterogenous cyst in the thoracic spinal canal is presented. Enterogenous cysts are rare cystic tumors located in the spinal canal and causing spinal compression, and about half of the cases of enterogenous cysts are associated with congenital anomalies. This patient, however, had no vertebral anomaly or other evidence of congenital melformation. We reviewed literatures and recorded the distinguished features of intraspinal enterogenous cysts and discuss the clinical, radiological and histological findings.
Adult ; Humans ; Spinal Canal*

The prognosis of severe head injured patients (Glasgow coma scale 3 to 8) was assessed through clinical prognostic factors in 209 cases, retrospectively. Severe head injured patients were 9.1% of all head trauma and 55% of cases were diffuse brain injury. Mechanism of injury were motorvehicle accident, falls, bicycle, and others. The patients with normal pupillary reaction had a significantly higher percentage of good outcome (77%) than the patient with bilateral 3rd nerve palsy (14.2%)(p<0.0001), 79% of good motor responsive patients had a good outcome compared to none of patients with poor motor response(p<0.0001). The patients with short duration of unawareness(within 30days) significantly higher percentage of good outcome(98%) than the patients with long duration of unawaereness(24%)(p<0.0001). The patients with initial high GCS score(6-8 score) had a significantly higher good outcome(58%) than the patients with low GCS score(3-5 score)(p<0.0001), 87% of pediatric patients had a good outcome compared to 38% of adults(p<0.0001). The diffuse head injured patients without basal cistern compression had a significantly hgher percentage of good outcome(83%) than the patients with basal cistern compression(41%)(p<0.0001), 62% of patients with skull fracture had a good outcome compared to 39% of patients without skull fracture(39%)(p<0.0017). Individual prognostic factors affect to patient's outcome and utilize to be powerful tool for assessing the relative efficacy of alternative treatments as well as patient's prognosis.
Brain Injuries ; Coma ; Craniocerebral Trauma ; Head* ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Skull ; Skull Fractures

No abstract available.
DNA* ; Kinetics* ; Nervous System Neoplasms* ; Nervous System*

Osmotic diuretics are used in neurosurgical patient to decrease intracranial pressure. Mannitol produces diuresis because it is filtered by the glomeruli and not reabsorbed from the renal tubule, leading to increased osmolarity of renal tubular fluid and associated excretion of water. There are some controversies about the effect of mannitol induced diuresis on the change of serum electrolytes. But these controversies are related to the mannitol dosage and infusion speed. We studied the effect of mannitol on serum and urine e1ectrolyte change in 10 patients undergoing operation of cerebral tumor or aneurysm. Every patient was free from cardiac and renal disease. We started infusion of 20% mannitol of which dosage is 0.6-0.9gm/kg for 5 to 10 min after cranium was opened and then injected furosemide O.l mg/kg for acceleration of diuresis. We measured serum electrolyte, urine volume and urine electrolyte before and after 30, 60 and 120 min of mannitol infusion. The results were as follows. 1) Seurm sodium and chloride level decreased significantly from 133 and 102 to l30 and 100 mEq/1 respectively after 30 min, but there was no statistic significance after 60 and 120 min of mannitol infusion. 2) Serum potassium level increased slightly from 4.2 to 4.5 mEq/1 after mannitol infusion but there was no statistic significance. 3) Urine volume increased abruptly from 57 to 477 ml/hr as soon as infusion of mannitol but the degree decreased slowly following times. 4) Urine electrolytes concentration increased abruptly as soon as infusion of mannitol but the degree decrease slowly following times. With the above results, we can conclude that intraoperative mannitol and furosemide infusion in healthy patient can cause only transient change in serum electrolyte and the magnitude of change was too small to have significant clinical effect.
Acceleration ; Aneurysm ; Diuresis ; Diuretics, Osmotic ; Electrolytes ; Furosemide ; Humans ; Intracranial Pressure ; Mannitol* ; Neurosurgery ; Osmolar Concentration ; Potassium ; Skull ; Sodium

Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy' in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuries patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analyasis was done compared with many criteria of red blood cell and white blood cell for the more actuate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accuracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).
Accidents, Traffic ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Female ; Humans ; Leukocytes ; Male ; Medical Records ; Peritoneal Lavage* ; Retrospective Studies