Traumatic intracranial lesion has been one of the most frequent and serous problem in neurosurgical pathology. CT made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastiness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospitalfor 15 months from Oct. 1983 to Dec. 1984. We have reviewed the computed tomographic scans of 264 patients whichshowed traumatic intracranial lesion. The results were as follows: 1. Head trauma was the most frequentlydiagnosed disase using computed tomographic scans(57.8%), and among 264 cases the most frequent mode of injury wastraffic accident (73.9%). 2. Skull fracture was accompained in frequency of 69.7% and it was detected in CT in38.6%: depression fractue was more easily detected in 81%. 3. Countercoup lesion(9.5%) was usually accompained with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling(24.6%), subdural hematoma(22.3%), epiduralhematoma(20.8%), intracerebral hematoma(6.1%), and subarachnoid hemorrhage(3.0%). 5. The shape of hematoma wasusually biconvex(92.7%) in acute epidural hematoma and cresentic(100%) in acute subdural hematoma, but the morechronic the cases became, they showed planoconvex and biconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin levelas single factor.
Chungcheongnam-do ; Craniocerebral Trauma ; Depression ; Diagnosis ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Pathology ; Skull Fractures

A teenaged female was found dead in front of a three story building. Blunt force injuries were found mainly in the right upper-posterior part of the body. Autopsy findings revealed basal skull fracture, multiple rib fractures of the right thoracic cage, both scapular fractures and right iliac bone fracture. Additionally, typical so-called 'tramline'bruises were bilaterally noted at buttocks. The hymen was intact, but showed mucosal hemorrhage. After the personal identity was revealed, the police could find a witness who heard the detailed description of the criminal acts from one of the suspects. According to the witness, the deceased was pushed by two other teenaged girls from the concrete fence of the roof floor after the suspects molested the genitalia of the deceased and beat on the buttocks with a wooden stick. Mathematical estimation of the height of fall based on the severity of injuries correlates with that of the three story building. Authors suggest that a careful examination of injury patterns is required to differentiate homicidal falls from suicidal or accidental ones. Furthermore, application of mathematical model might be helpful to estimate the height of falls or correlate the assumed height of fall with severity of injuries.
Accidental Falls ; Autopsy ; Buttocks ; Contusions ; Criminals ; Female ; Floors and Floorcoverings ; Forensic Pathology ; Fractures, Bone ; Genitalia ; Hemorrhage ; Homicide ; Humans ; Hymen ; Models, Theoretical ; Police ; Rib Fractures ; Skull Fractures ; Wit and Humor as Topic

Nasotracheal intubation is usually recommended when surgery in the oral cavity or on the mandible is facillitated by an unobstructed view. If the mouth is to be wired or banded shut after surgery, a nasal tube must be used. Contraindication to nasal intubation include coagulopathy, severe intranasal pathology, basal skull fracture, and presence of a cerebrospinal fluid leak. We experienced a case of blood aspiration during nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to mandible fracture. On preoperative evaluation, specific problem was not noted. During nasotracheal intubation, epistaxis was developed and the aspiration of blood into the lung was occurred, accidentally. Operation was postponed and the patient was transferred to recovery room. In recovery room, a chest x-ray of left lung revealed deerease of volume, increase of interstitial marking, and more opaque finding than right lung. Arterial blood gas revealed pH 7.43, PCO2 44mmHg, PO2 61mmHg. With frequent suction, encouraging expectoration, antibiotic therapy and 0, supplementation by nasal prong, patient was nearly normalized following 5 hours after the episode of aspiration. Carefully, retrial of nasotracheal intubation was done one week later under the preparation of bosmin (Jeil pharmacy) nasal packing and lubricated endotracheal tube. Intubation and the operation was finished uneventfully.
Cerebrospinal Fluid ; Epistaxis* ; Humans ; Hydrogen-Ion Concentration ; Intubation* ; Lung ; Mandible ; Mouth ; Pathology ; Recovery Room ; Skull Fractures ; Suction ; Thorax

Child ; Edema ; diagnostic imaging ; etiology ; Emphysema ; diagnostic imaging ; etiology ; Ethmoid Bone ; diagnostic imaging ; injuries ; Eyelid Diseases ; diagnostic imaging ; etiology ; Humans ; Male ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Skull ; diagnostic imaging ; pathology ; Skull Fractures ; complications ; diagnostic imaging

OBJECTIVE: To explore the general features and the keypoints of forensic medical examination in tumbling injury cases. METHODS: Twenty-eight cases dying of tumbling injury were collected and the locations and features of injury were analyzed. RESULTS: The occiput of head was the common position for the tumbling injury cases. Force, disease and alcohol were the main reasons for tumbling injury. CONCLUSION The injury is mild outside and severe inside from tumbling injury cases. The craniocerebral contrecoup is the significant feature in tumbling injury cases.
Accidental Falls/mortality* ; Adolescent ; Adult ; Aged ; Alcoholism/blood* ; Autopsy ; Cause of Death ; Contusions/pathology* ; Craniocerebral Trauma/pathology* ; Female ; Forensic Pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Scalp/pathology* ; Skull Fractures/pathology* ; Young Adult

Serial computed tomography(CT) was done on 168 patients suffering from craniocerebral trauma. The type of initial intracranial lesion in response to primary impact site was evaluated with special reference to the initial Glasgow Coma Scale(GCS), the number of specific CT findings on GCS outcome, and the skull fracture on resultant pathological findings. The development of delayed intracranial lesion, both intra - and extra - dural, was examined by comparing the intial scan with follow-up studies. The conclusions are as follows : 1) The initial GCS has a close relationship to outcome. 2) Initial CT findings(intraventricular hemorrhage, subdural hematoma, cerebral swelling, and subarachnoid hemorrhage) appear to be closely associated with poor outcome. 3) The more the number of intial pathological findings, the poorer the outcome. 4) The CT findings with skull fracture cause much more pathology than those without skull fracture. 5) The frontal lobe is shown to be the most vulnerable contusional site. 6) Delayed traumatic intracerebral hematoma, cerebral edema and cerebral inforction as new lesions encountered on subsequent CT scan have a bad outcome. We conclude that initial and follow-up scan help predict the outcome of patient with craniocerebral trauma, and may be very important in their examination and management.
Brain Edema ; Brain Injuries* ; Brain* ; Coma ; Contusions* ; Craniocerebral Trauma ; Follow-Up Studies ; Frontal Lobe ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural ; Humans ; Pathology ; Skull Fractures ; Tomography, X-Ray Computed

OBJECTIVE: To show imaging findings of inferior orbital fissure (IOF) and groove (IOG) on axial CT scans and to discover their anatomic variations, so as to avoid misdiagnosing them as orbital fracture. METHODS: 25 normal skull were used to investigate the configurations of IOF and IOG. Five skulls were performed axial CT scans. 20 normal orbital axial scans were studied as well. MPR and RT-3D reconstructions were used in this study. RESULTS: Skulls scans and normal orbital images on axial CT showed three sorts of findings: (1) single bony dehiscence between lateral and inferior walls; (2) first type of double bony dehiscence between lateral and inferior walls, among the dehiscence interposing a small bone. The long axis of the small bone was parallel to orbital wall; (3) second type of double bony dehiscence between lateral and inferior walls, but the long axis of the small bone was in anteroposterior direction. Anatomy and variation of three sorts of CT findings were corresponded respectively to: (1) a baseball club-shaped IOF; (2) a "V"-shaped IOF, that is composed of both of lateral and internal ramus, lateral ramus situates between the zygoma and the lateral portion of greater wing of sphenoid, and internal ramus between the maxilla and the internal portion of greater wing of sphenoid, both rami intercross caudally and open upwards in a "V"-shaped configuration; (3) a deep IOG with a protuberant lateral wall. CONCLUSION Familiarity of imaging features on the axial CT scans and understanding of their anatomy of IOF and IOG would be helpful for avoiding misdiagnosis of orbital fracture.
Cadaver ; Forensic Medicine ; Humans ; Imaging, Three-Dimensional ; Orbit/diagnostic imaging* ; Orbital Fractures/pathology* ; Skull/diagnostic imaging* ; Sphenoid Bone/diagnostic imaging* ; Tomography, X-Ray Computed/methods*

FEM combined with modern computer technology is a mathematical method for stress analysis. It has gradually become a significant experimental tool to explore the functions of biomechanically simulated human body structure and mechanism of craniocerebral injuries. This paper reviewed the features and biomechanical materials of the FEM human head models, materials assignment and their applications in blunt injury, fall, traffic accident. It also explore their merits and values in forensic head injury cases.
Accidents, Traffic ; Biomechanical Phenomena ; Computer Simulation ; Craniocerebral Trauma ; Finite Element Analysis ; Forensic Pathology ; Head/physiopathology* ; Humans ; Imaging, Three-Dimensional/methods* ; Models, Anatomic ; Models, Biological ; Skull Fractures/physiopathology*

The authors analysed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are frequently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows : 1) The basal skull fractures were more common in men than women-the ratio being 6 : 1. 2) In decreasing order of cause of basal skull fractures were traffic accidents(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(19%). 4) In decreasing order of clinical features were otorrhea(71%) rhinorrhea(48%) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55%), subdural hematoma(17%), epidural hematoma(16%) and intracerebral hematoma(12%) etc. 6) The facial nerve, vestibulo-cochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(96%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture(47%), clavicle fracture(19%), lower extremities fracture(9%) and upper extremities fracture(7%) etc.
Chungcheongnam-do ; Clavicle ; Cranial Nerve Injuries ; Cranial Nerves ; Craniocerebral Trauma ; Facial Bones ; Facial Nerve ; Glasgow Coma Scale ; Humans ; Incidence ; Lower Extremity ; Male ; Meningitis ; Neurosurgery ; Optic Nerve ; Pathology ; Raccoons ; Skull Fractures* ; Skull* ; Upper Extremity

The results of Brain CT in 93 children with seizure and or other neurologic problems are evaluated in relation to the age of onset, patients' history, final diagnosis & EEG. The overall incidence of abnormal scans were 78.5% in our series. Analysis of CT results showed that the incidence of abnormal scan was closely related to the following criteria. 1. Patients with onset of neurologic problems during the age of 1 year, have a higher incidence of abnormal CT scans(87.5%), particularly if the onset was below 1 month of age. (93.8%), Also the results of CT were markedly different between the age under the 6 years and the age above the 6 years. In the former group of paients, brain atrophy and hydrocephalus were the most common cause of abnormal findings and in the latter group, brain tumor and vascular lesions. 2. Patients with a first attack of seizure have a higher incidence of abnormal scans than that of recurrent attacks(87%, 75%). 3. CT was particularly valuable for the diagnosis of tumor, complicated with meningitis, congenital hydrocephalus, vascular lesions, tuberous sclerosis, infarction, abscess, congenital toxoplasmosis & skull fracture. 4. Patients with focal slowing or focal spike with focal slowing on EEG findings manifested significant positive results on CT scan.(93.4%, 100%). 5. The number of patients who revealed abnormalities on contrast enhancement were 13 patients Among those 13 patients, 4 patients were with tuberculous meningitis and these all 4 patients showed characteristic findings of hydrocephalus with prominent basal and Sylvian fissure enhancement after injection of intravenous contrast media. 6. No. particular correlationship was noticed between simple skull roentgenorraphy and brain CT scan in the diagnosis of intracranial pathology except in the detection of skull fracture & large calcification.
Abscess ; Age of Onset ; Atrophy ; Brain Neoplasms ; Brain* ; Child ; Contrast Media ; Diagnosis ; Electroencephalography ; Humans ; Hydrocephalus ; Incidence ; Infarction ; Meningitis ; Pathology ; Pediatrics* ; Seizures ; Skull ; Skull Fractures ; Tomography, X-Ray Computed ; Toxoplasmosis, Congenital ; Tuberculosis, Meningeal ; Tuberous Sclerosis