PURPOSE: To describe the neuro-ophthalmic findings in a group of patients with head trauma. METHODS: A retrospective chart review of all patients who were given a diagnosis code of cerebral concussion and cerebral contusion in a hospital between 1995 and 2003. A total of 1284 consecutive patients were reviewed (972 [76%] men and 312 [24%] women). The mean age was 40.36 years. Motor vehicle accident was the most common cause of head trauma, occurring in 944 (74%) patients. RESULTS: Ophthalmological examination was undertaken in 308 (24%) head trauma patients and an abnormal neuro-ophthalmic examination result was noted in 122 patients (9.5% of total patients, 40% of ophthalmologically examined patients). Traumatic optic neuropathy was the most common manifestation, followed by oculomotor, abducens, trochlear, facial nerve palsy, Terson syndrome and internuclear ophthalmoplegia. Loss of consciousness and cerebral concussion were not associated with any outcomes, but the presence of neuroimaging (computed tomography, magnetic resonance imaging) abnormality, particularly intracranial hemorrhage and skull fracture, was significantly associated with neuro-ophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuro-ophthalmic manifestations. Intracranial hemorrhage and skull fracture may be a reliable predictor of specific neuro-ophthalmic outcomes.
Brain Concussion ; Contusions ; Craniocerebral Trauma* ; Diagnosis ; Facial Nerve ; Head* ; Humans ; Intracranial Hemorrhages ; Male ; Motor Vehicles ; Neuroimaging ; Ocular Motility Disorders ; Optic Nerve Injuries ; Paralysis ; Retrospective Studies ; Skull Fractures ; Unconsciousness

PURPOSE: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. METHODS: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. RESULTS: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. CONCLUSION: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.
Brain Injuries ; Contusions ; Hematoma, Subdural ; Hemorrhage ; Humans ; Incidence ; Mandibular Fractures ; Maxilla ; Maxillary Fractures ; Medical Records ; Motor Vehicles ; Orbit ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage, Traumatic ; Zygoma

OBJECTIVE: The goal of our study was to identify and evaluate risk factors for late post-traumatic seizure. METHODS: This study is a retrospective clinical analysis of 52cases of late post-traumatic seizures among 1472 head injury patients treated in our institute from July 1986 to June 1996 and at least followed up over 2 years after head injury. RESULTS: 1) The incidence of late post-traumatic seizure was 3.5% of patients treated for head injury. 2) The factors affecting the incidence of late post-traumatic seizure were initial low Glasgow coma scale(3-8), subdural hematoma, depressed skull fracture(p<0.05). 3) Skull fracture located in temporal area showed higher incidence of late post-traumatic seizure(p<0.05). CONCLUSION: The risk factors for post-traumatic seizure are subdural hematoma, initial low Glasgow coma scale, depressed skull fracture and temporal bone fracture. Both newer antiepileptic drugs and therapies aimed at prevening the brain damage that underlies the development of seizures need to be studied to find an effective way of preventing late post-traumatic seizure through prospective study.
Anticonvulsants ; Brain ; Coma ; Craniocerebral Trauma ; Epilepsy, Post-Traumatic* ; Glasgow Coma Scale ; Hematoma, Subdural ; Humans ; Incidence ; Retrospective Studies ; Risk Factors* ; Seizures ; Skull ; Skull Fracture, Depressed ; Skull Fractures ; Temporal Bone

A case of the cryptococcal meningitis is reported and the literature reviewed. A cryptococcosis is the most common form of fungal infection of the nervous system. The disease may simulate tuberculous meningitis, tumor of the brain, encephalitis and various psychosis. Our case is no significant symptoms and sings before the head trauma which was accompanied by transient loss of consciousness. The patient's symptoms and signs were aggravated by the head trauma (a mild cerebral concussion only). The patient expired on the 10th hospital day. The cryptococcal meningitis was proved by autopsy.
Autopsy ; Brain ; Brain Concussion ; Craniocerebral Trauma ; Cryptococcosis ; Encephalitis ; Humans ; Meningitis, Cryptococcal* ; Nervous System ; Psychotic Disorders ; Tuberculosis, Meningeal ; Unconsciousness

A case of the cryptococcal meningitis is reported and the literature reviewed. A cryptococcosis is the most common form of fungal infection of the nervous system. The disease may simulate tuberculous meningitis, tumor of the brain, encephalitis and various psychosis. Our case is no significant symptoms and sings before the head trauma which was accompanied by transient loss of consciousness. The patient's symptoms and signs were aggravated by the head trauma (a mild cerebral concussion only). The patient expired on the 10th hospital day. The cryptococcal meningitis was proved by autopsy.
Autopsy ; Brain ; Brain Concussion ; Craniocerebral Trauma ; Cryptococcosis ; Encephalitis ; Humans ; Meningitis, Cryptococcal* ; Nervous System ; Psychotic Disorders ; Tuberculosis, Meningeal ; Unconsciousness

PURPOSE: This study is to analyze the frequency and pattern of associated injuries in patients with facial fractures. METHODS: A retrospective method was used to study facial fracture patients visiting our emergency room from May 2002 to April 2003. The patient's age, sex, injury mechanism, location of facial fracture, and associated injuries, as well as the records of emergency procedures and emergency operations were examined. RESULTS: During the research, a total number of 206 patients with facial fractures were examined. As for the injury mechanism, traffic accidents were the primary cause with 40.3%. Orbital fracture was the most common overall facial fracture (44.7%). Ninety-seven (47.1%) patients had associated injuries. Fifty-nine of those patients had head injuries, 48 had extremity injuries, 17 had chest injuries, 14 had abdominal injuries, and 13 had spine injuries. Among the facial-fracture patients, patients with maxillary fractures had the most associated injuries (95.3%). Of those associated injuries, head injuries were the most commonly reported ones (48.3%). The emergency procedures used were intubations (9) and thoracostomies (4). The emergency operations performed were craniotomies (5) and exploratory laparotomies (2). Four patients died due to brain injuries. CONCILUSION: Associated injuries often occur in patients with facial fractures. Head and extremity injuries are the most common associated injuries. We believe emergency physicians can maximize the effectiveness of their treatment of patients with facial fractures and their associated injuries through a coordinated team approach, while minimizing the complications and sequelae.
Abdominal Injuries ; Accidents, Traffic ; Brain Injuries ; Craniocerebral Trauma ; Craniotomy ; Emergencies ; Emergency Service, Hospital ; Extremities ; Facial Bones ; Head ; Humans ; Intubation ; Laparotomy ; Maxillary Fractures ; Orbital Fractures ; Retrospective Studies ; Spine ; Thoracic Injuries ; Thoracostomy

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.
Brain Concussion ; Child ; Craniocerebral Trauma ; Diagnosis ; Humans ; Male ; Nausea ; Orbit ; Orbital Fractures ; Prognosis ; Vomiting

During 3-year period, fourteen patients with air bubble in acute extradural hematomas were seen among 84 consecutively cases of extradural hematomas for a frequency of 16.7%. Extradural air were classified into 3 groups based on the location of air bubble ;frontal type(4 cases), temporal type(8 cases) & occipital type(2 cases). A skull fracture was seen in all cases & the air entrance was considered to frontobasal or laterobasal skull fractere. In patients with 4 cases of CSF leak & multiple air bubbles, delayed expansion of extradural hematoma was seen. The clinical significance of air bubble in acute extradural hematoma is disscussed.
Craniocerebral Trauma ; Hematoma* ; Humans ; Pneumocephalus ; Skull ; Skull Fractures

Bacterial meningitis after head trauma is a rare complication, but the cerebrospinal fluid(CSF) leakage after head trauma greatly increases the risk of bacterial meningitis. Most of the infections passes through the defects in the basal skull fracture, and Streptococcus pneumoniae is the most common organism. MRI, coronal thin sections of cranial CT and radioiosotope cisternography are considered to diagnose the CSF fistulae. We report a case of a 14-year-old girl with pneumococcal meningitis complicated by CSF rhinorrhea following an asymptomatic period of 3 years after head trauma. We found a bone defect of the cribrium of the skull base by means of paranasal sinus CT scanning and MRI.
Adolescent ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Craniocerebral Trauma ; Female ; Fistula ; Humans ; Magnetic Resonance Imaging ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Skull Base ; Skull Fractures ; Streptococcus pneumoniae ; Tomography, X-Ray Computed

Cerebrospinal fluid (CSF) rhinorrhea can be caused by head trauma, brain or sinus surgery, or neoplastic sinonasal disease. There are many diverse techniques for repairing skull base defects, and recently there has been a shift from using external approaches to endoscopic approaches. The reported success rate after endoscopic repair is 97%, but CSF rhinorrhea may recur in some cases. Recently, we witnessed one case of recurrent CSF rhinorrhea from the posterior wall of the frontal sinus after a traffic accident. The patient was a 48-year-old male and had recurrent CSF rhinorrhea, severe pneumocephalus and mental change even after a CSF leakage repair operation was performed by the neurosurgeon using the periosteal flap. We successfully treated recurrent frontal CSF rhinorrhea with fat graft and mucosal graft, using the above and below approach with the guidance of a navigation system.
Accidents, Traffic ; Brain ; Cerebrospinal Fluid Leak* ; Cerebrospinal Fluid Rhinorrhea ; Cerebrospinal Fluid* ; Craniocerebral Trauma ; Frontal Sinus* ; Humans ; Male ; Middle Aged ; Neurosurgeons ; Pneumocephalus ; Skull Base ; Transplants