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The Combined Use of Cardiac Output and Intracranial Pressure Monitoring to Maintain Optimal Cerebral Perfusion Pressure and Minimize Complications for Severe Traumatic Brain Injury.

Jin Shup SO ; Jung Ho YUN

Korean Journal of Neurotrauma.2017;13(2):96-102. doi:10.13004/kjnt.2017.13.2.96

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

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Epidemiology and Risk Factors for Bicycle-Related Severe Head Injury: A Single Center Experience.

Jun Chul PARK ; In Bok CHANG ; Jun Hyong AHN ; Ji Hee KIM ; Jae Keun OH ; Joon Ho SONG

Korean Journal of Neurotrauma.2017;13(2):90-95. doi:10.13004/kjnt.2017.13.2.90

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*

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Trauma Patterns of Drowning after Falling from Bridges over Han River.

Jung Hwan LEE ; Chung Kee CHOUGH ; Jae Il LEE

Korean Journal of Neurotrauma.2017;13(2):85-89. doi:10.13004/kjnt.2017.13.2.85

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

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Ganoderma Lucidum Protects Rat Brain Tissue Against Trauma-Induced Oxidative Stress.

Ozevren HÜSEYIN ; Irtegün SEVGI ; Deveci ENGIN ; Aşır FIRAT ; Pektanç GÜLSÜM ; Deveci ŞENAY

Korean Journal of Neurotrauma.2017;13(2):76-84. doi:10.13004/kjnt.2017.13.2.76

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

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Expression of Aquaporin 1 and 4 in the Choroid Plexus and Brain Parenchyma of Kaolin-Induced Hydrocephalic Rats.

Taehyung JEON ; Ki Su PARK ; Seong Hyun PARK ; Jeong Hyun HWANG ; Sung Kyoo HWANG

Korean Journal of Neurotrauma.2017;13(2):68-75. doi:10.13004/kjnt.2017.13.2.68

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

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Traumatic Cerebrospinal Fluid Leak: Diagnosis and Management.

Ji Woong OH ; So Hyun KIM ; Kum WHANG

Korean Journal of Neurotrauma.2017;13(2):63-67. doi:10.13004/kjnt.2017.13.2.63

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

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Traumatic Epidural Hematoma of the Posterior Cranial Fossa.

Jungin HAN ; Tack Geun CHO ; Jae Gon MOON ; Ho Kook LEE ; Chang Hyun KIM

Korean Journal of Neurotrauma.2012;8(2):99-103. doi:10.13004/kjnt.2012.8.2.99

OBJECTIVE: Epidural hematoma of posterior fossa is less common than epidural hematoma of supratentorial area, and there are not many articles about epidural hematoma of posterior fossa. This study investigated patients who underwent surgery of epidural hematoma of posterior fossa, and the relation between the clinical manifestation and postoperative outcome. METHODS: A retrospective analysis performed of 27 patients who underwent operation for acute traumatic epidural hematoma of posterior fossa from January 2004 to December 2011. Analyzed factors were gender, age, Glasgow Coma Scale (GCS) measured upon presentation to the hospital, preoperative GCS score, cause of trauma, time elapsed from the accident to the presentation to the hospital, time elapsed from the presentation to the hospital to the surgery, radiographic findings (brain CT findings), and Glasgow Outcome Scale (GOS). RESULTS: Two patients (7.4%) had GCS score on admission of 3-8, 11 (29.6%) had 9-12, and 17 (66.7%) had 13-15. In 1 (3.7%) patient, GCS score changed from 13 to 10, and preoperative GCS score was significantly correlated with GOS score (p<0.05). Mean thickness of hematoma was 19.3+/-7.5 mm, and was significantly correlated with GOS score (p<0.05). GOS score was 4-5 in 24 patients (88.9%), 3 (severe disability) in 1 patient (3.7%), and 1 (death) in 2 patients (7.4%). CONCLUSION: In the patients underwent surgery for epidural hematoma of posterior fossa, 88.9% had favorable outcome (in GOS score of 4 or more). Preoperative GCS score and thickness of hematoma on brain computed tomography are important determinants of prognosis.
Brain ; Cranial Fossa, Posterior ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Humans ; Prognosis ; Retrospective Studies

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Analysis of Precedents Related to the Lumbar Disc Herniation.

Kyeong Seok LEE ; Jae Jun SHIM ; Seok Mann YOON ; Jae Won DOH ; Il Gyu YUN ; Hack Gun BAE

Korean Journal of Neurotrauma.2012;8(2):94-98. doi:10.13004/kjnt.2012.8.2.94

OBJECTIVE: Herniated lumbar disc (HLD) is a relatively common disorder, while its causality is a matter of debate. Although there are a few rules in the Korean laws, they are usually nonspecific and comprehensive. By these rules, it is hard to solve the legal conflicts determining the work apportionment. The final judgments may be irrelevant by the inappropriate opinions of the doctors who are not concerned on the work apportionment. METHODS: We searched precedents related to the medical accidents of HLD in the Korean Supreme Court web site. There were 38 precedents related to the HLD from 1990 to 2011. We reviewed types of the court, types of the suits, legal judgments, the point of conflicts, and so on. We tried to find the problems and adequate solution. RESULTS: The Supreme Court made 20 in 38 precedents related to the HLD. The most common precedents were on the industrial insurance. Compensation suits for damages were the next. These two issues constituted about 70% of the precedents related to the HLD. There were other suits on the insurance money, accidental infliction of injury, and a man of national merit. The judgment on the work apportionment was independent to the year of suits, types of the court, and the types of the suits. CONCLUSION: By the precedents on the HLD, we could identify the importance of the doctors' opinion in various legal conflicts. Doctors should have concerns on the work apportionment of a certain trauma or a work objectively in HLDs.
Compensation and Redress ; Insurance ; Intervertebral Disc Displacement ; Judgment ; Jurisprudence ; Lumbar Vertebrae ; Occupational Injuries

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Analysis of Risk Factors Associated with Fusion Failure of Traumatic Odontoid Fracture Type III after Halo-Vest Immobilization.

Dong Kwang SEO ; Jin Hoon PARK ; Dong Ho LEE ; Sang Ryong JEON

Korean Journal of Neurotrauma.2012;8(2):87-93. doi:10.13004/kjnt.2012.8.2.87

OBJECTIVE: The purpose of this study is to identify risk factors related to the fusion failure after halo-vest immobilization of odontoid fracture type III. METHODS: We retrospectively analyzed ten patients who underwent halo-vest immobilization for acute traumatic odontoid fracture between October 2002 and December 2011. All patients had type III odontoid fracture using the Anderson and D'Alonzo classification. We reviewed digital radiographs and analyzed the images during conservative treatment with halo-vest immobilization. RESULTS: The patients consisted of nine men and one woman, with mean age of 40.2 years (range: 25-56), who had no history of medical comorbidity and significant neurologic deficit. The mean follow-up period was 6 months (range: 4-11). All patients were initially treated by halo-vest immobilization. Seven patients showed union of fractured site on radiologic findings after halo-vest immobilization only. However, other 3 patients underwent surgery for fixation due to fusion failure. Among the factors we analyzed such as, radiographic characteristics and clinical feature, presence of comminuted fracture, instability of fractured fragment and failed reduction of misalignment were the factors related to fusion failure. CONCLUSION: The fusion rate of halo-vest immobilization of odontoid fracture type III seem to be incomplete, but clinical decision using the risk factors such as comminution, instability of fractured fragment and failed reduction of misalignment improves the outcome with conservative management.
Comorbidity ; External Fixators ; Female ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Ununited ; Humans ; Immobilization ; Male ; Neurologic Manifestations ; Odontoid Process ; Retrospective Studies ; Risk Factors ; Spinal Fractures

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Analysis of Risk Factors for the Development of Post-Operative Epidural Hematoma after Intracranial Surgery.

Won Mo GU ; Won Il JOO ; Hyoung Kyun RHA ; Hae Kwan PARK ; Chung Kee CHOUGH ; Kyung Jin LEE

Korean Journal of Neurotrauma.2012;8(2):79-86. doi:10.13004/kjnt.2012.8.2.79

OBJECTIVE: Patients undergoing intracranial operations often suffer from post-operative epidural hematoma (EDH). The incidence and risk factors for with the occurrence of EDH after intracranial operations are not well described previously. The objective of this study was to identify the risk factors and the incidence of post-operative EDH adjacent and regional to the craniotomy. METHODS: This was a retrospective study of 23 (2.4%) patients, between January 2005 and December 2011, who underwent epidural hematoma evacuation after primary intracranial during this period, 941 intracranial operations were performed. The control group (46 patients) and hematoma group (23 patients) were categorized on the basis of having undergone the same pre-operative diagnosis and treatment within 3 months of their operations. The ages of the hematoma and control group were individually matched to similar ages within 10 years of each other to minimize bias of age. RESULTS: Univariate analysis showed that the significant pre-operative and intra-operative factors associated with post-operative EDH were a pre-operative Glasgow Coma Scale (GCS) scored <8 (crude odds ratio 8.295), prothrombin ratio >1.0 (p=0.014), prothrombin time (PT) >11.3 sec (p=0.008), intra-operative blood loss >650 mL (p=0.003) and craniotomy size >7,420 mm2 (p=0.023). In multivariate analysis, intra-operative blood loss exceeding 650 mL (median of total patients) placed a patient at significantly increased risk for post-operative EDH. CONCLUSION: Recognizing the limitations of the study, large intra-operative blood loss, wide craniotomy area, prolonged PT and a pre-operative GCS <8 are presented implicated with an increased risk of post-operative EDH after intracranial surgery.
Bias (Epidemiology) ; Craniotomy ; Glasgow Coma Scale ; Hematoma ; Hematoma, Epidural, Cranial ; Humans ; Incidence ; Multivariate Analysis ; Odds Ratio ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Risk Factors

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