Humans ; Infant ; Female ; Dandy-Walker Syndrome/diagnosis* ; Tomography, X-Ray Computed ; Craniocerebral Trauma/complications*

OBJECTIVES: To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions. METHODS: The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively. RESULTS: There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information. CONCLUSIONS In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.
Brain Concussion/diagnosis* ; Craniocerebral Trauma ; Headache/psychology* ; Humans ; Mental Disorders ; Post-Concussion Syndrome/psychology* ; Retrospective Studies

Meningeal dissemination (MDS) of glioblastoma is rare, although its incidence might have been underestimated. MDS of glioblastoma has a fatal course. Thus, rapid and precise diagnosis of MDS is important for further palliative treatment. Unfortunately, MDS of glioblastoma could be diagnosed at a delayed time, causing failure to treat patient optimally. Herein, we present a case of a 56-year-old male with MDS of glioblastoma mimicking chronic subdural hemorrhage (CSDH) after head trauma due to slip down. During treatment for CSDH, MDS of glioblastoma was not controlled appropriately. The patient succumbed to MDS of glioblastoma at 9 weeks after the date of diagnosis of CSDH which could be an MDS.
Craniocerebral Trauma ; Diagnosis ; Glioblastoma ; Gliosarcoma ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Male ; Middle Aged ; Mortality ; Palliative Care

PURPOSE: Mild traumatic brain injury (TBI) is common but accurate diagnosis and its clinical consequences have been a problem. Maxillofacial trauma does have an association with TBI. Neuron-specific enolase (NSE) has been developed to evaluate neuronal damage. The objective of this study was to investigate the accuracy of NSE serum levels to detect mild brain injury of patients with sustained maxillofacial fractures during motor vehicle accidents. METHODS: Blood samples were drawn from 40 healthy people (control group) and 48 trauma patients who had sustained isolated maxillofacial fractures and mild brain injury in motor vehicle accidents. Brain injuries were graded by Glasgow Coma Scale. In the trauma group, correlations between the NSE serum value and different facial fracture sites were also assessed. RESULTS: The NSE serum level (mean ± SD, ng/ml) in the 48 patients with maxillofacial fractures and mild TBI was 13.12 ± 9.68, significantly higher than that measured in the healthy control group (7.72 ± 1.82, p < 0.001). The mean NSE serum level (ng/ml) in the lower part of the facial skeleton (15.44 with SD 15.34) was higher than that in the upper facial part (12.42 with SD 7.68); and the mean NSE level (ng/ml) in the middle-and lower part (11.97 with SD 5.63) was higher than in the middle part (7.88 with SD 2.64). CONCLUSION An increase in NSE serum levels can be observed in patients sustained maxillofacial fractures and mild brain injury.
Accidents, Traffic ; Adult ; Aged ; Biomarkers ; blood ; Brain Injuries, Traumatic ; diagnosis ; Craniocerebral Trauma ; Female ; Humans ; Male ; Maxillary Fractures ; Maxillofacial Injuries ; Mesencephalon ; injuries ; Middle Aged ; Motorcycles ; Phosphopyruvate Hydratase ; blood ; Predictive Value of Tests ; Young Adult

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

Many of the dizziness patients annually visit ENT (ear, nose, throat) clinics because the vestibular function is the major organ to keep body balance and belongs to the Otorhinolaryngology. Nevertheless, many otolaryngologists feel that it is not easy to access the dizziness patients. The reason is that dizziness is not a final diagnosis and it is necessary to start the diagnosis of dizziness and find out the cause. Also, the causes of dizziness belong to multiple medical departments. That is why we need to pay more attention. Among them, traumatic vertigo can be manifested in various ways depending on the injury site and mechanism, and it is often difficult to predict the medical prognosis. Therefore, this review article focuses on traumatic vertigo. In this paper, we discussed its epidemiology and mechanism to help clinicians to treat patients with traumatic vertigo.
Craniocerebral Trauma ; Diagnosis ; Dizziness ; Epidemiology ; Humans ; Nose ; Otolaryngology ; Prognosis ; Vertigo

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.
Cranial Nerve Diseases ; Craniocerebral Trauma ; Diagnosis ; Head ; Humans ; Intracranial Hemorrhages ; Ocular Motility Disorders ; Optic Nerve Injuries ; Paralysis ; Prognosis ; Retrospective Studies ; Skull Fractures ; Strabismus ; Visual Fields

OBJECTIVE: Most patients with head trauma require brain computed tomography (CT) in the emergency department. However, the requirement for facial CT remains controversial. The aim of this study was to evaluate the diagnostic value of brain CT alone for detection of facial fractures and its ability to determine the requirement for additional facial CT. METHODS: This retrospective multicenter study was conducted in two tertiary hospitals in Seoul, Republic of Korea, between January 2014 and December 2015. Data were collected from the medical records of adult patients (aged over 18 years) who had undergone both brain and facial CT on the same day as their presentation to the emergency department with blunt trauma to the head and face. The same radiologist analyzed all brain and facial CT images. RESULTS: Eight hundred and sixty patients (668 men, 192 women; mean age 48.60±18.2 years) were identified to have had facial fractures. There was a statistically significant predominance of men but not of any particular age group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of brain CT were 83.72%, 98.87%, 97.17%, 92.92%, and 94.08%, respectively. CONCLUSION: These findings suggest that brain CT has high diagnostic value for detection of upper facial bone fractures with high accuracy and can aid emergency physicians when determining the requirement for additional facial CT.
Adult ; Brain* ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Facial Bones* ; Female ; Head ; Humans ; Male ; Medical Records ; Republic of Korea ; Retrospective Studies ; Sensitivity and Specificity ; Seoul ; Skull ; Tertiary Care Centers

PURPOSE: To report a case of moyamoya syndrome after an additional diagnosis of neurofibromatosis type 1 (NF 1) using an ophthalmic examination in a middle-aged patient with moyamoya disease. CASE SUMMARY: A 60-year-old male with no specific past medical history except moyamoya disease visited our hospital for an ophthalmic examination. Two years prior, he had been diagnosed with moyamoya disease by brain imaging performed after a head trauma. At the first visit, his best corrected visual acuity was no light perception in the right eye (OD) and 20/25 in the left eye (OS). The intraocular pressure was 8 mmHg (OD) and 10 mmHg (OS). On fundus examination, the right eye showed a dense opacity of an ocular media and the left eye showed no abnormality except an increased cup-to-disc ratio. However, infrared imaging showed multiple whitish lesions in the left eye. Fluorescein angiography showed a patchy choroidal filling delay. During the follow-up, slit-lamp microscopy revealed Lisch nodules and multiple café au lait spots and neurofibromas were found in the skin which led to the diagnosis of NF 1. CONCLUSIONS: When examining patients with moyamoya disease, ophthalmologists should check not only ocular comorbidity associated with moyamoya disease but also ocular comorbidity with other systemic diseases that can accompany moyamoya disease. NF 1 is the most common systemic disease associated with moyamoya syndrome. In this case, appropriate follow-up was essential to monitor the development of ocular or systemic vasculopathies and their complications.
Choroid ; Comorbidity ; Craniocerebral Trauma ; Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Male ; Microscopy ; Middle Aged ; Moyamoya Disease ; Neurofibroma ; Neurofibromatosis 1 ; Neuroimaging ; Skin ; Visual Acuity

OBJECTIVE: Post-traumatic hydrocephalus (PTH) is a frequent and serious complication following brain injury. The incidence of PTH varies greatly among studies. The purpose of this study was to investigate the incidence and treatment of PTH in patients with head trauma. METHODS: We examined 956 patients with head trauma who visited our center from January 2012 to December 2015. The hydrocephalus diagnosis was based on radiologic findings and clinical features, and patients were classified into the mild (Group 1, Glasgow Coma Scale score [GCS] 13–15), moderate (Group 2, GCS 9–12), or severe (Group 3, GCS 3–8) brain injury group according to their GCS at admission. To compare these groups, we used age, gender, radiologic findings, PTH developmental period, and postoperative results (Glasgow Outcome Scale). RESULTS: Of the 956 patients, 24 (2.5%) developed PTH. PTH occurred in 11 (1.4%), 3 (5.6%), and 10 (7.0%) patients in Groups 1, 2, and 3, respectively. Of the 24 patients with PTH, 22 (91.7%) developed PTH within 12 weeks post-trauma; the higher the GCS, the later the onset, and the lower the GCS, the earlier the onset (p=0.019). Twenty-one patients underwent ventriculoperitoneal shunting, and 13 had improved symptoms. CONCLUSION: The incidence of PTH cannot be ignored. The possibility of PTH needs to be considered in patients with head trauma and appropriate follow-up should be undertaken. PTH is a treatable complication and patients' quality of life and neurological status can be improved if the appropriate treatment is selected and applied.
Brain Injuries ; Craniocerebral Trauma* ; Diagnosis ; Follow-Up Studies ; Glasgow Coma Scale ; Head* ; Humans ; Hydrocephalus* ; Incidence ; Quality of Life ; Ventriculoperitoneal Shunt