OBJECTIVE: Blunt head injury can lead to isolated damage of the inner ear (cochlear labyrinthine concussion) or damage of the otolith organ (vestibular labyrinthine concussion) due to a bone conduction pressure. We evaluated the clinical characteristics of hearing impairment in patients who suffered from a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. METHODS: This retrospective study examined 9 patients presenting with hearing impairment after blunt head trauma within recent 5 years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients complained of associated auditory symptoms including tinnitus, dizziness, earfullness, and otalgia. Twelve ears of 9 patients showed sensorineural hearing loss; mild (1 ear), moderate (3 ears), moderate-severe (4 ears), severe (2 ears), and profound (2 ears). After high-dose steroid therapy, 2 ears had a significant hearing gain, but 10 ears showed no improvement of hearing. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.
Bone Conduction ; Craniocerebral Trauma* ; Dizziness ; Ear ; Ear, Inner ; Earache ; Head Injuries, Closed ; Head* ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Intracranial Hemorrhages ; Nervous System Diseases ; Otolithic Membrane ; Retrospective Studies ; Temporal Bone ; Tinnitus

An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head trauma, we performed a CT angiogram to exclude any vascular abnormalities. The CT angiogram showed no vascular abnormality. She was discharged after conservative treatment. One day after discharge, she returned to the emergency department because of mental deterioration. Brain CT showed diffuse SAH, which was dominant in the right Sylvian fissure. The CT angiogram revealed a right middle cerebral artery bifurcation aneurysm. During operation, a non-traumatic true saccular aneurysm was found. The patient recovered fully after successful clipping of the aneurysm and was discharged without neurologic deficit. Normal findings on a CT angiogram do not always exclude aneurysmal SAH. Follow-up vascular study should be considered in trauma patients who are highly suspicious of aneurysmal rupture.
Adult ; Aneurysm ; Brain ; Craniocerebral Trauma ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Head Injuries, Closed ; Headache ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Motorcycles ; Neurologic Manifestations ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic*

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.
Brain ; Child ; Colon, Sigmoid* ; Craniocerebral Trauma ; Diagnosis ; Head Injuries, Closed* ; Headache ; Hematoma ; Humans ; Jugular Veins ; Magnetic Resonance Imaging ; Male ; Nausea ; Phlebography ; Pneumocephalus ; Sinus Thrombosis, Intracranial* ; Skull ; Vomiting

Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.
Aneurysm ; Aneurysm, False* ; Carotid Artery Injuries ; Carotid Artery, Internal* ; Craniocerebral Trauma ; Diagnosis ; Follow-Up Studies ; Head Injuries, Closed* ; Headache ; Humans ; Magnetic Resonance Angiography ; Neck ; Phenobarbital ; Subarachnoid Hemorrhage

Dementia pugilistica (DP) or chronic traumatic encephalopathy (CTE) is a neurodegenerative disease or dementia that may affect amateur or professional boxers as well as athletes in other sports who suffer concussions. The condition is thought to affect around 15% to 20% of professional boxers and caused by repeated concussive or subconcussive blows. CTE was in the past referred to as dementia pugilistica, which reflected the prevailing notion that this condition was restricted to boxers. Recent research, however, has demonstrated neuropathological evidence of CTE in retired American football players, a professional wrestler, a professional hockey player and a soccer player, as well as in nonathletes. It is probable that many individuals are susceptible to CTE, including those who experience falls, motor vehicle accidents, assaults, epileptic seizures, or military combat, and that repeated mild closed head trauma of diverse origin is capable of instigating the neurodegenerative cascade leading to CTE. We report a 62-year old man suspicious of dementia pugilistica with clinical features of frontotemporal dementia and parkinsonism.
Athletes ; Brain Injury, Chronic ; Dementia ; Epilepsy ; Football ; Frontotemporal Dementia ; Head Injuries, Closed ; Hockey ; Humans ; Military Personnel ; Motor Vehicles ; Neurodegenerative Diseases ; Parkinsonian Disorders ; Soccer ; Sports

Isolated oculomotor nerve palsy (ONP) attributable to mild closed head trauma is a distinct rarity. Its diagnosis places high demands on the radiologist and the clinician. The authors describe this condition in a 36-year-old woman who slipped while walking and struck her face. Initial computed tomography did not reveal any causative cerebral and vascular lesions or orbital and cranial fractures. Enhancement and swelling of the cisternal segment of the oculomotor nerve was seen during the subacute phase on thin-sectioned contrast-enhanced magnetic resonance images. The current case received corticosteroid therapy, and then recovered fully in 13 months after injury. Possible mechanism of ONP from minor head injury is proposed and previous reports in the literature are reviewed.
Adult ; Craniocerebral Trauma* ; Diagnosis ; Female ; Head Injuries, Closed ; Head* ; Humans ; Magnetic Resonance Imaging ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Orbit ; Walking

OBJECTIVETo investigate the protective effects of carnosine against experimental closed head injury (CHI) in mice.

METHODSThe CHI model was established by free-falling weight-drop. Carnosine (250 mg/kg or 500 mg/kg) was administered intraperitoneally 30 min before brain trauma, then q.d for 7 d; while normal saline was administrated for control group. The neurological defect was evaluated by neurological severity score (NSS) within 7 d; the survival rate and the histological alternations were observed.

RESULTSCarnosine prevented the body weight loss of mice at dose of 500 mg/kg; significantly increased the survival rate, and reduced the neurological defect and histological damage at dose of 250 and 500 mg/kg.

CONCLUSIONCarnosine can attenuate closed head injury in mice.

Animals ; Carnosine ; therapeutic use ; Disease Models, Animal ; Head Injuries, Closed ; drug therapy ; pathology ; Male ; Mice ; Mice, Inbred ICR

OBJECTIVETo study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise.

METHODSThe statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries.

RESULTSAmong the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%), followed by suicide (49, 24.3%) and accident (44, 21.8%). The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants.

CONCLUSIONStudies on the morphology and its formative rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Forensic Medicine ; Head Injuries, Closed ; etiology ; mortality ; Humans ; Infant ; Male ; Middle Aged

Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.
Cranial Fossa, Posterior ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Head Injuries, Closed ; Hypoglossal Nerve ; Paralysis ; Skull ; Skull Fractures

OBJECTIVETo establish an animal model to replicate the blunt impact brain injury in forensic medicine.

METHODSTwenty-four New Zealand white rabbits were randomly divided into control group (n equal to 4), minor injury group (n equal to 10) and severe injury group (n equal to 10). Based on the BIM-II Horizontal Bio-impact Machine, self-designed iron bar was used to produce blunt brain injury. Two rabbits from each injury group were randomly selected to monitor the change of intracranial pressure (ICP) during the impacting process by pressure microsensors. Six hours after injury, all the rabbits were dissected to observe the injury morphology and underwent routine pathological examination.

RESULTSVarying degrees of nervous system positive signs were observed in all the injured rabbits. Within 6 hours, the mortality rate was 1/10 in the minor injury group and 6/10 in the severe injury group. Morphological changes consisted of different levels of scalp hematoma, skull fracture, epidural hematoma, subdural hematoma, subarachnoid hemo- rrhage and brain injury. At the moment of hitting, the ICP was greater in severe injury group than in mild injury group; and within the same group, the impact side showed positive pressure while the opposite side showed negative pressure.

CONCLUSIONSUnder the rigidly-controlled experimental condition, this animal model has a good reproducibility and stable results. Meanwhile, it is able to simulate the morphology of iron strike-induced injury, thus can be used to study the mechanism of blunt head injury in forensic medicine.

Animals ; Brain Injuries ; Head Injuries, Closed ; Intracranial Pressure ; Rabbits ; Reproducibility of Results ; Wounds, Nonpenetrating