OBJECTIVES: To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree. METHODS: A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ² test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected. RESULTS: χ² test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05). CONCLUSIONS EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.
Brain Contusion ; Brain Injuries/diagnostic imaging* ; Hematoma, Epidural, Cranial ; Hematoma, Subdural/etiology* ; Humans ; Logistic Models ; Skull Fractures/diagnostic imaging* ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/diagnostic imaging*

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.
Accidental Falls ; Angiography ; Brain ; Colon, Sigmoid ; Cranial Fossa, Posterior ; Craniotomy ; Embolization, Therapeutic ; Epidural Space ; Hematoma ; Hematoma, Epidural, Cranial ; Hemorrhage* ; Humans ; Lacerations ; Male ; Middle Aged ; Mortality ; Operating Rooms

Large amount of epidural hematoma usually requires surgical intervention. When the amount of epidural hematoma is increasing gradually, causing neurological symptoms, an early emergent surgery may be the only way to prevent lethal outcome. Among many factors associated with the prognosis, age, amount of hematoma, patient's consciousness at the time of admission, and other accompanying injuries are known to be important factors. However, in some cases, symptoms may be exacerbated due to causes other than the increase in epidural hematoma, such as cerebral infarction. In particular, calcification of the internal carotid artery is known to be an important factor that causes acute cerebral infarction before and after surgery. Correct identification is important for appropriate treatment between cerebral infarction and cerebral hemorrhage. Herein, we present a case that followed lethal outcome due to misdiagnosis between epidural hematoma expansion and acute cerebral infarction caused by dissection or calcification of the internal carotid artery after blunt trauma. To the best of our knowledge, there have been any reports regarding simultaneous occurrence of acute cerebral infarction and acute epidural hematoma on the same side following blunt trauma.
Carotid Arteries ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Cerebral Infarction* ; Consciousness ; Diagnostic Errors* ; Hematoma* ; Hematoma, Epidural, Cranial ; Prognosis ; Vascular Calcification

OBJECTIVE: The aim of this preliminary collaborative study was to assess the clinical characteristics, management, and outcome of epidural hematoma (EDH) based on the data collected and registered in the Korean Trauma Data Bank System (KTDBS). METHODS: Of 2,698 patients registered in the KTDBS between September 2010 and March 2014, 285 patients with EDH were analyzed. Twenty-three trauma centers participated in the study voluntarily to collect data. We subcategorized the patients into two groups with good and poor outcomes. Various clinical characteristics and the time intervals with regard to treatment course were investigated to determine the relationship between these parameters and the functional outcome. RESULTS: Of multiple parameters for this analysis, older age (p=0.0003), higher degree of brain injury (p<0.0001), cases of surgical EDH (p<0.0001), time interval from trauma to hospital before 6 hours, and the decreasing pattern of Glasgow Coma Scale (GCS) between and initial and final GCS were strongly associated with poor outcome. Use of prophylactic anticonvulsant did not affect the functional outcome. There was an interesting difference in the use of mannitol in treating EDH between the urban and rural regions (p<0.0001). CONCLUSION: This is the first multi-center analysis of etiology of injury, pre-hospital care, treatment, and functional outcome of EDH in Korea. The degree of brain injury and the GCS difference were notable factors that were significant in determining the functional outcome of EDH.
Brain Injuries ; Glasgow Coma Scale ; Hematoma* ; Hematoma, Epidural, Cranial ; Humans ; Korea* ; Mannitol ; Republic of Korea ; Trauma Centers

A 21-year-old female presented with acute epidural hemorrhage (EDH) on the left temporal region associated with skull fracture after traffic accident. She was neurologically deteriorated at four-hour after an admission, and follow-up computed tomography revealed increased amount of EDH. Under the general anesthesia, emergency craniotomy was performed. During the surgery, massive bleeding from the base of middle cranial fossa was observed. However, we could not identify an origin of bleeding and foramen spinosum due to brain swelling and obscured surgical field. Consequently, her systolic blood pressure was dropped to 60 mm Hg with >110 beat/min of heart rate. Therefore, we decided to perform an intraoperative angiography after gauze packing into the middle cranial fossa. Intraoperative angiography showed a large pseudoaneurysm with massive contrast leakage of the middle meningeal artery (MMA). Intraoperative endovascular embolization of the pseudoaneurysm and MMA by using n-butyl-2-cyanoacrylate was done. After that, her vital sign became stable, and we could complete the operation after the achievement of adequate hemostasis. Intraoperative angiography and endovascular embolization of MMA was effective in achieving adequate hemostasis in case with brisk bleeding from the middle cranial fossa could not be controlled in an open surgical field.
Accidents, Traffic ; Anesthesia, General ; Aneurysm, False* ; Angiography ; Blood Pressure ; Brain Edema ; Cranial Fossa, Middle ; Craniotomy ; Emergencies ; Enbucrilate ; Female ; Follow-Up Studies ; Heart Rate ; Hematoma, Epidural, Cranial ; Hemorrhage* ; Hemostasis* ; Humans ; Meningeal Arteries* ; Skull Fractures ; Vital Signs ; Young Adult

OBJECTIVE: A small epidural hematoma (EDH) that has been diagnosed to be nonsurgical by initial brain computed tomography (CT) can increase in size and need surgical removal, resulting in a poor prognosis. However, there have been few studies, which focused delayed operated EDH. Therefore, we analyzed the clinical factors to determine the predicting factors of delayed operated EDH. METHODS: Between January 2011 and January 2014, 90 patients, who were admitted due to EDH, were enrolled in this study. None of the patients were indicated for operation initially. Based on the presence of surgery, we classified the patients into a delayed-surgery group (DG) and a non-surgical group (NG). Additionally, we analyzed them according to the following: time interval between the trauma and the initial CT, gender, age, medical history, drinking, change of mean arterial pressure (MAP), volume of EDH and other traumatic brain lesion. RESULTS: Among the 90 patients, the DG was 19 patients. Compared with NG, the DG revealed increased MAP, less presence of drinking, and a short time interval (DG vs. NG: +9.684 mm Hg vs. -0.428 mm Hg, 5.26% vs. 29.58%, 1.802 hours vs. 5.707 hours, respectively, p<0.05). Analyzing the time interval with receiver operating characteristic, there was 88.2% sensitivity and 68.3% specificity at the 2.05-hour cut-off value (area under the curve=0.854). CONCLUSION: According to our results, the time interval between the trauma and the initial CT along with blood pressure change are potential predicting factors in the cases of delayed operation of EDH.
Arterial Pressure ; Blood Pressure ; Brain ; Craniocerebral Trauma ; Drinking ; Hematoma* ; Hematoma, Epidural, Cranial ; Humans ; Neurosurgery ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVETo investigate the risk factors of progressive brain contusion and to evaluate their impact on patients' outcome.

METHODSOne hundred and thirty two patients with traumatic brain contusion were enrolled in the study, including 70 cases with progressive contusion and 62 cases with non-progressive contusion. The risk factors were investigated with univariate and multivariate Logistic regression analysis.

RESULTSThe univariate analysis showed that Glasgow Coma Score (GCS) at admission, contusion volume at the first brain CT scans, midline shift, combined with skull fracture, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, location of brain contusion, D-dimer levels, combined with type 2 diabetes were associated with progressive brain contusion. Multivariate Logistic regression analysis showed that GCS at admission, contusion volume at the first CT scans, combined with subarachnoid hemorrhage, combined with type 2 diabetes were the independent risk factors for disease progression. The outcome in the progressive group was more aggravated than that in non-progressive group (P = 0.001).

CONCLUSIONPatients with disturbance of consciousness, the larger contusion volume, combined with subarachnoid hemorrhage and diabetes are at risk for progressive brain contusion and unfavorable outcome.

Brain Injuries ; complications ; pathology ; Diabetes Mellitus, Type 2 ; complications ; Disease Progression ; Fibrin Fibrinogen Degradation Products ; metabolism ; Glasgow Coma Scale ; Hematoma, Epidural, Cranial ; complications ; Hematoma, Subdural ; complications ; Humans ; Risk Factors ; Subarachnoid Hemorrhage ; complications ; Tomography, X-Ray Computed

OBJECTIVE: Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT. METHODS: Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores. RESULTS: Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status. CONCLUSION: We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.
Brain Injuries* ; Cohort Studies ; Craniocerebral Trauma ; Follow-Up Studies ; Glasgow Coma Scale ; Head* ; Hematoma, Epidural, Cranial ; Hemorrhage ; Humans ; Risk Factors ; Tomography, X-Ray Computed

Child ; Cochlear Implantation ; adverse effects ; Hematoma, Epidural, Cranial ; etiology ; Humans ; Male

Cervical spine epidural hematoma is a rare disease, which can sometimes be misdiagnosed as acute ischemic stroke when a patient shows hemiparesis. A 68-year-old woman visited the emergency department with right side motor weakness without signs of facial palsy or cranial nerve deficit. She also complained of accompanying neck pain. Acute ischemic stroke was suspected initially and a non-contrast computed tomography of the brain was taken, which showed no cerebral hemorrhage. Brain and cervical spine magnetic resonance imaging (MRI) was performed for further evaluation. No evidence of cerebral infarction. However, an epidural hematoma was detected on cervical spine MRI. The patient was consulted to the neurosurgery department and decompressive laminectomy and hematoma evacuation was performed. Emergency physicians should consider cervical spine epidural hematoma in cases of sudden onset hemiparesis with accompanying neck pain.
Aged ; Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Cerebrovascular Disorders ; Cranial Nerves ; Emergencies ; Emergency Service, Hospital ; Facial Paralysis ; Female ; Hematoma* ; Hematoma, Epidural, Spinal ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neck Pain ; Neurosurgery ; Paresis ; Rare Diseases ; Spine* ; Stroke*