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Adult skull fractures
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The differential diagnosis of the isolated anterior cranial fossa fracture includes penetrating injuries through the orbital roof as well as direct trauma. Fragments of glass, after a road traffic accident, may penetrate the orbit and orbital roof. Radiological examination may identify glass, but one should be aware that not all glass fragments are identified by this means.
Neurological Disease of the Pharynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Nasopharyngeal carcinomas and particularly skull-base tumours compress and invade the lower cranial nerves producing a variety of symptoms. MRI and CT scanning of the anterior cranial fossa, brain and temporal bone should follow the appropriate clinical examination. Surgery or radiotherapy can then be considered. A variety of jugular foramen syndromes exist, described in Table 54.1. A small number of paraneoplastic syndromes have been associated with neurogenic dysphagia including squamous cell carcinoma of the skin, transitional cell carcinoma of the bladder, ovarian cancer, prostate cancer and chronic lymphocytic leukaemia.9–13
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The receptor cells are derived from ectoderm and are unique in being replaced from stem cells every 30–50 days. They also enter the central nervous system (CNS) as very thin (0.1–0.4 ¼m), non-myelinated axons without synapse. These axons become grouped and ensheathed by Schwann cells forming some 20 fasciculi which are invested by pia and arachnoid mater, and pass through the orifices of the cribriform plate to enter the olfactory bulbs lying each side of the crista galli in the floor of the anterior cranial fossa. These axons synapse with dendrites of the large mitral cells of the olfactory glomeruli and each glomerulus receives axons from a wide area of the epithelium. There seems to be no functional grouping of axons. This arrangement allows a relatively small number of receptor cells to distinguish a large number of different odours. The axons of the mitral cells form the bulk of the olfactory tract but centrifugal axons of uncertain origin also pass to the olfactory bulb and undoubtedly modify activity in the olfactory glomeruli, perhaps having both inhibitory and facilitatory actions. The olfactory tracts pass posteriorly and slightly laterally crossing the floor of the anterior cranial fossa, the optic nerves and immediately above the optic chiasm. Just in front of the anterior perforated substance, each divides into medial, intermediate and lateral olfactory striae.
Radiological findings of orbital blowout fractures: a review
Published in Orbit, 2021
Ma ReginaPaula Valencia, Hidetaka Miyazaki, Makoto Ito, Kunihiro Nishimura, Hirohiko Kakizaki, Yasuhiro Takahashi
The occurrence of orbital blowout fracture in the orbital roof is rare. Orbital roof fracture accounts for 1–9% of craniofacial fractures.19 As orbital roof fracture is usually caused by high energy impact onto the frontal bone, this is often associated with multiple facial bone fracture or fracture of the superior orbital rim.19 This type of orbital blowout fracture is also referred to as “orbital blow-up fracture”.19,20 Fractures of the orbital roof over where the frontal sinus lies are more common (Figure 2j) than that of the orbital roof corresponding to the anterior cranial fossa (Figure 2k), when the frontal sinus is well developed and pneumatized.20 The latter leads to both intracranial and intraorbital injuries, resulting in a poor prognosis.19
Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis
Published in British Journal of Neurosurgery, 2019
Keisuke Yoshida, Raita Fukaya, Masahito Fukuchi, Yoshihiko Hiraga, Shinya Ichimura, Koji Fuji
Emergency angiography showed extravasation from the posterior septal branch of the sphenopalatine artery (SPA) (Figure 2(A,B)). In addition, an incidental anterior cranial fossa DAVF was detected. It was supplied by the ethmoidal branch of the right ophthalmic artery (OphA) aberrantly originating from the middle meningeal artery (MMA). The DAVF then drained into the anterior segment of the superior sagittal sinus through a dilated prefrontal cortical vein. Selective catheterisation of the SPA was achieved with a microcatheter, and endovascular embolisation was performed using Gelfoam® Sterile Sponge pledgets (Pfizer, Inc.; New York, NY, USA). The bleeding from the oral cavity stopped just after embolisation was achieved. Estimated blood loss was more than 4000 mL by the time haemostasis was achieved. Follow-up CT showed high density in the sphenoid sinus that had not been evident on the postoperative CT but did not show any evidence of intracranial haemorrhage.
Assessment of olfactory function after traumatic brain injury: comparison of single odour tool with detailed assessment tool
Published in Brain Injury, 2018
OD is common within clinical practice. It may be due to several different clinical conditions including Parkinson’s disease, hypertension, diabetes mellitus and idiopathic changes with age (3). However, up to 60% of OD cases are due to traumatic brain injury (TBI) and upper respiratory tract infection (URTI) including nasal and paranasal sinus disease (4). The relationship between OD and TBI is well understood, as the olfactory system is at risk of damage following TBI. The peripheral olfactory pathways may be damaged owing to blunt force trauma to the nose and olfactory epithelium or owing to shearing forces acting on the nerves in the cribriform plate. Alternatively, compression of the secondary olfactory centres within the basal frontal and temporal lobes can occur against the skull base of the anterior cranial fossa because of contrecoup damage following blunt force trauma to the occipital aspect of the skull (5). The incidence of OD following TBI increases with TBI severity (6–9).