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Role of antibiotics
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Martina Ornaghi, Valentina Ormas, Daniela Ferlicca
A basilar skull fracture (BSF) is a serious injury resulting from a break in the bones of the skull base. Such fractures represent 7% to 15.8% of all skull fractures, with 2% to 20.8% of CSF leakage occurring.5
Paper 2 Answers
Published in James Wigley, Saran Shantikumar, Andrew Paul Monk, Stuart Blagg, Get Through, 2014
James Wigley, Saran Shantikumar, Andrew Paul Monk, Stuart Blagg
Signs of basilar skull fractures include CSF otorrhoea, CSF rhinorrhoea, Battle’s sign (bruising by the mastoid process), haemotympanum, raccoon eyes (periorbital ecchymoses) and cranial nerve palsies (often VII and VIII, which may occur a few days after the initial injury). Vomiting can occur from a head injury of any cause and does not specifically relate to a basilar skull fracture.
Clinical management of pituitary dysfunction after traumatic brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Adam H. Maghrabi, Brent E. Masel, Randall J. Urban, David L. Ripley
The most possible mechanisms of injury are 1) the direct brain injury event itself; 2) the indirect injuries, such as hypoxia or hypotension; 3) the transient effect of critical illness or the “stress response;” and 4) the effects of different medications given during the initial critical period after injury that may have the inadvertent effect of suppressing normal hypothalamic and pituitary function. Direct mechanisms refer to fractures through the skull base and sella turcica as well as the shearing injuries of the pituitary, infundibulum, and/or hypothalamus. Although the risk of injury to the anterior lobe is greatest from a basilar skull fracture, the anterior lobe can be injured by any skull fracture or even by severe brain trauma in the absence of fracture.8 Fractures of the sella turcica after fatal brain injury are found on autopsy for as many as 20% of cases, depending on whether the petrous temporal bone is included in the statistics.9 Transection or rupture of the pituitary stalk results in anterior lobe infarction because of disruption of the portal blood supply from the hypothalamus to the anterior pituitary. Therefore, it can be inferred that shearing forces delivered from different angles and with varying forces could impair blood flow through the long hypophyseal portal veins to the peripheral pituitary and cause isolated, multiple, or partial deficiencies of anterior pituitary hormone secretion. Despite recent studies,10,11 there are still no adequate animal models to confirm this inference, and imaging techniques have not been developed to assess blood flow to the pituitary through the hypophyseal portal veins after TBI. In early 2015, Zheng et al. suggested that pituitary apparent diffusion coefficient using diffusion-weighted imaging may help predict pituitary function in patients with TBI;12 however, the practicality of such models is yet to be proven.
Cerebrospinal fluid leak management in anterior basal skull fractures secondary to head trauma
Published in Neurological Research, 2022
Jian-Cheng Liao, Buqing Liang, Xiang-Yu Wang, Jason H. Huang
Basal (or basilar) skull fractures involve bones in the base of the skull, which accounts for 7% to 15.8% of all skull fractures in non-penetrating head traumas [1]. The majority of these are secondary to motor vehicle accidents or other high-velocity impact forces, including gunshot wounds [2]. These fractures are often present with facial trauma and can be associated with cerebral contusion, hematoma formation, and dural laceration. Cerebrospinal fluid (CSF) leaks, also known as CSF fistulas, may form if the space between the meningeal tear and the outside environment is continuous. Eighty per cent of CSF leaks are due to trauma, while the rest are iatrogenic or spontaneous [3]. CSF leaks after a head injury have been estimated to be 10% to 30% in basal skull fractures [4]. However, a recent study suggested that it may be lower as 4% [5]. The location of basal skull fractures can be categorized into three fossae: anterior, middle, and posterior cranial fossa. In this article, we specifically discuss fractures of the anterior (or frontobasal) cranial fossa, which occurs in 4% of head injuries [6].
The effect of time on cognitive impairments after non-traumatic subarachnoid haemorrhage and after traumatic brain injury
Published in Brain Injury, 2018
Anna Tölli, Charlotte Höybye, Bo-Michael Bellander, Fredrik Johansson, Jörgen Borg
In addition to the GCS score (44) (3–8 severe injury, 9–13 moderate injury), clinical severity in patients with SAH severity was graded according to the Hunt-Hess scale (HH) (45). The CT lesion after SAH was graded according to Fisher scale (FS) (46). Aneurysms were verified by computed tomography angiography (CTA) or digital subtraction angiography (DSA). Aneurysms were divided into aneurysm from the anterior cerebral circulation and the posterior cerebral circulation. Computed tomography (CT) lesion (46) grading of TBI was according to the CRASH model (47) with addition of brain oedema, basilar skull fractures and facial fracture data. Coma Recovery Scale Revised (CRS-R) (48) was used to assess disorders of consciousness (DOC) (49).
Clinically significant traumatic intracranial hemorrhage following minor head trauma in older adults: a retrospective cohort study
Published in Brain Injury, 2020
Toby O’Brien, Biswadev Mitra, Natalie Le Sage, Pier-Alexandre Tardif, Marcel Emond, Myreille D’Astous, Eric Mercier
Patients were excluded if they were transferred from another hospital for investigations or treatments. Patients with suspected basilar skull fracture, known intracranial anatomic abnormalities such as cancer, previous neurosurgical intervention, chronic subdural hematoma (SDH) or with genetic coagulation disorders were excluded. Due to the potential confounding effect of post-ictal symptoms, patients with witnessed seizures were excluded. Patients with non-isolated minor head injury were eligible provided that all inclusion criteria were met. Repeat presentations by the same patient were deemed to be acceptable only in the case of a new episode of head injury. Headache was not ground for exclusion as it is not specific to TBI.