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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Extradural haematoma is usually an early consequence of head trauma, where a damaged middle meningeal artery bleeds into the extradural space. Blood accumulates rapidly, causing mass effect and dysfunction of underlying brain, often with significant midline shift. Without treatment, it is often fatal.
Basics of CT Scan Head and Trauma Radiographs
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Ujjwal Gorsi, Chirag Kamal Ahuja
It is reiterated that in any manifestation of head injury, it is a dictum to evaluate for contralateral midline shift and transcompartmental herniations, e.g. uncal herniation, tonsillar herniation and ascending transtentorial herniation along with corresponding vascular ischaemic effects in the anterior and posterior cerebral territories. There may be late effects of head injury in the form of internal carotid artery injury resulting in carotid-cavernous fistula (Figure 29.7) and CSF rhinorrhoea (Figure 29.8).
Intracranial haematomas
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Other features present include indentation of the brain with or without midline shift. This is often severe in well-developed cases. There may be discolouration of the underlying arachnoid. Associated conditions include atrophy, related to age, dementia or alcohol, as well as other pathologies such as old cerebral infarction or previous head injury.
Decompressive hemicraniectomy in the management of subcortical spontaneous intracerebral hemorrhage
Published in International Journal of Neuroscience, 2020
Ifeanyi Iwuchukwu, Cuoung Bui, Billie Hsieh, Vivek Sabharwal, Alaa Mohammed, Harold McGrade, Erin Biro, Doan Nguyen, Olawale Sulaiman
Standard practice at our institution for ICH management include serial head CT at 6 hr intervals to demonstrate hematoma stability and/or a 18–24 hr follow up head CT. Each patients initial and follow up neuroimaging studies were reviewed for ICH location, hematoma volume, midline shift, intraventricular hemorrhage (IVH), and Graeb scores. The ABC/2 formula, a validated formula, was used to calculate hematoma volume [17]. The Graeb score measures IVH severity using a 12-point scale centered on gross hemorrhage size and ventricle dilatation with higher scores indicating worse intraventricular hemorrhage [18]. A 30% increase in hematoma volume on follow-up 24-hour neuroimaging was defined as hematoma expansion. Midline shift was defined as lateral deviation of the septum pellucidum from the midline; a central line connecting the anterior and posterior attachments of the falx to the skull at the level of the foramen of munro in millimeters.
Subdural drainage techniques for single burr-hole evacuation of chronic subdural hematoma: two drains frontal-occipital position versus one drain frontal position
Published in British Journal of Neurosurgery, 2021
Qiangjun Wu, Qin Liu, Duoning Chen, Zhufeng Chen, Xuecai Huang, Ming Luo, Shike He
The low recurrence rate in patients with TFOP may be explained by the reasons as follow: 1) In this study, we found that midline shift on first postoperative day was greater in OFP group than the TFOP group. Prior studies had shown that larger postoperative midline shift was associated with a higher risk of recurrence.6,23 Because large postoperative midline displacement reflected poor reexpansion of the brain, which may predispose to re-accumulation of the hematoma.23 2) Our results showed patients with OFP had much more residual subdural air than those with TFOP. Many studies reported that the amount of residual air was correlated positively with the recurrence rate of CSDH.15,18,24 Massive subdural air is thought to disturb adhesion between the inner and outer hematoma membrane and thus facilitate postoperative recurrence. 3) Patients with TFOP had larger percent of hematoma evacuation and smaller residual subdural fluid volume compared with OFP in the present study. In accordance with the findings of Motiei-Langroudi et al., there were fewer recurrences of CSDH in patients with larger amount of hematoma evacuation after surgery.24 Stanišić et. al also found that higher residual total hematoma cavity volume on first postoperative day was an independent predictor for hematoma recurrence.25 The possible mechanism is that persistence of hematoma space postoperatively may inhibit brain reexpansion and prevent reduction of the hematoma cavity.25 For these reasons, patients treated with TFOP may have a lower risk for recurrence compared to those with OFP.
Neuroprotection by trans-resveratrol against collagenase-induced neurological and neurobehavioural deficits in rats involves adenosine A1 receptors
Published in Neurological Research, 2020
Noor Azliza Wani Abd. Aziz, Igor Iezhitsa, Renu Agarwal, Roqiah Fatmawati Abdul Kadir, Azian Abd. Latiff, Nafeeza Mohd Ismail
After the neurobehavioural assessments, rats were euthanized and subjected to transcardial perfusion as described previously by Gage et al. [62]. After perfusion, the whole brain was dissected and was fixed in 4% paraformaldehyde in 10 times the volume of brain tissue, overnight at room temperature. The fixed brain was cut coronally through the needle entry site, followed by another cut at 4 mm anterior to the coronal plane as described by Del Bigio et al. [63]. Brain tissues were processed according to the standard protocol for light microscopy. Briefly, tissues were dehydrated through graded alcohol series (50–100%), cleared in xylene and embedded in paraffin wax. Paraffin-embedded blocks were sectioned at 3-μm thickness using a microtome. The regions were selected with reference to the rat brain atlas as described by Paxinos and Watson [51] and included the point of collagenase injection which contained maximal haematoma diameter. Slides were stained with haematoxylin and eosin (H&E) based on routine staining protocol. Histological slides were digitally scanned and the images were captured at objective magnification of 1×, 5×, 10× and 40×. Morphological features of the brain tissue at 48 h post-ICH were analysed according to the description of histopathology of collagenase-induced ICH in rats in a previous report [64] (refer Figure 3). Brain midline shift was determined based on the method described previously [65] and the measurement was done using Pannoramic Viewer software. The volume of damaged area was determined based on the method described previously [61] and the percentage of the damaged area in the whole-brain hemisphere in that particular section was measured using Image J software.