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Management of hyphema, repair of iridodialysis, and repair of corneoscleral lacerations
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
A complete examination of both eyes and a general examination of the patient’s overall health and stability are critical in any trauma patient. Patients with traumatic hyphema may have sustained blunt trauma to the head, potentially resulting in a closed head injury. Particularly in elderly people, who are prone to falling and predisposed to subdural hematoma, it is necessary to ascertain the mental status and perform a neurologic screening examination. Once the patient’s stability has been established, the ophthalmic examination can be performed. Visual acuity and particularly a pupillary examination may alert the examining physician to more extensive pathology, such as suprachoroidal hemorrhage, occult scleral rupture, or traumatic optic neuropathy. Slit-lamp biomicroscopy is essential to assess the size and appearance of the hyphema and any concurrent ocular pathology. Because traumatic hyphema results from tearing of iris or ciliary body structures as the eye is compressed and the lens–iris diaphragm is displaced posteriorly, the physician should look specifically for concurrent sphincter ruptures, iridodialysis, cyclodialysis, angle recession, and zonular dialysis.
Subdural hematoma
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
This patient has a subdural hematoma. A subdural hematoma is typically caused by tearing of the cerebral bridging veins. The onset of symptoms is more gradual and appears crescentic on CT. The hematoma is able to cross suture lines but cannot cross dural reflections (i.e. the tentorium cerebelli or the falx cerebri). Conversely, epidural hematomas are caused by injury to cerebral arteries, most commonly the middle meningeal artery. They appear biconvex on CT and are able to cross dural reflections but cannot cross suture lines.
Trauma from child abuse
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Charles S. Cox, Margaret L. Jackson, Benjamin M. Aertker
Infants with abusive head trauma often present with sudden infant death syndrome (SIDS), seizures, coma, or apnea. The most common lesion on imaging is a subdural hematoma not associated with signs of external trauma [27–29]. The cause of the subdural hematoma is avulsion of the venous bridges between the brain and dura due to the rapid acceleration and deceleration that occurs with violent shaking or impacts [2]. There may also be associated skull fractures. Accidental subdural hematoma is rare in infants, and is not typically related to low-level falls (<4 feet). In the absence of a high-energy mechanism of injury, such as a motor vehicle crash or fall from a significant height, child abuse must be considered in every case of subdural hematoma in children. In the clinical scenario of reported minimal trauma in infants, the presence of a skull fracture without intracranial injury suggests accidental trauma, whereas skull fractures and intracranial bleeding or intracranial bleeding alone are highly suggestive of child abuse [30].
Length of Stay, Cost, and Outcomes related to Traumatic Subdural Hematoma in inpatient setting in the United States
Published in Brain Injury, 2022
Eshani J Choksi, Kumar Mukherjee, Khalid M Kamal, Steven Yocom, Richard Salazar
Traumatic subdural hematoma is a prevalent neurosurgical condition that imposes a considerable social and economic burden on the healthcare system. Published studies in the US have shown a rapidly increasing prevalence and hospitalization costs of TSDH (4,5). However, since these publications, numerous technological advances and preventative strategies have been implemented which has potentially impacted hospitalization costs, LOS, and treatment outcomes in TSDH. This study found a significant increase in number of TSDH cases with the highest increase seen among 75–84 years old. The present study also found a decreasing trend in the proportion of patients who required surgery, inpatient mortality and mean inpatient cost of treatment. Inpatient mortality and complications were significantly associated with the ISS, patients’ comorbid conditions requiring use of anticoagulants and age.
The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article
Published in British Journal of Neurosurgery, 2022
Ehsan Alimohammadi, Sonia V. Eden, Sharath Kumar Anand, Paniz Ahadi, Arash Bostani, Seyed Reza Bagheri
Hecht et al. in an observational, longitudinal cohort study sought to evaluate whether patients with neuro-emergencies were seeking and/or receiving the medical care they require during the pandemic. They found that during the pandemic, the total number of neuro-emergencies, particularly vascular, spinal, and hydrocephalus emergencies, reduced significantly. Interestingly, they reported cases with spinal emergencies presented 48 hours later despite comparable symptom severity. Moreover, elderly patients with chronic subdural hematoma presented less frequently, with more severe symptoms, and had a less favorable outcome in comparison with previous years.34 Several authors have postulated this reduction in neurosurgical emergencies during the pandemic may be secondary to lockdown and stay-at-home measures.37–39
Retrospective study of functional outcomes and disability after non-ischaemic vascular causes of spinal cord dysfunction
Published in The Journal of Spinal Cord Medicine, 2021
Chiu Pin Teo, Kevin Cheng, Peter Wayne New
More than half of our cases had an iatrogenic contribution to their non-ischemic vascular SCDys. We presented six different spinal procedures leading to SCDys, but further subgroup analysis on their rehabilitation outcome differences was not performed due to the small sample size. The causative anticoagulant reported in our study was warfarin, and no cases were identified as involving aspirin. Numerous case reports describe the correlation between spinal cord hemorrhage and warfarin,13–23 and as early as in 1956.24 A review of nine published cases reported minimal or no recovery following surgery for warfarin-associated spinal cord hemorrhage.22 No novel oral anticoagulant agent caused spinal cord hemorrhage in our study. These agents were first introduced in Australia in 2013, and we ended our data collection two years later. Cases of spinal cord hemorrhage related to rivaroxaban, a factor Xa inhibitor, have been reported.25–29 Two were epidural hematoma and reported complete neurological recovery.25,26 Another two were due to subdural hematoma, with no neurological improvement after six months,27,28 and one subdural hematoma, with marked but incomplete recovery.29