Clinical management of pituitary dysfunction after traumatic brain injury
Mark J. Ashley, David A. Hovda in Traumatic Brain Injury, 2017
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.
Role of antibiotics
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
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
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.
Pediatric minor head trauma in Brazil and external validation of PECARN rules with a cost-effectiveness analysis
Published in Brain Injury, 2020
Leopoldo Mandic Ferreira Furtado, José Aloysio da Costa Val Filho, André Ribeiro dos Santos, Raísa Furfuro e Sá, Bruno Lacerda Sandes, Yangpol Hon, Eustáquio Claret dos Santos Júnior, Rodrigo Moreira Faleiro
According to the PECARN rules, the recommendations regarding CT were divided based on whether the patient was younger or older than 2 years. For those younger than 2-years old, CT was considered if the child presented with a GCS score of 14, other signs of altered mental status or palpable skull fracture, occipital or parietal, or temporal scalp hematoma, a history of loss of consciousness for more than 5 s, a severe mechanism of trauma, or behavior alterations according to the parents. For those older than 2 years, CT was considered if there was a history of altered mental status, a GCS score of 14, signs of basilar skull fracture, a history of loss of consciousness, vomiting, severe headache, or a severe mechanism of injury.
NeuroQuant® and NeuroGage® reveal effects of traumatic brain injury on brain volume
Published in Brain Injury, 2018
David E. Ross, John Seabaugh, Leah Cooper, Jan Seabaugh
Computed tomographic (CT) imaging showed extensive abnormal findings, including a left parietal scalp hematoma with an underlying non-displaced calvarial fracture, a right frontal scalp hematoma, a basilar skull fracture, subarachnoid bleeding, large bifrontal haemorrhagic contusions and overlying subdural hematomas, small haemorrhagic contusion in the inferior aspect of the left temporal lobe, parenchymal haemorrhage in the posterior left temporal lobe, small contusion in the inferior lateral right temporal lobe, and hydrocephalus. Treatment included placement of a right ventriculostomy catheter, resulting in resolution of the hydrocephalus over several days and no need for further neurosurgical procedures.
Related Knowledge Centers
- Bone Fracture
- Base of Skull
- Battle'S Sign
- Raccoon Eyes
- Hemotympanum
- Cerebrospinal Fluid Leak
- Rhinorrhea
- Otitis Media
- Meningitis
- Cranial Nerves