Extradural hematoma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Adult patients will typically present with a history of a “blow to the head” or polytrauma with a mechanism consistent with significant head trauma, such as an RTC. Typically, with an isolated EDH, there is a history of a transient loss of consciousness that, in approximately 20% to 50% of adult patients is followed by a falsely reassuring “lucid interval.” The lucid interval can last from a few to many hours following the injury before neurologic deterioration occurs due to compression of the brain and increased ICP, which, if not managed well, can lead to cerebral/tonsillar herniation (coning) and death. Other common symptoms include: headache and nausea and vomiting (63%), which are thought to be caused by the dura stripping from the skull periosteum. There is focal neurological deficit (a problem with nerve, spinal cord, or brain function) in around 30% of patients at the time of presentation (hemiparesis, decerebration [loss of cerebral function], seizures), 60% have a Global Coma Score (GCS) <153; pupillary abnormalities occur in approximately 18% to 44% of patients presenting with EDH.
Central nervous system
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding extra-dural (epidural) haematomas true or false? Extra-dural (epidural) haematomas may cross suture lines.A skull fracture is associated with 75–95% of extra-dural haematomas.More than 50% of patients have a lucid interval.Disruption of dural sinuses is a common cause in young children.The attenuation of fresh blood is approximately 50–80 Hounsfield units (HU).
Trauma of the Brain and Spinal Cord
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
SDH and EDH are often the result of mechanical injury of nearby vascular structures. EDH (Figure 11.1) frequently constitutes a surgical emergency. Radiologically, it is described as a lens-shaped extra-axial hematoma limited by suture lines, commonly resulting from an arterial bleed from a meningeal artery (middle meningeal artery usually). A lucid interval after the trauma may be present; however, clinical deterioration can be rapid. The mortality of acute EDH continues to decrease in recent decades as outcome is largely related to triage and timely surgical management. Acute SDHs (Figures 11.2 and 11.3) are extra-axial blood collections that cross sutures lines and may lead to brain compression, and in some cases possible focal underlying cerebral ischemia. Because they are often the result of tearing of the bridging veins between the cerebral cortex and the dural sinuses, conditions associated with brain atrophy (old age, alcoholism, and dementia) render those individuals more susceptible to SDH.
Evaluation of relationship between coronary artery status evaluated by coronary computed tomography angiography and development of cardiomyopathy in carbon monoxide poisoned patients with myocardial injury: a prospective observational study
Published in Clinical Toxicology, 2018
Yong Sung Cha, Hyun Kim, Yoonsuk Lee, Woocheol Kwon, Jung-Woo Son, Hyun Youk, Hyung Il Kim, Oh Hyun Kim, Kyung Hye Park, Kyoung-Chul Cha, Kang Hyun Lee, Sung Oh Hwang
The clinical parameters were assessed as follows: age; gender; intention for self-harm; source of CO; duration of CO exposure; time elapsed from rescue to arrival at the ED; cardiovascular risk factors including diabetes mellitus, hypertension, hyperlipidaemia, and smoking; symptoms and signs including cognitive dysfunction according to the Korean version of the Mini-Mental State Examination, which was developed for use in the Korean population (cognitive dysfunction was defined as scores less than 24 points); vital signs (blood pressure, heart and respiratory rates) and Glasgow Coma Scale (GCS) upon ED arrival; and HBOT utilization. The duration of CO exposure was investigated from the patients or their guardians. The duration of exposure was recorded as the estimated maximum duration of CO exposure measured from the time of normal consciousness to the time of detected CO exposure. In the ED, a 12-lead electrocardiogram (ECG) was obtained and ischemic changes were classified as new ST-segment elevation (≥1 mm), depression (≥0.5 mm), or T-wave inversion (≥2 mm) in two consecutive leads [15]. Final neurologic outcomes including full recovery, delayed neuropsychiatric sequelae (DNS), and permanent neurologic sequelae (PNS) were investigated for at least two months based on Choi et al.’s [16] observation of a lucid interval generally lasting from 2 to 40 days of follow-up. DNS was defined as the delayed onset of neuropsychiatric symptoms after the apparent recovery of neurocognitive symptoms due to acute CO poisoning [16]. In-hospital mortality was also evaluated.
Sport-related concussive convulsions: a systematic review
Published in The Physician and Sportsmedicine, 2018
Nicholas O. Kuhl, Aaron M. Yengo-Kahn, Hannah Burnette, Gary S. Solomon, Scott L. Zuckerman
The most common concussive convulsive phenomenon was posturing (68%) when compared to other ictal phenomenologies. Consequently, athletic trainers, team coaches, and emergency personnel should become familiar with the recognition of convulsive posturing immediately following SRC, especially in comparison to other convulsive-like movements that might have been observed elsewhere. Particularly in a nonmedical environment, it is possible that all convulsions might appear similar to onlookers. As such, education regarding phenotypic and mechanistic characterization of SRC-C can improve sideline recognition and acute stabilization of the athlete. For example, as 68% of SRC-C is characterized by posturing, recognizing the ‘bear hug’ posture or ‘righting’ reflex immediately after head impact is paramount. Delayed seizure onset, extended periods of unconsciousness, or a lucid interval prior to losing consciousness should prompt emergency medical attention. Of note, the mechanism for this posturing has not been extensively elucidated, though the authors agree with prior hypotheses that the general pathophysiology of SRC-C likely involves a brief, immediate loss of cortical inhibitory function with possible reflex brainstem release analogous to convulsive syncope. Nevertheless, additional research is required to better mechanistically and phenotypically describe SRC-C [19,22,23].
Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning
Published in Clinical Toxicology, 2018
J. M. Moon, B. J. Chun, S. D. Lee, E. J. Jung
Long-term neurological outcomes were classified into three groups according to the GOS score after discharge: good neurological outcomes (scores of 4–5 on the GOS after discharge), acute persistent severe neurological sequelae, and delayed persistent severe neurological sequelae. Acute persistent severe neurological sequelae were defined as an altered mental status (GCS score <13) at presentation and progression to dependency on assistance with daily activities (scores of 1–3 on the GOS after discharge) without recovery. Dependency on assistance with daily activities (scores of 1–3 on the GOS) that developed after a lucid interval was designated delayed persistent severe neurological sequelae. Because the lucid interval reportedly ranged from 2 to 45 days [2], delayed persistent severe neurological sequelae must have developed within 3 months.
Related Knowledge Centers
- Coma
- Emergency Medicine
- Intracranial Pressure
- Skull
- Traumatic Brain Injury
- Blood
- Cerebral Edema
- Pseudoaneurysm
- Brain
- Epidural Hematoma