Severe head injuries
Brian Sindelar, Julian E. Bailes in Sports-Related Concussion, 2017
Skull fractures occur due to direct blunt trauma to the skull. The incidence of this type of injury in athletics has seen a dramatic reduction due to the implementation and improvement in protective equipment, specifically helmets. For example, in American football, the yearly fatality rate dropped from 9.5 (from 1945 to 1975) to 5–6 during the 1980s, likely due to the improvement in football helmets and the precipitous reduction in skull fractures.1 Skull fractures can be characterized as depressed or comminuted if bony fragments extend into the cranial vault. Depressed skull fractures can further be subdivided into simple or complex, depending on whether the overlying scalp is closed or open. Skull fractures are rare in sports, but when they occur, they are usually as a result of player-to-ground collision or player-to-player collisions in nonhelmeted sports.
Depressed skull fracture pneumocephalus
Alisa McQueen, S. Margaret Paik in Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Non-accidental trauma (NAT). The CT head scan shows a depressed skull fracture with pneumocephaly, which, in the absence of a history of injury, very strongly indicates NAT. Children under 5 years of age are at the greatest risk of NAT and children under 3 are at the highest risk of fatal injuries, most commonly from head trauma. In 2014, there were 702,000 cases of confirmed child abuse/neglect in the United States, and 1580 of those cases ended in death. Twenty percent of these cases had a delay in diagnosis, which highlights the need for clinicians to consider NAT early in a patient's course. Risk factors for NAT include past abuse in the victim or perpetrator, intellectual disability in the child, a stressful home environment, and substance abuse. More than 80% of these cases are caused by a biological parent, whereas 12% are caused by a non-biological parent or partner. Patients with skull fractures can have concurrent intracranial hemorrhage and symptoms of lethargy, irritability, altered mental status, vomiting, headaches, and seizures. Other injuries include retinal hemorrhages and spinal cord injuries. The gold standard for the diagnosis of skull fractures and intracranial bleeding is a CT scan without contrast. MRI can be performed after initial resuscitation and treatment to assess for axonal injury and brain edema.
A motorcycle accident
Tim French, Terry Wardle in The Problem-Based Learning Workbook, 2022
Signs that indicate a base of skull fracture include: fluid from the ears/nose: this can be colourless with or without blood (CSF otorrhoea/rhinorrhoea with or without blood)racoon eyes: black eyes with no associated damage around the eyescleral/retinal haemorrhageloss of hearing in one or both earsBattle’s sign: bruising over the mastoid behind one/both earspenetrating injury signs, or visible trauma to the skull.
Impact of childhood traumatic brain injury on educational outcomes and adult standard of living
Published in Disability and Rehabilitation, 2020
Riana K. De Netto, Audrey McKinlay
The audit of hospital records identified 271 individuals who met the inclusion criteria for a moderate/severe TBI. Of those identified, 96 individuals were excluded for the following reasons: (a) deceased (11); (b) no current contact information (49); (c) no longer living in the Canterbury region of New Zealand (29); and (d) injury severity prevented testing (7). Of the remaining 175 individuals, 58 agreed to participate (33%). A further four individuals who met the inclusion criteria were identified through community recruitment. Individuals in the moderate/severe TBI group required: (a) medically confirmed diagnosis of moderate or severe TBI, and/or (b) skull fracture/evidence on imaging, and/or (c) cerebral hemorrhage, and/or (d) PTA of more than 24 h. Moderate TBI was specifically defined as (a) GCS of 9–12 (or higher if there was positive evidence on imaging), (b) PTA of <1 week, and (c) LOC <6 h. For severe TBI, the criteria were set as (a) GCS of <9, (b) PTA of more than 1 week, and (c) LOC more than 6 h. Mode of injury for the TBI groups include falls, running into or being hit by an object, sports, motor vehicle accidents, and assault.
Neurosurgical trauma from E-Scooter usage: a review of early case series in London and a review of the literature
Published in British Journal of Neurosurgery, 2022
Sami Rashed, Anna Vassiliou, James Barber
These case series and the wider literature demonstrate the breadth and severity of neurosurgical trauma related to E-scooter usage documented thus far. In terms of cranial trauma, we see head injuries are frequently cited in the literature and often recorded as the most frequently injured body region with mild head injury/concussion accounting for the greatest proportion of these.10,34,35 However, it is also apparent that a significant amount of head injuries reflect more severe pathologies with ICH representing around 15% of head injuries, of which tSAH was the most common. Skull fractures were also seen in around 15% of the head injury population with skull base and frontal bone fractures the most commonly cited. Spinal trauma appears to occur less frequently than head injuries however a wide range of spinal pathologies from E-scooter usage is seen including acute vertebral compression fractures, central cord syndromes, spinal contusions, and ligamentous injuries. Concordantly the level of intervention required for these injuries is varied between simple wound closures, brace fitting, and neurological observations to immediate neurosurgery, protracted stays in the ITU, and 6 mortalities. Two mortalities were assigned to TBI and one to an occipital bone fracture in the literature.
Ability of S100B to predict post-concussion syndrome in paediatric patients who present to the emergency department with mild traumatic brain injury
Published in British Journal of Neurosurgery, 2023
Fatos M. Kelmendi, Arsim A. Morina, Agon Y. Mekaj, Shefki Dragusha, Feti Ahmeti, Ridvan Alimehmeti, Qamile Morina, Murat Berisha, Blerim Krasniqi, Berat Kerolli
To the best of our knowledge, this study is the first to compare the number of intracranial lesions, S100B value and the presence of PCS. Using the same set of PCS criteria, Bohnen et al. reported that symptoms in 25% of patients persisted for up to six months.28 This large variation is due to different definitions of mTBI and the use of different outcome variables. The presence of headache, vomiting, LOC, amnesia and nausea in the emergency room after mTBI is closely associated with the presence and severity of PCS. Although the presence of headache within 24 h after the trauma has previously been described as a prognostic factor for outcome after mTBI,29 the relationship with LOC and amnesia has not, to the best of our knowledge, been reported; in our study, 68.2% of patients had amnesia, and 95.5% had LOC. In the literature, a twofold increased risk of skull fracture has been reported in association with post-traumatic vomiting.30 In our study, we did not find any strong correlation between skull fracture and vomiting because only 27% of patients with PCS had a skull fracture and 81% of patients with PCS displayed vomiting in the emergency room. However, in our study, there was a strong association between skull base fracture and dizziness after three months, which can be explained by labyrinth contusion.
Related Knowledge Centers
- Bone
- Concussion
- Consciousness
- Meninges
- Skull
- Traumatic Brain Injury
- Blunt Trauma
- Blood Vessel
- Brain
- Neurology