Biomechanics of temporo-parietal skull fracture

This paper presents an analysis of research on the biomechanics of head injury with an emphasis on the tolerance of the skull to lateral impacts. The anatomy of this region of the skull is briefly described from a biomechanical perspective. Human cadaver investigations using unembalmed and embalmed and intact and isolated specimens subjected to static and various types of dynamic loading (e.g., drop, impactor) are described. Fracture tolerances in the form of biomechanical variables such as peak force, peak acceleration, and head injury criteria are used in the presentation. Lateral impact data are compared, where possible, with other regions of the cranial vault (e.g., frontal and occipital bones) to provide a perspective on relative variations between different anatomic regions of the human skull. The importance of using appropriate instrumentation to derive injury metrics is underscored to guide future experiments. RELEVANCE: A unique advantage of human cadaver tests is the ability to obtain fundamental data for delineating the biomechanics of the structure and establishing tolerance limits. Force-deflection curves and acceleration time histories are used to derive secondary variables such as head injury criteria. These parameters have direct application in safety engineering, for example, in designing vehicular interiors for occupant protection. Differences in regional biomechanical tolerances of the human head have implications in clinical and biomechanical applications.     

颅骨粉碎性骨折自体碎骨成形一期修复的临床研究

目的研究并评价颅骨粉碎性骨折急诊手术一期修复的可能性。方法对 3 6例颅骨粉碎性骨折常规清创处理 ,将创伤区颅骨碎片用丝线及医用胶粘合成形 ,头皮分层缝合。结果所有病例无感染及皮下积液 ,术后复查X线颅骨片及头颅CT扫描显示颅骨碎片融合 ,外观塑形好。结论颅骨粉碎性骨折在急诊清创的同时 ,行一期修复是对传统治疗方法的一种突破 ,减少了患者再次手术的痛苦 ,术后并发症少 ,对脑组织起到很好的保护作用 ,是一种值得临床推广的术式。     

Golf club related basal skull fracture: a case study

Basal skull fractures, although rare, do occur and a high index of suspicion for high velocity injuries, should be at the forefront of the clinicians mind, particularly those from a golf club. Head injury in children is a common presentation to any Paediatric Emergency Department. With effective examination skills, recognition of signs of basal skull fracture such as haemotympanum, even in the absence of altered neurological findings, ensures safe and effective practice enabling correct and justifiable clinical decisions to be made. This is vital to ensure not only the correct investigative procedure is requested and performed, but also on discussion with the appropriate specialists, the correct treatment is also prescribed. This case study examines the use of computed tomography in the diagnosis of basal skull fractures and highlights further discussion into the appropriate treatment of children diagnosed with basal skull fractures.     

The incidence and prevention of meningitis after basilar skull fracture

The survey of 1,077 consecutive skull fractures admitted to the Massachusetts General Hospital between July 1, 1969 and July 1, 1979 were reviewed. One hundred sixty-eight basilar skull fractures (15.6%) were diagnosed according to clinical and radiological criteria. In 128 patients with basilar skull fracture but without CSF leak, two out of 65 patients (3.1%) who received prophylactic antibiotics developed meningitis in contrast to none of 63 patients who were treated. Nine of 15 patients with otorrhea developed meningitis regardless of treatment. Of 18 patients with rhinorrhea, 13 were treated with prophylactic antibiotics and were free of meningitis but 2 of 5 patients not treated (40%) did develop meningitis. The overall incidence of CSF leak was 20.8%. There is no clear evidence to demonstrate that prophylactic antibiotics are effective in general in reducing the incidence of meningitis after basilar skull fracture with active rhinorrhea. However, the difference in the incidence of meningitis between the treated and the untreated group was noteworthy though not statistically significant. Meningitis can develop despite antibiotic prophylaxis. Additional investigation and therapy should be considered whenever the clinical situation warrants.     

Basilar artery thrombosis

Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment. Of particular relevance to emergency medicine is the recognition and consideration of the unusual signs that may be present in an often previously well patient. It is therefore crucial to expedite investigations, confirm the diagnosis and commence life‐saving treatment through the early involvement of a number of disciplines including neurology, radiology and intensive care. This paper confirms the use of magnetic resonance imaging and angiography as the preferred investigative mode and microcatheter directed intra‐arterial thrombolysis as the treatment strategy of choice.     

老年单纯颅骨骨折的损伤原理及CT特点

老年颅脑损伤的发生率较其他年龄组低,但老年人血管弹性差、脆性大,易导致小血管破裂,造成脑内血肿.老年人无脑内出血的颅骨骨折(老年单纯颅骨骨折)未见文献报道.本组报道27例,旨在探讨其创伤机制及临床、CT特点. 1 方法 收集老年单纯颅骨骨折27例,男15例(55.5%)、女12例(44.4%),年龄60～83岁,平均(65.0±3.5)岁.受伤到就医的时间为5h～90d,平均39d.受伤原因为交通事故伤11例(48.7%),高度坠落伤7例(25.9%),撞击伤9例(33.3%).     

Open depressed skull fracture missed on computed tomography: a case report

A case of an open depressed skull fracture that was missed on standard computed tomographic (CT) scan is presented. The fracture was seen on a CT generated lateral scout film, and after repositioning the gantry, further CT images clearly showed the fracture and underlying brain injury. The authors recommend that all patients with head trauma undergoing head CT have either a CT generated lateral scout film or a lateral skull radiograph to assess the vertex of the skull, an area poorly visualized on standard axial images.     

Basilar Artery Migraine Stroke

A 25-year-old woman with a history of basilar migraine attacks ultimately resulting in a basilar artery migraine stroke is described. Brain computed tomography showed bilateral hypodense lesions in the cerebellar hemispheres. A survey of literature on basilar artery migraine is presented and the relation between stroke and migraine is discussed.     

创伤性前颅底粉碎性骨折的处理及缺损修复

目的 探讨创伤性前颅底粉碎性骨折的手术处理及缺损修复.方法 对47例创伤性前颅底粉碎性骨折患者临床资料进行回顾分析,结合文献对急诊处理、手术清创和缺损修复进行讨论.结果 3个月后按国际GOS预后评分标准判定,恢复良好36例,轻残6例,重残3例,死亡2例.随访发现31例完全恢复工作和生活,14例遗有不同程度的神经功能障碍,未发现有脑膜膨出.结论 彻底清创术、闭合受损局部的蛛网膜下腔、修复或重建前颅底硬脑膜、骨缺损,是手术成功的关键.     

刀砍伤致颅骨开放性骨折61例诊治体会

目的探讨刀砍伤致颅骨开放性骨折的临床特点及诊治方法。方法回顾性分析61例刀砍伤致颅骨开放性骨折患者的临床资料。结果 25例保守治疗,定期复查CT,其中6例出现慢性头痛,4例改为手术后头痛消失;36例全麻下手术治疗;手术患者治愈29例,遗留一侧肢体无力3例,癫痫发作2例,术后慢性头痛6例。结论对于头部刀砍伤患者,门诊医生应坚持常规头颅CT检查,以免漏诊颅内损伤。     

Inadvertent intracranial placement of a nasogastric tube through a basal skull fracture.

Inadvertent intracranial placement of nasogastric tubes may occur during intubation of patients with severe maxillofacial trauma and basal skull fractures. Oral intubation, nasogastric intubation under fluoroscopy, or nasogastric intubation under direct vision will eliminate the possibility of this complication.     

Basilar Invagination,Basilar Impression,and Platybasia: Clinical and Imaging Aspects

The congenital and acquired deformities of the craniovertebral junction (CVJ), such as basilar invagination, basilar impression, or platybasia, can present in the form of slowly progressive or acute neurologic deterioration. In many cases, an insidious headache is the only symptom and can be a diagnostic challenge for the neurologist. Proper imaging studies as well as recognizing often associated neurologic or systemic conditions are required for early diagnosis and effective therapy. In the current report, the primary focus will be on clinical aspects of these CVJ abnormalities; the pathologic and radiologic aspects, such as developmental and pathophysiologic background or radiographic analysis, will be discussed briefly, confined to clinically relevant data.     

Association of skull fracture with in-hospital mortality in severe traumatic brain injury patients

IntroductionTo identify the association between skull fracture (SF) and in-hospital mortality in patients with severe traumatic brain injury (TBI).Materials and methodsThis multicenter cohort study included a retrospective analysis of data from the Japan Trauma Data Bank (JTDB). JTDB is a nationwide, prospective, observational trauma registry with data from 235 hospitals. Adult patients with severe TBI (Glasgow Coma Scale <9, head Abbreviated Injury Scale (AIS) ≥ 3, and any other AIS < 3) who were registered in the JTDB between January 2004 and December 2017 were included in the study. Patients who (a) were < 16 years old, (b) developed cardiac arrest before or at hospital arrival, and (c) had burns and penetrating injuries were excluded from the study. In-hospital mortality was the primary outcome assessed. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) of SF and their 95% confidence intervals (CIs) for in-hospital mortality.ResultsA total of 9607 patients were enrolled [median age: 67 (interquartile range: 50–78) years] in the study. Among those patients, 3574 (37.2%) and 6033 (62.8%) were included in the SF and non-SF groups, respectively. The overall in-hospital mortality rate was 44.1% (4238/9607). A multivariate analysis of the association between SF and in-hospital mortality yielded a crude OR of 1.63 (95% CI: 1.47–1.80). A subgroup analysis of the association of skull vault fractures, skull base fractures, and both fractures together with in-hospital mortality yielded adjusted ORs of 1.60 (95% CI: 1.42–1.98), 1.40 (95% CI: 1.16–1.70), and 2.14 (95% CI: 1.74–2.64), respectively, relative to the non-SF group.ConclusionsThis observational study showed that SF is associated with in-hospital mortality among patients with severe TBI. Furthermore, patients with both skull base and skull vault fractures were associated with higher in-hospital mortality than those with only one of these injuries.     

螺旋CT高分辨扫描及多平面重建对颅底骨折的诊断

目的通过螺旋CT高分辨扫描及多平面重建(mutipleplanarreconstruction,MPR)技术与常规扫描诊断颅底骨折的对照比较,进一步探讨螺旋CT高分辨扫描及MPR技术对颅底骨折的诊断价值。方法对65例临床怀疑颅底骨折的脑外伤病人除进行头颅常规CT扫描外,又对其颅底进行高分辨扫描及MPR。结果65例脑外伤病人颅底高分辨CT扫描及MPR发现颅底骨折58例194处,其中线样骨折76处,粉碎骨折118处;而常规CT扫描发现颅底骨折52例111处,其中线样骨折49处,粉碎骨折62处,6例颅底骨折被漏诊,83处骨折不能明确显示。薄层高分辨及MPR图像能清晰显示骨折线,并且每个病例有多幅图像支持诊断,与颅底常规CT扫描比较差异有非常显著性意义(χ2=40.82,p<0.005)。结论对颅脑外伤病人进行CT检查时,增加颅底薄层高分辨扫描及MPR,能提高颅底骨折的检出率,减少漏诊。对临床硬脑膜修补的筛选、预防颅内感染具有重要的指导意义。     

Cardiac Arrhythmia in Basilar Migraine

SYNOPSIS
Basilar migraine may produce temporary change in brainstem function resulting in impairment of activity of medullary autonomic nuclei. A case of basilar migraine with transient cardiac arrhythmia is described and it is suggested that abnormalities in cardiac rhythm may be detected by cardiographic monitoring in some cases of basilar migraine. This report emphasizes the occasional occurrence of serious complications during a migraine attack.