Occult ligamentous injury of the cervical spine

Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or "distracting" injuries. In such cases, cervical spine injury that is not apparent on radiographs may be missed. This case report illustrates a purely ligamentous cervical spine injury resulting in cervical instability. We describe our method of screening for and evaluating these types of injuries using physician-controlled stretch, flexion, and extension examination under fluoroscopy.     

Segmental anatomy of the temporal bone.

More of us suffer from hearing loss than from visual impairment, coronary artery disease, and cancer combined. Auditory dysfunction is detected in less than one third of newborns afflicted and is underdiagnosed in the elderly. Despite biomedical and technological advances, our understanding of vestibular dysfunction has grown little. Forming part of the lateral and inferior surfaces of the skull, the temporal bone contains the organs of hearing and balance. Diagnosis of diseases in these important regions requires adequate clinical information and a thorough knowledge of normal temporal bone anatomy to recognize abnormal findings when present. This article dissects the temporal bone into segments, describes the relevant radiologic anatomy of each, and discusses the imaging appropriate to specific concerns.     

Quality of life after spinal cord injury caused by gunshot.

OBJECTIVE: To determine what effect gunshot-caused spinal cord injury (SCI) has on self-reported quality of life (QOL) and on the frequency of pain sufficient to interfere with day-to-day activities. DESIGN: Follow-up, case-control design. SETTING: Analysis of data obtained from the (US) National Spinal Cord Injury Statistical Center from 18 funded Spinal Cord Injury Model Systems. PARTICIPANTS: Individuals with traumatic onset SCI (n = 1901). From these, 111 persons with gunshot-caused SCI were matched to persons with nongunshot SCI. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS), the Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study Short-Form Health Survey (SF-12), and an individual pain item from the SF-12. RESULTS: No between-group differences were found on any of the QOL outcome measures. In contrast, those with SCI caused by gunshot reported that pain more frequently interfered with day-to-day activities than the matched comparison group. CONCLUSIONS: SCI caused by gunshot appears largely unrelated to QOL, after controlling for demographic and medical characteristics associated with this group. Gunshot as a mechanism of SCI may place individuals at an increased risk of subsequent development of pain that interferes with activities of daily living.     

Occult head injury: its incidence in spinal cord injury

This study investigated the suspicion that a significant proportion of individuals having spinal cord injury (SCI) also sustain a concomitant undiagnosed occult head injury during the trauma accident. The criteria for high risk of head injury included the following: (1) quadriplegia with high energy deceleration accident, (2) loss of consciousness at time of injury, (3) brainstem or cortical neurologic indicators, or (4) respiratory support required at time of injury. In this study, 67 patients admitted to the rehabilitation unit were given a neuropsychologic evaluation a median of 48 days after injury. Motor free scales used were the Galveston Orientation and Amnesia Test (GOAT), Quick Test, Raven Progressive matrices, serial 7s, Shipley Hartford, Stroop Color/Word Interference, and the Wechsler Memory Scale Associate Learning Tests. Forty-three of the 67 patients (64%) scored mildly to profoundly impaired on the test battery. Evidence of poor premorbid academic history was present in 19 (44%) of those with impaired performance on the neurologic evaluation and in only three (13%) of those scoring unimpaired. Consequently, 56% (24/43) of the impaired had no previous record of scholastic difficulties, presumably acquiring cognitive impairment at the time of injury. The implications of this high incidence of impaired cognitive functioning for treatment of individuals with SCI are significant.     

Congenital anomalies of the temporal bone

Inner ear anomalies are a rare but important cause of sensorineural hearing loss. Combined external and middle ear anomalies are more common, causing conductive hearing loss and cosmetic deformity. The course of the facial nerve canal is altered in many temporal bone anomalies. Its location is of great importance when surgical therapy is anticipated. Vascular anomalies and bone dysplasias occasionally affect the temporal bone. High resolution CT, using thin sections and edge enhancement techniques, is capable of demonstrating the finer bony details of these temporal bone anomalies.     

Cryptococcal infection of the temporal bone

Cryptococcus neoformans is a yeast-like organism which, after inhalation, may cause pulmonary disease or a systemic fungemia associated with numerous extrapulmonary sites of infection, but most notably affecting the central nervous system. Despite this frequent involvement of the leptomeninges, only three cases of infection of the temporal bones have been previously described. We describe an additional case with comments on the possible significance of infection of this site.     

Occult metastasis.

The most important factor affecting the outcome of patients with invasive cancers is whether the tumor has spread, either regionally (to regional lymph nodes) or systemically. However, a proportion of patients with no evidence of systemic dissemination will develop recurrent disease after primary 'curative' therapy. Clearly, these patients had occult systemic spread of disease that was undetectable by methods routinely employed (careful pathological, clinical, biochemical and radiological evaluation). In addition, the success of adjuvant therapy is assumed to stem from its ability to eradicate occult metastases before they become clinically evident [1]. Therefore, methods for the detection of occult metastases in patients with the earliest stage of cancer, i.e., prior to detection of metastases by any other clinical or pathological analysis, have received a great deal of attention.     

Imaging of the windows of the temporal bone

Imaging of the window of the temporal bone has became an important tool in the analysis of hearing loss, vertigo, tinnitus in a context of trauma, malformation, otosclerosis, and chronic otitis media. A good knowledge of the anatomy and a good technical procedure are necessary for making an efficient diagnosis. The increased thickness of the footplate may be delineated in otosclerosis, chronic otitis media, malformation, when it is measured at 0.7 mm or more in horizontal computed tomography (CT) sections. The traumatic displacement of the stapes, particularly within the labyrinths, is easily diagnosed in horizontal CT section. Imaging of the round window is now very important for the detection of otosclerotic foci, congenital stenosis, and perilymphatic fistula with or without fracture. Magnetic resonance imaging (MRI) with the high-resolution T2 plays an important role in the detection of a small amount of fluid in the round window recess, confirming the traumatic perilymphatic fistula without fracture.     

Mechanism of injury in gunshot wounds: myths and reality

Despite technological advances, ballistic literature in the 20th century remains replete with errors, misconceptions, half truths, and false representations. In the majority of the literature, there has not been a deliberate attempt to distort or misrepresent the facts but rather a reliance on myth and misconception. It is this author's goal to impart a sound, scientifically supported overview of gunshot wounds and their mechanism of injury. In doing so, critical care nurses can care better for individuals suffering from gunshot wounds and more effectively assist the criminal justice system.     

Cardial gunshot injury: treatment in a trauma hospital without a cardiac unit.

Gunshot injuries to the chest often require urgent admission to the nearest hospital, because of the cardiorespiratory status, transfer to a hospital without a cardiothoracic unit might be unsafe. In this case, a male patient was transferred to the nearest hospital on being shot through the heart. On admission, he was in shock, and immediate surgery was performed. We report our treatment regime for thoracic injuries and the specific management of this patient. We conclude that every hospital with an accident and emergency department has to be prepared for such an injury and that operative management is possible without cardiopulmonary bypass.     

Occult fractures of the femoral neck.

Occult fractures of the femoral neck can be subtle or even undetectable on plain radiographs. Yet, untreated, the morbidity of this fracture significantly increases. This report discusses the clinical and radiologic findings seen in occult fractures of the femoral neck. It also discusses the role of tomograms, bone scan, computed tomography, and magnetic resonance imaging in further delineating this entity.     

脑外伤颞骨骨折致周围性面瘫的临床治疗

目的探讨脑外伤颞骨骨折致周围性面瘫的临床治疗方法。方法选择60例脑外伤颞骨骨折患者,按照骨折类型分为两组：纵行骨折组和横行骨折组,每组30例。两组患者均进行颞下-迷路上隐窝进路膝状神经节减压术,比较两组手术前后的面神经功能恢复情况和临床疗效。结果两组术后面神经功能分级均明显优于手术前;纵行骨折组的临床疗效好于横行骨折组（P〈0.05）。结论根据骨折类型选择恰当的面神经减压术对脑外伤颞骨骨折所致周围性面瘫效果显著。