Preparticipation assessment for head injury.

OBJECTIVE: To determine the evidence base for recommendations regarding the pre-participation screening for head injury. DATA SOURCES: The relevant literature was searched through the use of Medline (1966 to 2004), Google and Sport Discus (1975 to 2004) searches, hand searches of journals and reference lists and discussions with experts and sporting organisations worldwide. DATA SYNTHESIS/METHODS: Consensus recommendations are summarized. No formal statistical analysis is presented RESULTS: Although pre-participation examinations are widely performed, there are no evidence-based guidelines to direct physicians as to the minimum requirements for the baseline assessment of head injury. CONCLUSIONS: Expert consensus would suggest that a baseline neuropsychological examination, preferably using a computerised test battery, should be performed in order to guide return to play following subsequent concussive injuries. In addition, there are important medicolegal considerations in regard to the value of a documented assessment both at the start and end of an athlete's career with any team.     

Early diagnosis of diffuse brain damage resulting from a blunt head injury

Diffuse types of traumatic brain injury (TBI) are more difficult to diagnose than focal types in forensic postmortem examination, since macroscopic abnormalities may be minimal. In addition, most microscopic findings are not specific to TBI and are sometimes not obvious in cases when the survival period is short. Therefore, early diagnosis of diffuse TBI is most difficult. Histopathological and immunohistochemical examinations of various elements including axons, nerve cells, and glial cells in a sufficient number of blocks are indispensable. Mapping of changes in these elements with complicated focal lesions, even if the lesions are trivial, on anatomical diagrams would be useful. The combination of histopathological and immunohistochemical examinations as well as analysis of the exact history of the trauma, if possible, and elimination of other causes of death would lead to accurate diagnosis of diffuse types of TBI in cases when the survival period is brief.     

头盔与颅脑伤

道路交通伤是全球性重大公共问题.世界卫生组织(WHO)预期,至2020年,道路交通伤将成为第三位DALY(因残废和早死而损失的寿命年数)[1].目前,全球每年因道路交通事故致死者约120万,伤3 000万～5 000万,其中,约1/3为青年人,而这些人中有相当一部分是摩托车手、骑自行车人等弱势群体成员[2].     

The effect of helmet materials and simulated bone and tissue layers on bullet behaviour in a gelatine model of overmatch penetrating head injury

International Journal of Legal Medicine - The aim of this work was to simulate an overmatch ballistic event against a head wearing a helmet. The experiments were designed to understand how layers...     

Neurodiagnostic studies and the management of head injury.

The rational management of patients with head injury calls for the closest cooperation between the radiologist and neurosurgeon. Until the last three to four years, cerebral angiography had been considered the diagnostic procedure of choice for the management of patients with suspected traumatically induced intracranial mass lesions. Experience with CT scanning now indicates that for a number of reasons this procedure is to be preferred in the diagnosis of head injuries. It is more rapid than angiography, routinely visualizes the entire brain, is noninvasive, resolves lesions that are much smaller than any visualized by angiography and defines the density and thus the nature of traumatic lesions in a manner not possible with previously employed techniques. Using CT scanning in a sequential fashion we have routinely been able to visualize the appearance of new lesions in the post-traumatic period and have as well, been able to develop insights into the temporal appearance and disappearance of white matter edema as measured by Hounsfield numbers. In the late post-traumatic period, it has been valuable in defining hydrocephalus, porencephaly and other post-traumatic lesions that have a significant bearing on both therapy and prognosis.     

多种损伤因子与重型颅脑损伤凝血功能障碍的相关性研究

目的 探讨内毒素（LPS）、白细胞介素-6（IL-6）、磷脂酶A2（PLA2）、血小板活化因子（PAF）与重型颅脑损伤凝血功能障碍的相关性.方法 收集我院急诊科符合重型颅脑损伤诊断标准的患者65例作为观察组,急诊抢救的同时检测其血小板计数（PLT）、部分活化凝血酶原时间（APTT）、凝血酶原时间（PT）、血浆D-二聚体（D-D）、LPS、IL-6、PLA2、PAF;以同期健康体检者43例作为对照组,对两组检测结果进行统计学分析.结果 两组比较,观察组PLT减少（t=3.892,P＜0.01）,APTT、PT、D-D、LPS、IL-6、PLA2、PAF均升高（t=3.971、3.904、6.532、4.028、4.115、4.274、5.037,P＜0.01）;观察组PLT与LPS、IL-6、PLA2、PAF之间相关系数（r）均≤-0.9319,呈显著负相关;APTT、PT、D-D与LPS、IL-6、PLA2、PAF之间r值均≥0.9091,呈显著正相关.结论 LPS、IL-6、PLA2、PAF参与了重型颅脑损伤凝血功能障碍的发生过程,对LPS、IL-6、PLA2、PAF进行早期干预,可减轻患者凝血功能障碍.     

Cervicocranium and the aviator's protective helmet.

An analogy based on the likenesses of the APH-6 aviator's protective helmet and the hangman's noose has some interesting relationships to aircraft accident investigation and to the associated traumatic pathology. A superficial examination of the similarities might propose that the inferior edge of the helmet, when considered part of the continuous circle completed by the nape strap and the chin strap, forms a loop which can be likened to a hangman's noose. The analogy might be extended to the comparison of lesions made about the neck by the straps or the edge of the helmet compared with abrasions and contusions that might be associated with a rope encircling the same structures. Such a hangman's noose, when the knot is at the side of the head (subaural), produces fractures of the base of the skull tending to extend bitemporally through the basisphenoid. When the knot is anterior and beneath the chin (submental), the hangman's noose causes a fracture dislocation at the axis. Characteristically, the posterior arch is fractured and, interestingly enough, the odontoid process is not involved. Many of us anticipate that a fractured, displaced odontoid process is the prototype lesion which so precariously endangers the patient with cervical cord compromise and death similar to the hangman's fracture. More recent assessments of the mortality of the odontoid fracture suggest less than 10%.     

Preventing head and neck injury

A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.     

Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings.

PURPOSETo assess the prevalence of MR evidence for diffuse axonal injury at 1.5 T in patients with normal head CT findings after mild head injury.METHODSTwenty consecutive patients with mild head injury (Glasgow Coma Scale, 13 to 15; no subsequent deterioration, loss of consciousness < 20 minutes) and normal head CT findings were examined with MR at 1.5 T. Pulse sequences included a conventional T2-weighted spin-echo sequence (2500-3000/30,80/1[repetition time/echo time/excitations]) and a T2*-weighted gradient-echo sequence (750/40/2, 10 degrees flip angle). Each sequence was read independently by two blinded readers.RESULTSThe readers agreed that abnormalities compatible with diffuse axonal injury were present in the white matter of 6 (30%) of 20 patients (95% confidence interval, 12% to 54%). Both readers agreed that foci of high signal intensity were present on the T2-weighted spin-echo sequence in 3 (15%) of the 20 cases (95% confidence interval, 3% to 38%) and that foci of hypointensity compatible with hemorrhagic shear injury were present on the T2*-weighted sequence in 4 (20%) of the 20 patients (95% confidence interval, 6% to 44%). Both types of abnormality were noted by the readers in one patient.CONCLUSIONSMR shows evidence of diffuse axonal injury in some patients with normal head CT findings after mild head injury. These lesions may represent the pathologic substrate underlying the postconcussion syndrome that occurs in many patients with moderate to severe head injury.     

Axonal injury in closed head injury by assault: a quantitative study.

Due to the controversy in the literature regarding the time course of axonal balloon formation in human material, we wished to determine if it was possible to diagnose axonal injury before the development of axonal balloonings. The hypothesis was that the presence of axonal swellings or axonal enlargements associated with a glial reaction could be used as a diagnostic aid in human axonal injury before 12 hours. The brains of eight individuals that survived for less than 48 hours following head injury, and also had evidence of axonal injury using the criteria of Vanezis et al. (1987), were systematically studied by looking at axonal swellings, axonal balloonings, reactive astrocytes, maximum diameter of axonal enlargements and density of axonal enlargements. Controls were eight selected cases without neurological disease. The variables studied were assessed in 25 fields from ten different areas of the brain, using silver stains and immunoperoxidase for glial fibrillary acidic protein (GFAP). Logarithms of one plus the count of each variable were taken from the raw data and these were analysed using percentile distribution and the median, the t-test, Mann-Whitney U test and the Wilcoxon signed rank test. We conclude that quantitation of axonal damage allows the detection of mild degrees of axonal injury that could be overlooked on routine examination, and that the criteria of axonal enlargements, rather than axonal balloonings, are indications of axonal damage, cannot be endorsed with the evidence provided.     

腹部闭合性损伤合并颅脑外伤的诊治

探讨颅脑外伤意识障碍状态下腹部闭合性损伤的诊断和治疗。认为早期诊断、防止漏诊,把握时机,审时度势决定手术方式是腹部闭合性损伤合并颅脑外伤救治的关键。     

Delayed sequelae of head injury

The evaluation of delayed sequelae of head injury is greatly facilitated by CT. This non-invasive technique provides us with the opportunity to evaluate the head trauma patients sequentially to detect the development and clinical significance of post-traumatic sequelae like delayed intracerebral hemorrhage, hydrocephalus, and post-traumatic atrophy.