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Fulltext An epidemiological study of abdominal and pelvic injury trauma in post-mortem cases at Hospital Kuala Lumpur between the year of 2002-2003

Abdul Halim Mansar, Muhammad Aadeel T., Khairul Osman, Sharin Iskandar, A.W.

Jurnal Sains Kesihatan Malaysia, 2008;6(2):65-73.
MyJurnal

The abdominal pelvic cavity has always been regarded as one of the most vulnerable regions of the body. Injuries to this part have been known to be very serious. Based on this a retrospective study was performed on postmortem cases with abdominal and pelvic trauma from 1 October 2002 to 31 January 2003 at the Forensic Institute, Hospital Kuala Lumpur to determine the common pattern of abdomino-pelvic injuries, the injury’s relationship to epidemiological and socio-economic factors, risk organ within the abdominopelvic region and relationship between injuries and survival period. A total of 122 cases abdomino-pelvic were obtained stemming from medico legal postmortems procedures. Results indicated that those aged between 21 to 30 years (38.5%) had the highest incidence of this type of injury. Categorization based on gender showed that males (90.2%) dominated most of the cases. Prevalence based on socio-economic status showed that lower socioeconomy class (52.5%) had the highest incident. This was followed by the middle income (39.3%) and finally the higher income group. The most numerous type of trauma was non-penetrating trauma (94.3%). It was also found that victims with low injury severity score (ISS) had a longer survival period as compared to those with high ISS. It was also noted that victims with two or more region injuries either were spot dead or brought dead. The most common combination of injuries was abdomen, pelvic, chest and limb. In most blunt trauma cases majority of victims had one or two organ involvement while penetrating injuries were difficult to asses. The most common organ involved in this type of trauma was liver (72.1%), pelvic bone (47.5%) and spleen (43.4%). In conclusion, abdomino-pelvic injury is a serious condition and should not be overlooked. Proper attention towards their diagnosis and management is important and so any patient of head injury with coma must be considered as having intra-abdominal injury until proven otherwise.

Matched MeSH terms: Craniocerebral Trauma
CT scan in minor head injury: a guide for rural doctors

Abdul Latip LS, Ahmad Alias NA, Ariff AR, Shuaib IL, Abdullah J, Naing NN

J Clin Neurosci, 2004 Nov;11(8):835-9.
PMID: 15519858 DOI: 10.1016/j.jocn.2003.12.017

Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 (p<0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities (p<0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities (p=0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities (p=0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.

Matched MeSH terms: Craniocerebral Trauma/diagnosis*; Craniocerebral Trauma/etiology; Craniocerebral Trauma/epidemiology
Fulltext Massive epistaxis secondary to pseudoaneurysm of internal carotid artery

Abdullah A, Putra SH, Saim L

Med J Malaysia, 2006 Mar;61(1):84-7.
PMID: 16708739 MyJurnal

Post-traumatic pseudoaneurysms of internal carotid arteries are uncommon. The patients may present with massive epistaxis due to rupture of the aneurysm into the sphenoid sinus. Early diagnosis and treatment is mandatory as the likelihood of exsanguinations increases with each subsequent episode of epistaxis. The clinical features of unilateral blindness and massive epistaxis after head injury should indicate the diagnosis. The high mortality of this entity underlines the importance of early angiography in these patients to confirm this diagnosis. We present 3 cases of post-traumatic aneurysm of the ICA.

Matched MeSH terms: Craniocerebral Trauma/complications*
Fulltext Limited Evaluation of Image Quality Produced by a Portable Head CT Scanner (CereTom) in a Neurosurgery Centre

Abdullah AC, Adnan JS, Rahman NA, Palur R

Malays J Med Sci, 2017 Mar;24(1):104-112.
PMID: 28381933 DOI: 10.21315/mjms2017.24.1.11

INTRODUCTION: Computed tomography (CT) is the preferred diagnostic toolkit for head and brain imaging of head injury. A recent development is the invention of a portable CT scanner that can be beneficial from a clinical point of view.
AIM: To compare the quality of CT brain images produced by a fixed CT scanner and a portable CT scanner (CereTom).
METHODS: This work was a single-centre retrospective study of CT brain images from 112 neurosurgical patients. Hounsfield units (HUs) of the images from CereTom were measured for air, water and bone. Three assessors independently evaluated the images from the fixed CT scanner and CereTom. Streak artefacts, visualisation of lesions and grey-white matter differentiation were evaluated at three different levels (centrum semiovale, basal ganglia and middle cerebellar peduncles). Each evaluation was scored 1 (poor), 2 (average) or 3 (good) and summed up to form an ordinal reading of 3 to 9.
RESULTS: HUs for air, water and bone from CereTom were within the recommended value by the American College of Radiology (ACR). Streak artefact evaluation scores for the fixed CT scanner was 8.54 versus 7.46 (Z = -5.67) for CereTom at the centrum semiovale, 8.38 (SD = 1.12) versus 7.32 (SD = 1.63) at the basal ganglia and 8.21 (SD = 1.30) versus 6.97 (SD = 2.77) at the middle cerebellar peduncles. Grey-white matter differentiation showed scores of 8.27 (SD = 1.04) versus 7.21 (SD = 1.41) at the centrum semiovale, 8.26 (SD = 1.07) versus 7.00 (SD = 1.47) at the basal ganglia and 8.38 (SD = 1.11) versus 6.74 (SD = 1.55) at the middle cerebellar peduncles. Visualisation of lesions showed scores of 8.86 versus 8.21 (Z = -4.24) at the centrum semiovale, 8.93 versus 8.18 (Z = -5.32) at the basal ganglia and 8.79 versus 8.06 (Z = -4.93) at the middle cerebellar peduncles. All results were significant with P-value < 0.01.
CONCLUSIONS: Results of the study showed a significant difference in image quality produced by the fixed CT scanner and CereTom, with the latter being more inferior than the former. However, HUs of the images produced by CereTom do fulfil the recommendation of the ACR.

Matched MeSH terms: Craniocerebral Trauma
Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy

Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, et al.

Acta Neurochir. Suppl., 2005;95:311-4.
PMID: 16463872

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy.

Matched MeSH terms: Craniocerebral Trauma/diagnosis*; Craniocerebral Trauma/epidemiology; Craniocerebral Trauma/surgery*
Association of traumatic head injuries and maxillofacial fractures: A retrospective study

Abosadegh MM, Rahman SA, Saddki N

Dent Traumatol, 2017 Oct;33(5):369-374.
PMID: 28504848 DOI: 10.1111/edt.12349

BACKGROUND/AIMS: The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated.
MATERIALS AND METHODS: A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF.
RESULTS: A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value

Matched MeSH terms: Craniocerebral Trauma/etiology; Craniocerebral Trauma/epidemiology*
Fulltext Demographic characteristic of patient with traumatic dental injury attending Kulliyyah of Dentistry IIUM Kuantan campus

Ahmad Faisal Ismail, Aifaa Ghazali, Afiza Fatihah Abdullah, Muhamad Sharifuddin Mat Daud

International Medical Journal Malaysia, 2017;16(21):55-55.
MyJurnal

Traumatic dental injuries (TDI) refer to injury to the teeth and/or peridontium and
perioral soft tissues. To date, very few dental trauma studies conducted in the university setting,
thus the aim of this research is to provide an epidemiological data of TDI cases among patients
attending Kulliyyah of Dentistry (KOD), IIUM Kuantan Campus. (Copied from article).

Matched MeSH terms: Craniocerebral Trauma
Fulltext Neuropsychological profile at three months post injury in patients with traumatic brain injury

Ali R, Wahab S, Abdul Rahman AH

Sains Malaysiana, 2013;42(3):403-408.

This study looked into the rate and pattern of neuropsychological impairment in patients with traumatic brain injury patients at three months post injury. Forty patients attending the neurosurgery outpatient clinic were included in the study. Benton visual retention test (BVRT), rey auditory verbal learning test (RAVLT), digit span test, trail making test (TMT) and mini mental state examination (MMSE) were used for assessment. Forty five percent (n=18) sustained moderate to severe head injury. Twenty five percent (n=10) have abnormal MMSE result. Forty two and a half percent (n=17) have abnormal BVRT result. Seventy five percent (n=30) have abnormal RAVLT result while 35% (n=14) have abnormal digit span test result. Seventy seven and a half percent (n=31) have at least one neurological deficit. There was significant association between severity of head injury (GCS score) and neuropsychological deficit. This study highlights the point that in post head injury patients, there are high occurrences of cognitive dysfunction. MMSE and GCS play a significant and important role in assessing cognitive dysfunction. Severity of head injury as determined by GCS scores also influence the outcome in patients with head injury

Matched MeSH terms: Craniocerebral Trauma
Head injury from fan blades among children

Alias A, Krishnapillai R, Teng HW, Abd Latif AZ, Adnan JS

Asian J Surg, 2005 Jul;28(3):168-70.
PMID: 16024308

OBJECTIVE: Head injury caused by fan blades is rare among children. We analysed 14 cases of such injury and discuss the causes, type of injury and preventive measures.
METHODS: A retrospective analysis of 14 cases of children who were admitted to the Pediatric Neurosurgical Unit of Hospital Kuala Lumpur after sustaining head injuries caused by fan blades between January 2000 and December 2002 was performed.
RESULTS: The causes of fan-blade head injury included jumping on the upper bunk of a bunk-bed, climbing on a ladder, climbing up onto a table, and being lifted by an adult. Thirteen patients were injured by ceiling fans and one by falling onto an uncovered table fan. School-aged boys were the predominant victims. Mean patient age was 7.9 years (range, 1.0-12.2 years). There was a twin peak incidence of when the accidents occurred: just before lunch in the afternoon and bedtime at night. The types of injury were scalp lacerations, compound depressed fractures and multiple intracranial haemorrhages. Two patients had the complication of wound infection, and one of these patients developed cerebral spinal fluid leak. One patient died from severe head injuries.
CONCLUSION: Safety awareness among parents and caretakers are important as fan-blade head injury among children is preventable.

Matched MeSH terms: Craniocerebral Trauma/etiology*; Craniocerebral Trauma/epidemiology*; Craniocerebral Trauma/therapy
Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction

Boo NY, Foong KW, Mahdy ZA, Yong SC, Jaafar R

BJOG, 2005 Nov;112(11):1516-21.
PMID: 16225572

To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction.

Matched MeSH terms: Craniocerebral Trauma/etiology*
Which mild head injured patients should have follow-up after discharge from an accident and emergency ward? A study in a university hospital setting in Kelantan, Malaysia

Chan HC, Adnan WA, Jaalam K, Abdullah MR, Abdullah J

Southeast Asian J. Trop. Med. Public Health, 2005 Jul;36(4):982-93.
PMID: 16295557

Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.

Matched MeSH terms: Craniocerebral Trauma/diagnosis*; Craniocerebral Trauma/therapy*
Delayed traumatic extradural haematomas

Chandrasekaran S, Zainal J

Aust N Z J Surg, 1993 Oct;63(10):780-3.
PMID: 8274120

A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.

Matched MeSH terms: Craniocerebral Trauma/complications*
Fulltext Supraclinoid direct carotid-cavernous sinus fistula

Che Ani MF, Kumar R, Md Noh MSF, Muda AS

BJR Case Rep, 2018 Mar;4(3):20170058.
PMID: 31489208 DOI: 10.1259/bjrcr.20170058

Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid arterial system with direct drainage into the cerebral venous system, mainly to the cavernous sinus. Direct CCF is a well-recognised complication following head trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the cavernous segment of the internal carotid artery, between the fixed and free segment. Tears at the supraclinoid segment are rare. We report a case of an internal carotid artery supraclinoid segment pseudoaneurysm, with a direct communication with the cavernous sinus, draining into the superior ophthalmic vein.

Matched MeSH terms: Craniocerebral Trauma
Fulltext Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma

Che Mohamed SK, Abd Aziz A

Malays J Med Sci, 2009 Oct;16(4):69-72.
PMID: 22135515 MyJurnal

When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury.

Matched MeSH terms: Craniocerebral Trauma
Fulltext A retrospective review of paediatric head injuries in Asia - a Pan Asian Trauma Outcomes Study (PATOS) collaboration

Chong SL, Khan UR, Santhanam I, Seo JS, Wang Q, Jamaluddin SF, et al.

BMJ Open, 2017 Aug 18;7(8):e015759.
PMID: 28821516 DOI: 10.1136/bmjopen-2016-015759

OBJECTIVE: We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.
DESIGN AND SETTING: We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 - August 2015.
PARTICIPANTS: We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients' physical findings on presentation.
OUTCOMES: Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.
RESULTS: 1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0-10.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p<0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p<0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95% CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls.
CONCLUSIONS: Among children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.

Matched MeSH terms: Craniocerebral Trauma/etiology; Craniocerebral Trauma/mortality
Fulltext Mild paediatric head injury: the diagnostic value of physical examinations compared with computed tomographic scans

Farizal F, Mohd Haspani MS

Malays J Med Sci, 2012 Jul;19(3):64-8.
PMID: 23610551 MyJurnal

The study objective was to determine the diagnostic value of physical examinations for positive computer tomography (CT) scans in children with mild head injuries. Retrospective data of patients evaluated for mild head injuries with loss of consciousness (LOC) or amnesia were reviewed. Estimations of prevalence, sensitivity, specificity and predictive values were calculated. Agreement between the physical examinations and CT brain scans was calculated using the Kappa test. 225 patients were included in the study. Of this group, 19.56% of patients had positive CT scans and 7.56% had normal physical examinations. 15 underwent neurosurgical intervention. For positive CT scans, sensitivity and specificity were 61.36% and 60.22%, respectively. Agreement between physical examinations and CT scans was Kappa = 0.147 (P < 0.05), 95% CI (0.035, 0.259). The present study demonstrated that physical examinations were significantly associated with positive CT scans (P = 0.01). However, the calculated Kappa value showed only slight agreement between these 2 variables and the low sensitivity and specificity of the physical examinations suggest that intracranial pathology in children with mild head injuries and LOC or amnesia cannot be excluded based on physical examinations alone.

Matched MeSH terms: Craniocerebral Trauma
Fulltext Prediction and explanation on adolescent aggression: a study protocol

Fatimah Ahmad Fauzi, Nor Afiah Mohd Zulkefli, Anisah Baharom

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):106-114.
MyJurnal

Introduction: Adolescent aggression is an important public health concern with escalating prevalence of juvenile cases and violence among these age groups including robbery, homicide, and gang fights. The objectives of this study protocol are to determine the biopsychosocial predictors and explore the contextual factors of adolescent ag- gression among secondary school students in Hulu Langat. Methods: Explanatory mixed method study design will be used, consist of quantitative cross-sectional study followed by basic qualitative study. Proportionate population sampling among Form 4 secondary school students from selected public secondary schools in Hulu Langat will be executed. Questionnaires will be distributed to 481 students on aggression as the dependent variable, and several independent variables: demographic (ethnicity, family income), biological (sex, head injury, nutritional deficiency, breakfast skipping), psychological (attitude and normative beliefs, personality trait, emotional intelligence), and so- cial factors (family environment, single parent status, domestic violence, peer deviant affiliation, alcohol, smoking, substance abuse). Subsequently, participants with moderate to high aggression scores will be further explored on the contextual factors of adolescent aggression by in-depth interview. Multiple linear regression will be executed using SPSS to determine significant predictors whereas thematic analysis will be applied for qualitative data analysis on the context of adolescent aggression. Both findings will be further integrated and discussed to give comprehensive description on the phenomena. Conclusion: Better knowledge and understanding on adolescent aggression may generate new framework to drive more effective preventive strategies and unravel adolescent aggressive related Pub- lic Health problems.

Matched MeSH terms: Craniocerebral Trauma
Fulltext Accidents and injuries related to powered paragliding: a cross-sectional study

Feletti F, Goin J

BMJ Open, 2014;4(8):e005508.
PMID: 25168039 DOI: 10.1136/bmjopen-2014-005508

Powered paragliding (PPG) and paragliding are two totally different sports, mainly because of the use of an engine in powered paragliding. As a consequence, the pattern of injuries caused by each of these two sports may be different.

Matched MeSH terms: Craniocerebral Trauma/epidemiology*
Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience

Gendeh BS, Mazita A, Selladurai BM, Jegan T, Jeevanan J, Misiran K

J Laryngol Otol, 2005 Nov;119(11):866-74.
PMID: 16354338

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

Matched MeSH terms: Craniocerebral Trauma/complications
Clinical course and determination of brainstem death in a children's hospital

Goh AY, Mok Q

Acta Paediatr, 2004 Jan;93(1):47-52.
PMID: 14989439

AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.

Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom

Matched MeSH terms: Craniocerebral Trauma/physiopathology*; Craniocerebral Trauma/therapy

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