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  1. Fulltext Post traumatic parkinsonian syndrome: a case report
    Pratap Chand R
    Med J Malaysia, 1985 Dec;40(4):335-7.
    PMID: 3842736
    Parkinsonian syndrome attributed to craniocerebral trauma is rare. Two young adult males developed Parkinsonism following severe head injury. The clinical features and response to therapy are described.
    Matched MeSH terms: Craniocerebral Trauma/complications*
  2. Fulltext Bizarre ECG in head injury mimicking ventricular tachycardia
    Loke YK, Lai VM, Tan MH, Gunn A
    Singapore Med J, 1997 Apr;38(4):166-8.
    PMID: 9269397
    Bizarre electrocardiographic (ECG) changes were found in an 18-year-old girl who had a subdural haematoma following head trauma. The initial diagnosis was of ventricular tachycardia (VT) and she was treated with intravenous anti-arrhythmic drugs and electrical cardioversion, but to no effect. It was later concluded that the ECG appearances were not of a ventricular arrhythmia but were the result of the intracranial pathology. ECG abnormalities related to head injuries have been reported on many occasions, and our case report illustrates how this can create difficulties for the attending clinicians.
    Matched MeSH terms: Craniocerebral Trauma/physiopathology*
  3. Fenestrated Falx Cerebri and Additional Sinuses in the Tentorium Cerebelli
    Nayak SB, Vasudeva SK
    J Craniofac Surg, 2020 Sep;31(6):e585-e586.
    PMID: 32502106 DOI: 10.1097/SCS.0000000000006604
    Morphological variations of falx cerebri and tentorium cerebelli are extremely rare. The authors report an extremely rare type of combined variation of falx cerebri and dural venous sinuses in the tentorium cerebelli. During the removal of the brain from cranial cavity, it was noted that the anterior part of the falx cerebri had fenestrations and it looked like a mesh. There was no associated variations of medial surface of cerebrum. Further, there were unusual sinuses within the tentorium cerebelli. Two of them were present in the right half of the tentorium cerebelli and one in the left half of the tentorium cerebelli. There variations could be of importance to radiologists and neurosurgeons. The fenestrations of falx cerebri might lead to misinterpretations in cases of head injuries and the additional sinuses in the tentorium cerebelli might cause unexpected bleeding during surgeries of posterior cranial fossa.
    Matched MeSH terms: Craniocerebral Trauma
  4. 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
  5. An unusual case of bilateral vestibulopathy, chronic subjective dizziness and spondyloarthropathy
    Wong RS, Abdul Kadir SY
    Gen Hosp Psychiatry, 2015 Jul-Aug;37(4):372.e3-4.
    PMID: 25840702 DOI: 10.1016/j.genhosppsych.2015.03.011
    Vertigo and dizziness are two common symptoms seen in everyday practice. However, in some cases, making a diagnosis can be challenging. This case report shows the relevance of a careful psychiatric history, which led to the diagnosis of chronic subjective dizziness associated with bilateral peripheral vestibulopathy.
    Matched MeSH terms: Craniocerebral Trauma/complications
  6. Neurotrauma without neurosurgeons?
    Simpson D
    Aust N Z J Surg, 1994 Aug;64(8):525-6.
    PMID: 8048887
    Matched MeSH terms: Craniocerebral Trauma/surgery*
  7. Fulltext Delayed intracranial haemorrhage in head injury
    Zahari M, Mohd Ali AK, Chandrasekharan S
    Singapore Med J, 1996 Jun;37(3):285-7.
    PMID: 8942231
    To determine the incidence of delayed intracranial haemorrhage and the indication for repeat computed tomography (CT), a one and a half year retrospective study was made. A total of 289 patients had CT scan for head injury of which 78 (26.9%) had multiple scans. Out of these, 5 patients developed delayed haemorrhages (one extradural, one subdural, and three intracerebral haematoma). The incidence of delayed intracranial haemorrhage in our series is small when compared with others. The main predisposing factors are decompressive surgery, hyperventilation and cerebral dehydration therapy. It is important to know when to repeat the CT scan. A review of the literature regarding this aspect is presented and compared with our protocol. Intracranial pressure monitoring plays an increasingly important role in the management of head injury and should be used to decide the patient requiring repeat CT. Follow-up CT without other indication is not necessary.
    Matched MeSH terms: Craniocerebral Trauma/complications*
  8. Prevalence and determinants of non-standard motorcycle safety helmets amongst food delivery workers in Selangor and Kuala Lumpur
    Kulanthayan S, See LG, Kaviyarasu Y, Nor Afiah MZ
    Injury, 2012 May;43(5):653-9.
    PMID: 21764054 DOI: 10.1016/j.injury.2011.06.197
    BACKGROUND: Almost half of the global traffic crashes involve vulnerable groups such as pedestrian, cyclists and two-wheeler users. The main objective of this study was to determine the factors that influence standard of the safety helmets used amongst food delivery workers by presence of Standard and Industrial Research Institute of Malaysia (SIRIM) certification label.
    METHODS: A cross sectional study was conducted amongst 150 food delivery workers from fast food outlets in the vicinity of Selangor and Kuala Lumpur. During observation, safety helmets were classified as standard safety helmet in the presence of SIRIM label and non-standard in the absence of the label. They were approached for questionnaire participation once consent was obtained and were requested to exchange their safety helmet voluntarily with a new one after the interview. Data analysis was carried out using SPSS. Chi square and logistic regression analysis was applied to determine the significance and odds ratio of the variables studied, respectively (penetration test, age, education level, knowledge, crash history, types of safety helmet, marital status and years of riding experience) against the presence of SIRIM label.
    RESULTS: The response rate for this study was 85.2%. The prevalence of non-standard helmets use amongst fast food delivery workers was 55.3%. Safety helmets that failed the penetration test had higher odds of being non-standard helmets compared with safety helmets passing the test. Types of safety helmet indicated half-shell safety helmets had higher odds to be non-standard safety helmets compared to full-shell safety helmets. Riders with more years of riding experience were in high odds of wearing non-standard safety helmets compared to riders with less riding experience.
    CONCLUSION: Non-standard (non-SIRIM approved) helmets were more likely to be half-shell helmets, were more likely to fail the standards penetration test, and were more likely to be worn by older, more experienced riders. The implications of these findings are discussed.
    Matched MeSH terms: Craniocerebral Trauma/etiology; Craniocerebral Trauma/epidemiology; Craniocerebral Trauma/prevention & control*
  9. Post traumatic cerebral oedema in severe head injury is related to intracranial pressure and cerebral perfusion pressure but not to cerebral compliance
    Nujaimin U, Saufi A, Rahman AG, Badrisyah I, Sani S, Zamzuri I, et al.
    Asian J Surg, 2009 Jul;32(3):157-62.
    PMID: 19656755
    This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP) as well as cerebral perfusion pressure (CPP) with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure thus assisting in the acute post operative management of severely head injured patients. Hence post operative CT brain scans may be done to verify the ICP and CPP readings postoperatively. Subsequently, withdrawal of sedation for neurological assessment after surgery could be done if the CT brain scan showed an opened basal cistern and Marshall I and II coupled with ICP of less than 20 mmHg.
    Matched MeSH terms: Craniocerebral Trauma/complications; Craniocerebral Trauma/physiopathology; Craniocerebral Trauma/surgery*
  10. Exploring the economics of motorcycle helmet laws--implications for low and middle-income countries
    Hyder AA, Waters H, Phillips T, Rehwinkel J
    Asia Pac J Public Health, 2007;19(2):16-22.
    PMID: 18050559
    This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the effectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the U.S.A. experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of traffic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-effective interventions available.
    Matched MeSH terms: Craniocerebral Trauma/economics; Craniocerebral Trauma/etiology; Craniocerebral Trauma/prevention & control*
  11. Fulltext Non-accidental fatal head injury in small children--a clinico-pathological correlation
    Nooraudah AR, Mohd Sham K, Zahari N, Fauziah K
    Med J Malaysia, 2004 Jun;59(2):160-5.
    PMID: 15559164
    Non-accidental head injury leading to massive intracranial trauma has been identified as a leading cause of death in small children. In a typical case, a child usually below the age of one year is violently shaken, leading to rupture of the connecting veins between the dura mater and the brain substance with variable degrees of bleeding into the subdural space resulting in increased intracranial pressure. The accompanying venous thrombosis affecting the vessels of the brain substance leads to cerebral hypoxia and cellular death. In this study conducted throughout the year 1999, all children below the age of 3 years who were admitted to Hospital Kuala Lumpur and had died due to non-accidental injuries were included. Postmortems, including histopathological studies, were conducted to determine the most likely mechanisms of the injuries. Ten cases were identified for the whole year. In 2 cases, both below one year of age, the features presented showed evidence of violent shaking of the infants. In 6 other cases whose average age was 13 (range 4-24) months, there were evidences of direct trauma and violent shaking. In the last two cases, aged 24 and 33 months respectively, there was only evidence of direct trauma on the heads without being shaken. This study shows that death due to intracranial trauma caused by shaking with or without direct impact is the most frequent cause of mortality in abused children. Death due to direct impact between the head and another object is a less frequent occurrence.
    Matched MeSH terms: Craniocerebral Trauma/etiology; Craniocerebral Trauma/mortality*; Craniocerebral Trauma/pathology*
  12. The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents
    You X, Liew BS, Rosman AK, Dcsn, Musa KI, Idris Z
    Neurosurg Focus, 2018 05;44(5):E7.
    PMID: 29712526 DOI: 10.3171/2018.1.FOCUS17796
    OBJECTIVE Traumatic brain injury due to road traffic accidents occurs mainly in the younger age group in which injury-related disability leads to long-term impact on employment and economic and social consequences across the lifespan. This study was designed to assign a monetary cost (in Malaysian ringgits [RM]) to the treatment of patients with surgically treated isolated traumatic head injury as determined up to 1 year after injury. METHODS Relevant resource items used were identified and valued using the direct measurement of costs method, cost accounting methods, standard unit costs method, fees, charges and/or market prices method. These values were then tabulated to generate the total costs for each patient, via a combination of macro-costing and micro-costing methods. Malaysian currency values were converted to US dollars according to the average conversion rate for the period from January to May 2016: RM1 = US$0.2452. RESULTS This costing study analyzed data from 49 patients. The estimated cost for the 1st year of care for all patients was RM1,471,919.80 (US$360,914.735), with a mean (± SD) cost per case of RM30,039.18 ± 22,986.25 or $7365.61 ± $5636.23. The mean cost of care per case was RM11,041.35 ± 10,936.88 or $2707.34 ± $2681.72 for mild head injury, RM32,550.00 ± 20,998.76 or $7981.26 ± $5148.90 for moderate head injury, and RM36,917.86 ± 23,697.34 or $9052.26 ± $5810.59 for severe head injury. Severe head injury (p = 0.001), sustaining 2 or more intracranial pathologies (p = 0.01), having a poor Glasgow Outcome Scale (GOS) score (GOS score 1-3) (p = 0.02), requiring a tracheostomy (p < 0.001), and contracting pneumonia (p < 0.001) were significantly associated with higher cost. Logistic regression analysis revealed that cost of care increased by RM591.60 or $145.06 per year increment of age (β = RM591.60, p = 0.05). CONCLUSIONS The mean cost of treatment for traumatic head injury is high compared to the per capita income of RM37,900 in 2016. The cost values generated in this study provide baseline cost estimates that the authors hope will be used as a guide to determine where adequate funding should be allocated to provide timely and appropriate delivery of care.
    Matched MeSH terms: Craniocerebral Trauma/economics*; Craniocerebral Trauma/epidemiology; Craniocerebral Trauma/surgery*
  13. Head injuries
    Monro JK
    Journal of the Malaya Branch of the British Medical Association, 1939;3:294-96.
    Matched MeSH terms: Craniocerebral Trauma
  14. 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
  15. Relationship between neurological outcome and early oxidative changes in erythrocytes in head injury patients
    Nayak C, Nayak D, Bhat S, Raja A, Rao A
    Clin Chem Lab Med, 2007;45(5):629-33.
    PMID: 17484625
    Experimental data indicate that destructive oxidative events reach their peak within the first 24 h after trauma in head injury (HI) and that brain damage occurring due to this impact can be the cause of death or irreversible permanent disabilities in affected patients.
    Matched MeSH terms: Craniocerebral Trauma/blood; Craniocerebral Trauma/complications; Craniocerebral Trauma/diagnosis*; Craniocerebral Trauma/mortality
  16. Relationship between cervical spine injury and helmet use in motorcycle road crashes
    Ooi SS, Wong SV, Yeap JS, Umar R
    Asia Pac J Public Health, 2011 Jul;23(4):608-19.
    PMID: 21768134 DOI: 10.1177/1010539511413750
    Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson χ(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet.
    Matched MeSH terms: Craniocerebral Trauma/etiology; Craniocerebral Trauma/physiopathology
  17. Relationship between markers of lipid peroxidation, thiol oxidation and Glasgow coma scale scores of moderate head injury patients in the 7 day post-traumatic period
    Nayak C, Nayak D, Raja A, Rao A
    Neurol Res, 2008 Jun;30(5):461-4.
    PMID: 18953735
    Epidemiologic works reveal that moderate head injury (MHI) is more frequent and a substantial number of these patients develop complications resulting in neurological disabilities. Reactive oxygen species (ROS) play a major role in post-traumatic neuronal damage following traumatic head injury. Thus, the current study analysed the post-traumatic changes in the erythrocyte markers of oxidative damage and the relationship between these parameters and Glasgow coma scale (GCS) scores of MHI patients during the 7 day study period.
    Matched MeSH terms: Craniocerebral Trauma/metabolism*; Craniocerebral Trauma/physiopathology*
  18. Coagulopathy in acute head injury--a study of its role as a prognostic indicator
    Selladurai BM, Vickneswaran M, Duraisamy S, Atan M
    Br J Neurosurg, 1997 Oct;11(5):398-404.
    PMID: 9474270
    The aim of this investigation was to determine the prognostic value of coagulation abnormalities in a defined subset of patients with acute head injury. Prothrombin time, accelerated partial thromboplastin time (APTT), thrombin clotting time, fibrinogen assay, platelet count, fibrin degradation products (FDP) were assayed in 204 patients with acute closed head injury. Their values were graded on a score 0-3 and the sum score for each patient regarded as the disseminated intravascular coagulation (DIC) score. Moderate to severe DIC scores were evident in 38% of the cohort. At least one parameter was abnormal in 71% of patients. The DIC score correlated inversely with the Glasgow coma score (GCS) (p < 0.0001). In the GCS 13-15 subset, FDP scores were significant predictors of poor outcome (p < 0.001). In the GCS 6-12 subset, the APTT score (p < 0.001), and DIC score (p < 0.0001) predicted an adverse outcome. The DIC scores were significantly abnormal in most patients who had a poor outcome, without evidence of adverse predictors on CT. Logistic regression analysis confirmed the independent predictive capacity of APTT, FDP and DIC scores when values for GCS were fixed. Abnormal haemostatic parameters may enhance the predictive ability in subsets of patients with acute head injury defined by clinical or CT predictors.
    Matched MeSH terms: Craniocerebral Trauma/blood*; Craniocerebral Trauma/complications
  19. 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*
  20. Time-relative changes in the erythrocyte antioxidant enzyme activities and their relationship with Glasgow Coma Scale scores in severe head injury patients in the 21-day posttraumatic study period
    Nayak CD, Nayak DM, Raja A, Rao A
    Indian J Med Sci, 2007 Jul;61(7):381-9.
    PMID: 17611343
    BACKGROUND: Reactive oxygen species are indicated to play a prime role in the pathophysiology of brain damage following a severe head injury (SHI).

    AIM: The current study was designed to understand the time-relative changes and relationship between erythrocyte antioxidant enzyme activities and Glasgow Coma Scale (GCS) scores of SHI patients in the 21-day posttraumatic study period.

    SETTINGS AND DESIGN: The study included 24 SHI patients and 25 age- and sex-matched normal controls (NC). Activities of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GSH-Px) were assayed in these patients and controls. The GCS scores of these patients were also recorded for the comparative study.

    MATERIALS AND METHODS: Venous blood samples were collected on day 7 (D7) and D21 from SHI patients and NC for the assay of SOD, GR and GSH-Px activities. These changes were correlated with age and changes in GCS scores of patients.

    STATISTICAL ANALYSIS: A one-way analysis of variance (ANOVA) was used to compare mean values of each parameter between group 1 (NC), group 2 (D7 changes in SHI patients) and group 3 (D21 changes in SHI patients). ANOVA was followed by Bonferroni post hoc tests. The Pearson correlation was applied to correlate between the antioxidant parameters and age and GCS scores of these patients.

    RESULTS: A significant increase in erythrocyte SOD and GSH-Px activities was observed in group 3 as compared to groups 1 and 2. The increase in GSH-Px activity was significant in group 2 as compared to group 1. Although not significant, there was an increase in mean GR activity in groups 2 and 3 as compared to group 1.

    CONCLUSION: These findings indicate that SHI patients have shown significantly enhanced erythrocyte SOD and GSH-Px activities during the 21-day posttraumatic study period.

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