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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical course of patients admitted following minor head injuries (Glasgow Coma Score [GCS] 13-15) has been studied less extensively than in severely head injured patients. Admission criteria, methods and indications for radiological evaluation are controversial. To study this further, a retrospective review of 633 patients admitted following such injuries to King Khalid University Hospital between 1986 and 1993 was undertaken. Their ages ranged from one month to 80 years (average 17 years). The mechanisms of injury were mainly falls in 339 (53.5%) cases and road traffic accidents in 234 (37%). None of the cases resulted from a non-accidental injury. Radiological evaluation was by skull radiography in 616 (97.3%) cases followed by CT scan in 131 (20.7%). These studies revealed a skull fracture in 78 (12.7%) cases. Six of these 78 patients with skull fracture required a neurosurgical procedure during the first week post injury. These represented 0.97% of the cases who had skull radiographs. A base of skull fracture was an ominous sign, since 3 of the 5 cases with such fractures required ventilation of which one resulted in the only mortality of this series, the fourth developed meningitis. Of the cases studied, 3 (0.5%) developed growing skull fractures all had the initial injury during their first year of life. Other complications were as follows: 25 (3.9%) early post-traumatic seizures, 10 (1.6%) chronic subdural haematomas, 9 (1.4%) extradural haematomas, 2 (0.3%) post-traumatic hydrocephalus and one (0.2%) cerebral abscess. We conclude that patients who have an abnormal GCS, a neurological deficit, post-traumatic seizure, signs or suspicion of basal or depressed skull fracture should be admitted for observation because of the risk of deterioration. Patients with a history of loss of consciousness or amnesia without any of the previous may be discharged to be observed at home by a competent observer, otherwise, will need admission for observation. Radiological evaluation once indicated must be by CT scan. There is no benefit from immediate skull radiography in the initial evaluation of minor head injuries. The indications for CT are an abnormal GCS, presence of neurological deficit, signs of basilar or depressed fracture and persistent or progressive headache or vomiting. Infants with minor injuries should be followed up at least once after two to three months for possible growing fractures.
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PMID:Management of minor head injuries: admission criteria, radiological evaluation and treatment of complications. 952 9

Much has been written about the evaluation and management of mild brain trauma in sports. No less than 10 different 'guidelines' have been proposed and published to aid the clinician in the diagnosis of the condition. Too often, these guidelines have creating confusion instead of promoting an understanding of the spectrum of brain injury. As the understanding of the basic science of mild brain injury evolves, so must the approach to the concussed athlete. This article presents an up-to-date and clinically useful approach to the management of the athlete with a mild brain injury. The definition of 'concussion' is discussed and clarified and pertinent epidemiological data which highlight the importance of management skills as applied to athletes in a wide variety of sports are also reviewed. There is really no such thing as a 'mild concussion' if one considers the rare but catastrophic outcome of the second impact syndrome. For this reason, we review and expand upon the mechanisms of injury and pathophysiology. The accurate diagnosis of mild brain injury requires considerable experience, a high index of suspicion, a careful history and a series of examinations of the athlete, and a working knowledge of the athlete's personality and the likelihood of minimising their symptoms. The value of orientation questions pertinent to the athlete is now well established. Any focal neurological deficit or the deterioration of an athlete's condition warrants immediate hospitalisation, brain imaging and neurosurgical consultation. More commonly, athletes present with a brief alteration of consciousness, headache and amnesia and require careful examination and observation before returning to competition. The astute clinician will always err on the side of conservative management. The complete resolution of all symptoms before a return to play is imperative. Computerised tomography is very sensitive in the imaging of mild brain injuries. Neuropsychological testing is also very sensitive in the evaluation of brain injuries in athletes, and may become more clinically useful in the future.
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PMID:Mild brain trauma in sports. Diagnosis and treatment guidelines. 968 Jun 57

The objective was to determine why some people who are involved in minor motor vehicle accidents, without loss of consciousness, have persisting headaches and neckache, and to suggest management of these symptoms. Between 1954 and 1994, over 4400 cases were referred for medico-legal opinions. A group has been selected for discussion. During the period 1954-1966, 414 cases following closed head injuries were seen with varying periods of post traumatic amnesia (PTA) from nil to greater than 72 h. The average time between the accident and the examination was 21 months. The shortest period was 3 months and the longest 7 years. The age at the time of the accident varied from 2.5 to 72 years. The largest group fell between the ages of 20 and 40 years. The main complaints were headache, giddiness, loss of concentration and poor memory. 380 were reviewed by questionnaire after settlement of the case. 112 cases of extension/flexion injuries of the neck were seen between 1985 and 1989 and their symptoms and resolution were compared with 50 cases seen over the same period following significant head or neck injury. The results showed that the more severe the head or neck injury, the less likely were the cases to suffer symptoms of post-traumatic headaches or persisting neck symptoms. In conclusion, while 70% of minor head and neck injuries settle within a few weeks of a motor vehicle accident, about 30% continue to complain of headaches and/or neck pain. The prolonged management, extensive physiotherapy and slow court settlement lead to excessive introspection and prolongation of symptoms.
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PMID:Neurological sequelae of minor head and neck injuries. 970 21

Post-concussion symptoms (PCS) (such as headaches, irritability, anxiety, dizziness, fatigue and impaired concentration) are frequently experienced by patients who have sustained a minor head injury (MHI). The post-concussion syndrome has been defined as a clinical state where 3 or more symptoms persist for more than 3 months. This report focuses on the quantification of PCS according to the Rivermead Postconcussion Symptoms Questionnaire (RPQ). We studied 100 consecutive patients with MHI and normal computed tomography of the brain. At 3 months after injury, 62% reported the presence of one or more symptoms, and 40% fulfilled the diagnostic criteria for post-concussion syndrome. Patients with post-concussion syndrome had significantly (P < 0.001) higher RPQ scores (mean 19.1, SD 11.9) than those without (mean 1.2, SD 1.8). Patients on sick leave owing to the injury reported significantly (P = 0.05) higher RPQ scores (mean 10.3, SD 13.2) than those not on sick leave (mean 5.5, SD 8.6). We observed no association between age, gender, cause of injury, severity of injury, duration of amnesia and RPQ score. RPQ score provides useful information about the severity of PCS regardless of whether the diagnostic criteria for the post-concussion syndrome are met or not.
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PMID:Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. 975

We report the case of a 42-year-old man with repeated attacks of headache associated with retrograde amnesia. Neuropsychological tests before and after the major episode of amnesia showed mild neuropsychological deficits but with spared anterograde memory and learning functions. The amnesia was dense for a period of 15-20 years and included people and events (public and private). There was also a suggestion of amnesia for learned skills. Neurologically he had mild clinical signs and focal EEG-abnormalities in the left fronto-temporal region, but CT, MRI, and SPECT showed no abnormality. Five years after the onset of amnesia there was no recovery of the retrograde memory deficit, but a PET (glucose) scan was normal and neuropsychological testing showed no deficits. An association with migraine has been reported for some non-classical amnesias, but this is the first case of selective retrograde amnesia in a patient with headache as a primary neurological diagnosis.
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PMID:Focal retrograde amnesia associated with vascular headache. 986 87

A case of an amnestic syndrome caused by a subcortical haematoma in the right occipital lobe is reported. A 62-year-old right-handed man presented with a sudden onset of headache to the hospital. On admission, he had a left homonymous hemianopsia, disorientation and recent memory disturbance, but had normal remote memory and digit span. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a subcortical haematoma in the right occipital lobe. These findings suggest that the patient's amnesia was caused by a lesion of the retrosplenial region in the non-dominant hemisphere.
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PMID:A case of amnestic syndrome caused by a subcortical haematoma in the right occipital lobe. 1008 2

A 75-year-old male was hit by a car, when riding a bicycle. The diagnosis of acute epidural hematoma was made based on computed tomography (CT) findings of lentiform hematoma in the left temporal region. On admission he had only moderate occipitalgia and amnesia of the accident, so conservative therapy was administered. Thirty-three hours later, he suddenly developed severe headache, vomiting, and anisocoria just after a positional change. CT revealed typical acute subdural hematoma (ASDH), which was confirmed by emergent decompressive craniectomy. He was vegetative postoperatively and died of pneumonia one month later. Emergent surgical exploration is recommended for this type of ASDH even if the symptoms are mild due to aged atrophic brain.
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PMID:Abrupt exacerbation of acute subdural hematoma mimicking benign acute epidural hematoma on computed tomography--case report. 1009 58

Patients who suffered a closed head injury (CHI) are frequently with various subjective complaints: headache, forgetfulness, irritability, poor concentration, etc. Such complaints were observed in patients with both severe and mild CHI. The aim of this study was to establish the degree of the subjective complaints in the group of 40 patients who continuously expressed the complaints even in the follow-up period from 6 to 47 months after the injury. Special questionnaire adopted for this category of patients was used for the registration of their complaints. The severity of CHI was estimated upon the classification of the initial impaired consciousness by Glasgow Coma Scale (GCS) and upon the duration of post-traumatic amnesia (PTA), while the recovery was estimated upon the five-levels scale of return to work (RTW). The most frequent disturbances were: forgetfulness (4%), irritability (40%) and poor concentration (35%). The analyses indicated the occurrence of two groups of symptoms, and the explanation for their most probable genesis was given.
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PMID:[Subjective complaints in patients after a closed head injury]. 1043 18

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS-R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI.
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PMID:Factors influencing outcome following mild traumatic brain injury in adults. 1093 76

The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam(Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5%). Adverse reactions to the procedure such as nausea, vomiting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.
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PMID:Analgesia-sedation for day-case inguinal hernia repair. A review of patient acceptance and morbidity. 1094 57


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