جستجوی مقالات مرتبط با کلیدواژه « آسیب به مغز » در نشریات گروه « پزشکی »

Introduction & Penetrating head wound are classified according to the velocity of the in-driven missile into; low velocity and high velocity missiles. The low velocity missiles are usually non-bullets, so called ‘cold weapons’. These are the instruments formally used in the work stations not critically controlled for safety. Case report: A 19 year old man suffering from penetrating brain injury (PBI) with a nail in-driven by a pneumatic nailer was referred to the emergency room. His neurological examination was normal. Regular radiological exams and angiograms were done before the operation. The postoperative course was uneventful and the control of cerebral angiogram was also normal. Awareness of the potential harms of the instruments used in the working areas is necessary to prevent possible mortal damages. Even though different studies have tried to elucidate different aspects of PBIs, but there are still poorly defined questions regarding the duration of antibiotherapy, anti-epileptic therapy and the probable duration needed for development of traumatic aneurysms.

Although intracranial pressure (ICP) monitoring is considered as the standard care for traumatic brain injuries، it is not routinely used in Iran. Hence، the purpose of this study is to reveal the primary results of the applying ICP monitoring in patients with traumatic head injuries in Bahonar Hospital in Kerman. The present study is a cross-sectional one in which all the patients with traumatic brain injuries referred to this given center and received the ICP monitoring were evaluated. We examined the clinical and imaging findings at admission as well as mortality and the complications related to the ICP catheter. The outcome was assessed according to the Glascow Outcome Scale (GOS) at six months after occuring trauma. The data were analyzed using t-test for quantitative variables and Chi-square test for categorical ones. Eighteen patients with traumatic brain injury were undergone ICP monitoring during this time. Eight operations were performed on 6 patients based on their ICP. All the three patients with refractory high ICP died during hospital admission. Higher primary GCS and reactive pupil، were related to the better GOS scores six months after trauma. It seems that ICP monitoring is a safe and effective treatment modality in patients with traumatic brain injury. However، it is necessary to conduct more studies with a large sample size and control group.

Damage caused by traumatic brain injury (TBI) depends on the extent of primary and secondary damages. The latter can cause induced neurological inflammation by releasing pro- and anti-inflammatory cytokines and chemokines. Measurement of serum interleukin-6 (IL-6), as a pro-inflammatory cytokine, can be useful in predicting outcome in patients with TBI. In a cross-sectional study, 44 patients with GCS≤8 (Glasgow Coma Scale) and age ≥ 14 years, hospitalized in Poursina teaching hospital, were included in the study. Blood samples were collected from patients in the first 6 hours after the accident; and serum was tested by ELISA method for the determination of IL-6 levels. Patient's outcomes were recorded 6 months after head injury according to Glasgow Outcome Scale (GOS), and were divided in two good (GOS ≥4) and bad (GOS<3) outcome groups. Data were analyzed in SPSS software version18 using the Spearman's rho, independent-t test, Fisher Exact test and Mann-Whitney test. Comparison of IL-6 serum levels, in the two groups after 6 months of head injury, showed that mean serum levels of IL-6 in good outcome group was lower than bad outcome group (85.2 ±51.6 vs. 162.3±141.1, respectively) (P <0.03). Elevated serum levels of IL-6 in patients with severe TBI, is associated with poor clinical outcome.

Shaken baby syndrome is the most severe form of physical abuse in infancy and the most frequent unnatural cause of death. More than two-thirds of all fatal cases of child abuse occur at this age. Over 90% of all intracranial injuries during infancy are due to abuse. This study aims at investigating definition, prevalence, risk factors, clinical symptoms and diagnosis of shaken baby syndrome.

This study is a review article conducted based on on the data available in credible databases of the years 2000-2011.

Shaken baby syndrome encompasses a set of symptoms resulting from shaking the baby. This syndrome occurs when caregivers shake a crying baby strongly forward and backward by holding him/her at the trunk or arms. shaken baby syndrome can occur at any age but due to having big head, heavy brain and weakness in muscles of the neck, babies are more susceptible to it. Children who have been under severe shakes show such symptoms as irritability, weakness, sickness, vomiting, convulsion, lack of consciousness, apnea, or death, while those of weaker shakes show non-specific symptoms similar to viral diseases, infection and malnutrition. Shaken baby syndrome is diagnosed based on triple symptoms including encephalopathy and subdural and retinal hemorrhage. These children experience various consequences ranging from healthy look to permanent disability including mental retardation, developmental delays, paralysis, epilepsy, visual and hearing deficiency and personality disorders. Discussion and

Although prevalent, shaken baby syndrome is completely preventable. Such prevention is achievable through different ways including protecting child against misbehavior of caregivers, providing parents with information regarding legal rights of their children and training health caregivers, physicians, nurses, social workers as well as parents on reasons and dangers resulting from shaken baby syndrome.

Nitric Oxide (NO) is one of the most important neurotransmitters in the brain which has a key role in brain edema and ischemia pathophysiology. The aim of this study was to determine the serum NO concentration in traumatic brain injury and its relation with Glascow Coma Scale (GCS) and consciousness level. In this analytic-descriptive study, patients with traumatic brain injury who had a mass volume in CT scan less than 25mm were assessed. GCS was measured during the study (14 days) and serum NO level was measured on days 0, 7 and 14 using Griess reagent method. Data were analyzed by one-way variance analysis and Pearson correlation coefficient (P < 0.05). Results showed that there was no significant difference in serum NO concentration in different GCS scores (GCS ≤ 7:7.61 ± 0.51, GCS ═ 8: 9.65 ± 1.52, GCS ≥ 9:8.5 ± 0.95 μ mol/lit). Also, serum NO level had no significant correlation with GCS score. It seems that serum NO concentration has no correlation with GCS score in traumatic brain injury. More studies on local brain NO changes in brain and CSF are needed.

The brain damage caused by trauma is the most common cause of death. The neuroprotection effects of estrogen and progesterone have been reported in numerous studies. In the present study, the role of different doses of sex steroids has been investigated on the aquaporin 4 protein concentration changes in brain tissue of ovariectomized (OVX) rats after traumatic brain injury (TBI). In this experimental interventional study, 140 female rats N-MRI were randomly divided into seven groups and each group group further subdivided into two subgroups as follows; sham group, ovariectomized sham group, vehicle, physiologic and pharmacologic estrogen at doses 33.3 µg/kg, and 1 mg/kg respectively, physiologic and pharmacologic progesterone at doses 1.7 mg/kg and 8 mg/kg group. TBI was induced for groups 3-7 by Marmarou method. Thirty minutes after TBI, the hormones were intraperitoneally injected. Parameters such as Evans blue content, and water content and aquaporin 4 concentration were determined 5h and 24h after TBI respectively. Compared to the vehicle group, physiologic and pharmacologic doses of estrogen could significantly diminish the aquaporin 4 expression and water content (p<0.01), and permeability of blood - brain barrier (p<0.001). While physiologic and pharmacologic doses of progesterone had a same effect as estrogen on brain water content (p<0.001), this effect was not observed on aquaporin 4 expression. The brain Evans blue content at physiologic dose of progesterone was significantly lower than vehicle group, but it was higher at pharmacologic dose (p<0.001). We concluded that only physiologic and pharmacologic doses of estrogen reduce d the aquaporin 4 expression in OVX rats after TBI. Based on our results, estrogen may have a therapeutic effect on brain injury.

Traumatic brain injury (TBI) is a risk factor in creation of mental disorders.Therefore, psychometrhc study is necessary to provide a mental disorder screening tool in these patients. To assess the factor structure, clinical cut-off point and psychometric properties of ‎28- Itemes version for General Health Questionnaire (GHQ-28) in patients with TBI. In descriptive- longitudinal study, 238 patients (43 females and 195 males) were chosen by nonprobability and consecutive sampling method. Each of them completed modified version for GHQ-28. After 4 months pursuit 155 patients (65.1%) reffered to a psychiatrist in order to determine the nature of mental disorder due to TBI, according to structured clinical interview based on DSM-IV diagnostic criteria. Data was analyzed by ROC curve, independent T tests, factor and discrimination analysis methods, Pearson’s correlation, Cronbach's alpha coefficients and split half reliability(Spearman- Brown’s and Guttmann’s). The results showed that cut off point, sensitivity, specificity and area under the curve was 16.5%, 62.2%, 60% and 0.66% respectively by using the conventional scoring method, for the Likert scoring method same values were 40.5%, 72.2%, 57.1% and 71.0 respectively. Reliability coefficients of mentioned questionnaire by Cronbach's alpha and split half reliability method, to conventional scoring method were 0.89, 0.76 and by Likert scoring method were 0.92, 0.81, respectively.According to factor analysis by oblique direct method, Four factors were extracted from the GHQ-28 which were named, social dysfunction, depression, physical symptoms, anxiety and insomnia respectively. The correlation coefficients among these questionnaire sub-scales and the total score founded level optimum were between 0.46 – 0.81 (P<0.0001). Factor analysis indicated that four major factors are the basis of Modified Version for GHQ-28 and psychometric properties implicated their capabilities for screening of mental disorders in patients with TBI.

Traumatic brain injury is a cause of death in adult populations. Adrenal insufficiency has a great impact on the prognosis of patients with traumatic brain injury. However there is a lack of consensus regarding the diagnostic criteria of adrenal insufficiency. Our aim was to assess adrenal function in patients with moderate to severe traumatic brain injury. In a multicenter case-series study, 50 patients, aged 15 to 70 years, with moderate to severe traumatic brain injury were enrolled from 4 intensive care units in Tehran. Adrenal function was assessed using the 1 and 250µg ACTH stimulation tests. The incidence of adrenal insufficiency in the first 10 days after traumatic brain injury varied from 34% to 82%, based on various definitions of adrenal insufficiency. More cases of adrenal insufficiency were detected by 1µg ACTH stimulation test compared to the basal cortisol and 250µg ACTH tests. Since the gold standard insulin stimulation test is regarded as potentially dangerous in the acute phase of post traumatic brain injury, the sensitivity and specificity of the stimulation tests could not be assessed. Kappa test showed no agreement between the two tests (Kappa=0.17). The incidence of hypotension and vasopressor requirement was higher in patients diagnosed by the 250µg ACTH test. Baseline cortisol had linear correlation with the 60-minute cortisol of both the 1 and 250µg ACTH tests (P<0.0001). The prevalence and associated morbidity of adrenal insufficiency in patients with traumatic brain injury warrant early diagnosis of subclinical cases by dynamic stimulation tests and judicious corticosteroid therapy.

Because of its ability to demonstrate the nature, extent, sites, and multiplicity of brain injury, computed tomography (CT) is now the primary diagnostic method for head trauma. Although there have been numerous reports on the CT findings of most types of intracranial injuries, the findings in brainstem injuries have not been well described. This study aimed at comparing the autopsy findings of brainstem in head trauma in comparison with CT scan results. Two hundred patients with head trauma, who expired after a period of time of hospitalization, were assessed in a diagnostic value study. Brain stem involvement was determined by autopsy as well as CT scanning of the brain during their hospitalization. The results of the two methods compared with each other, emphasizing the type and the location of probable lesions in the brain stem. Considering the autopsy as the method of the choice, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT scan in brain stem lesions of patients with head trauma were calculated. The effect of primary cause of head trauma, survival time and Glasgow coma scale (GCS) were evaluated, as well. Brain stem lesions detected in 39 (19.5%) patients in autopsy. However, CT scan revealed brain stem lesions in 23(11.5%) cases. The sensitivity, specificity, PPV and NPV of CT scan was 59%, 100%, 100% and 91% respectively. The most common lesions of the brain stem region were as contusion of pons (8.5%), medulla (5%) and midbrain (4.5%). There were 6 (3%) cases of pontomedullary junction tear and 1 (0.5%) case of cervicomedullary junction tear. Admitting GCS and survival time were significantly lower in patients with brain stem lesion (p<0.001 for both of them); however, the initial mechanism of trauma did not significantly differed between the two groups (p=0.343). CT scan is a specific method of evaluating patients with probable brain stem injuries after head trauma, but low sensitivity limits its efficacy. Our results are in conformity with the reports in the literature.