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Neurosurgery Without TearsPathophysiology of head injury
The management of head injury has been based on the concept of primary and secondary brain injury. The primary brain injury was defined as the irreversible pathology sustained at the time of the trauma, whereas the secondary brain injury has been considered the subsequent or progressive brain damage that occurs due to [...]
Patients with head injuries may have associated injuries in other parts of the body. In particular it is essential to examine for life-threatening cervical spine, chest, abdominal-viscera, pelvic and long-bone injuries. This post reviews cranial nerve injuries that may occur with head injury. enjoy it!
Cranial Nerves Injury
The cranial nerves may be injured as a result [...]
Head injuries are a major cause of morbidity and mortality in all communities. Trauma is the third most common cause of death in the United States, exceeded only by cerebrovascular disease and cancer. Trauma is the leading cause of death in youth and early middle age and the death is often associated [...]
Management of brain abscess has witnessed tremendous improvements in recent times. In the pre-antibiotic era, the condition is almost uniformly fatal. However, with the introduction of antibiotics into surgery, the outlook for brain abscess, like other intracranial infection, has remarkably improved.
The most important single contribution to the present improved prognosis is the introduction of computed [...]
A high index of suspicion is necessary to make an early diagnosis of cerebral abscess. Clinical presentation of cerebral abscess usually take the following pattern:
short clinical course, usually days, as opposed to tumours that run a longer course, usually months/years
Predominant symptom: headache (70-95% of cases)
Alteration in mental status
Focal neurological deficits (such as hemiparesis, aphasia, visual [...]
In the preantibiotic era brain abscess was caused predominantly by Staph. aureus and streptococci. After the introduction of antibiotics the incidence of staphylococcal abscesses declined and most abscesses were thought to be due to streptococci, although up to 50% of culture results in some series were ‘sterile’.
With advancements in microbiology that has led to improved [...]
Neuroimaging is very essential in the diagnosis of a brain abscess. Radiographs may show depressed skull fractures, intracranial foreign bodies or fluid in the paranasal sinuses when these are present but is otherwise not useful for diagnosis.
The introduction of computed tomography brought about the most important single advancement in the management of intracranial infections especially [...]
Pyogenic inflammation of the brain leading to cerebral abscess may result from:
direct spread from an adjacent focus of infection such as sinusitis, otitis or dental infections. The infection usually involve the adjacent part of the brain. As such, frontal sinusitis affects the frontal lobe while otitis spread to the temporal lobe. They are usually [...]
The histogenesis of cerebral abscess was defined by defined by Britts and associates (1985).
The following stages are recognized in the development of brain abscess:
• Stage 1: Early cerebritis
o Days 1-3
o local inflammatory response surrounding the adventitia of blood vessels
o development of oedema
o beginning of a central necrotic region
• Stage 2: Late cerebritis
o Days 4-9
o Most important pathological changes occur
o Oedema reaches its maximum
o Increase in [...]
A quick and concise history is essential in the care of the patient with head injury. Necessary details include:
• Age
• Type of accident that caused the head injury and the events surrounding it
• Time of occurrence
• Details of rescue/transportation to the hospital
• Occurrence and details of
o Vomiting: may indicate raised ICP
o Convulsions (early/late post traumatic seizures)
o Bleeding (craniofacial orifices and others)
o CSF leaks
o Fever
o Loss of [...]
