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14 pages, 2311 KiB

Open AccessFeature PaperArticle

Patient Outcomes following Immediate Tracheostomy and Emergency Decompressive Craniectomy in the Same Setting

by Ramesh Kumar, Mohd Sofan Zenian, Tang Yiu Maeng, Farizal Fadzil and Anis Nabillah Mohd Azli

Int. J. Environ. Res. Public Health 2022, 19(23), 15746; https://doi.org/10.3390/ijerph192315746 - 26 Nov 2022

Viewed by 1864

Abstract

Early tracheostomy is recommended for patients with severe traumatic brain injury or stroke. Tracheostomy in the same setting as emergency decompressive craniectomy, on the other hand, has never been investigated. Our goal was to compare the outcomes related to the duration of mechanical [...] Read more.

Early tracheostomy is recommended for patients with severe traumatic brain injury or stroke. Tracheostomy in the same setting as emergency decompressive craniectomy, on the other hand, has never been investigated. Our goal was to compare the outcomes related to the duration of mechanical ventilation in patients who had immediate (IT) vs. early (ET) tracheostomy following an emergency decompressive craniectomy in a Neurosurgical centre in Sabah, Malaysia. We reviewed 135 patients who underwent emergency decompressive craniectomy for traumatic brain injury (TBI) and stroke patients between January 2013 and January 2018 in this retrospective cohort study. The cohort included 49 patients who received immediate tracheostomy (IT), while the control group included 86 patients who received a tracheostomy within 7 days of decompressive surgery (ET). The duration of mechanical ventilation, length of stay (LOS) in the critical-care unit, and intravenous sedation were significantly shorter in the IT group compared to the ET group, according to the study. There was no significant difference between the two groups in the incidence of ventilator-associated pneumonia (VAP), tracheostomy-related complications, or 30-day mortality rate. In conclusion, compared to early tracheostomy, immediate tracheostomy in the same setting as emergency decompressive craniectomy is associated with a shorter duration of mechanical ventilation and LOS in critical-care units with acceptable morbidity and mortality rates. This practise could be used in busy centres with limited resources, such as those where mechanical ventilators, critical-care unit beds, or OT wait times are an issue. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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11 pages, 785 KiB

Open AccessArticle

Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression

by Farizal Fadzil, Amy Khor Cheng Mei, Azudin Mohd Khairy, Ramesh Kumar and Anis Nabillah Mohd Azli

Int. J. Environ. Res. Public Health 2022, 19(21), 14311; https://doi.org/10.3390/ijerph192114311 - 2 Nov 2022

Cited by 5 | Viewed by 2854

Abstract

Patients with mild traumatic brain injury (MTBI) with intracerebral hemorrhage (ICH), particularly those at higher risk of having ICH progression, are typically prescribed a second head Computer Tomography (CT) scan to monitor the disease development. This study aimed to evaluate the role of [...] Read more.

Patients with mild traumatic brain injury (MTBI) with intracerebral hemorrhage (ICH), particularly those at higher risk of having ICH progression, are typically prescribed a second head Computer Tomography (CT) scan to monitor the disease development. This study aimed to evaluate the role of a repeat head CT in MTBI patients at a higher risk of ICH progression by comparing the intervention rate between patients with and without ICH progression. Methods: 192 patients with MTBI and ICH were treated between November 2019 to December 2020 at a single level II trauma center. The Glasgow Coma Scale (GCS) was used to classify MTBI, and initial head CT was performed according to the Canadian CT head rule. Patients with a higher risk of ICH progression, including the elderly (≥65 years old), patients on antiplatelets or anticoagulants, or patients with an initial head CT that revealed EDH, contusional bleeding, or SDH > 5 mm, and multiple ICH underwent a repeat head CT within 12 to 24 h later. Data regarding types of intervention, length of stay in the hospital, and outcome were collected. The risk of further neurological deterioration and readmission rates were compared between these two groups. All patients were followed up in the clinic after one month or contacted via phone if they did not return. Results: 189 patients underwent scheduled repeated head CT, 18% had radiological intracranial bleed progression, and 82% had no changes. There were no statistically significant differences in terms of intervention rate, risk of neurological deterioration in the future, or readmission between them. Conclusion: Repeat head CT in mild TBI patients with no neurological deterioration is not recommended, even in patients with a higher risk of ICH progression. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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10 pages, 1281 KiB

Open AccessArticle

Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

by Nicola Montemurro, Antonino Indaimo, Davide Tiziano Di Carlo, Nicola Benedetto and Paolo Perrini

Int. J. Environ. Res. Public Health 2022, 19(4), 1926; https://doi.org/10.3390/ijerph19041926 - 9 Feb 2022

Cited by 13 | Viewed by 2413

Abstract

Background: Long-standing overt ventriculomegaly in adults (LOVA) is an uncommon type of adult chronic hydrocephalus. In recent years, conflicting case series described different outcomes after treatment of LOVA with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS). The aim of this study is [...] Read more.

Background: Long-standing overt ventriculomegaly in adults (LOVA) is an uncommon type of adult chronic hydrocephalus. In recent years, conflicting case series described different outcomes after treatment of LOVA with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS). The aim of this study is to report a single institutional surgical experience of patients with LOVA in order to evaluate the clinical outcome of those patients treated with one or, sometimes, both surgical procedures, analyzing the main clinical features of these patients, before and after surgery. Methods: We conducted a retrospective study on 31 patients with diagnosis of LOVA, who were treated in our University Hospital between December 2010 and October 2020. We reported gender, age, clinical presentation, surgical treatment, and clinical outcome according to the Kiefer index (KI). Evans’ index, head circumference, aqueductal stenosis and expanded/destroyed sella turcica were assessed on preoperative MRI. Results: The most common clinical manifestation was gait disturbances (100%) followed by urinary incontinence in 23 (74.2%) patients and cognitive deficits in 22 (71%) patients. On preoperative MRI, the overall mean Evans’s Index was 0.49, whereas the overall mean head circumference was 57.3 cm. Twenty-three patients (74.2%) had obliterated cortical sulci, 20 (64.5%) patients had aqueductal stenosis, and 22 (71%) patients had an expanded/destroyed sella turcica on preoperative MRI. Fifteen (48.4%) patients underwent ETV and sixteen (51.6%) were treated with VPS as first surgical procedure. Four (26.6%) out of fifteen patients treated with ETV required a subsequent VPS. The overall median age of patients was 64 (IQR: 54.5–74) and the overall median follow-up was 57 months (IQR 21.5–81.5). Overall morbidity was 22.5%. Mean recovery index (RI), according to KI, was 3.8 ± 4.3 and 2.2 ± 5.6 (p = 0.05) at last follow-up in patients treated with ETV and VPS, respectively. Conclusions: The choice of surgical treatment of LOVA remains under discussion. Although EVT is a tempting option for patients with LOVA, conversion to VP shunt is not uncommon. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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13 pages, 356 KiB

Open AccessArticle

Quality of Life and Physical Activity of Persons with Spinal Cord Injury

by Tjasa Filipcic, Vedrana Sember, Maja Pajek and Janez Jerman

Int. J. Environ. Res. Public Health 2021, 18(17), 9148; https://doi.org/10.3390/ijerph18179148 - 30 Aug 2021

Cited by 20 | Viewed by 3207

Abstract

The higher quality of life of people with spinal cord injury is closely related with their reintegration into the social environment. Social reintegration is a demanding and complex process, requiring individuals to become active again and acquire age-, gender-, and culture-appropriate roles and [...] Read more.

The higher quality of life of people with spinal cord injury is closely related with their reintegration into the social environment. Social reintegration is a demanding and complex process, requiring individuals to become active again and acquire age-, gender-, and culture-appropriate roles and social status. It also involves independence and productive behavior as part of multiple interpersonal relationships with family, friends, and others. In order to establish whether individuals with spinal cord injury who are physically active subjectively rate their quality of life to be higher compared to those who are not, sixty-two respondents from Slovenia with spinal cord injury were interviewed. Thirty-one of them were physically active, and 31 were not. The level of injury of the responders was from Th6–Th12. The participants gave the highest assessments to their interpersonal relationships, and the lowest to their satisfaction with material prosperity. Data comparison showed that subjective estimates in all areas of quality of life are higher in respondents who were involved in physical activity after their injury. The results may encourage persons with spinal cord injury to participate more often in sports programs, and also encourage others to do so. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

11 pages, 1961 KiB

Open AccessArticle

Reducible Nonunited Type II Odontoid Fracture with Atlantoaxial Instability: Outcomes of Two Different Fixation Techniques

by Torphong Bunmaprasert, Vorapop Trirattanapikul, Nantawit Sugandhavesa, Areerak Phanphaisarn, Wongthawat Liawrungrueang and Phichayut Phinyo

Int. J. Environ. Res. Public Health 2021, 18(15), 7990; https://doi.org/10.3390/ijerph18157990 - 28 Jul 2021

Cited by 8 | Viewed by 5823

Abstract

Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of [...] Read more.

Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated with Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring, and 11 were treated with Harms-Goel C1-C2 screw-rod fixation technique. The bony fusion rate was 100% in both groups. The mean time to fusion was 69.7 (95%CI 53.1, 86.3) days in Magerl’s C1-C2 transarticular screw fixation technique and 75.2 (95%CI 51.8, 98.6) days in Harms-Goel C1-C2 screw-rod fixation technique. No severe complications were observed in either group. Displaced reducible, nonunited type II odontoid fracture with cervical myelopathy should be treated by surgery. Both fixation techniques promote bony fusion and provide substantial construct stability. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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10 pages, 632 KiB

Open AccessArticle

Secular Trend, Seasonal Variation, Epidemiological Pattern, and Outcome of Traumatic Head Injuries Due to Road Traffic Accidents in Aseer, Saudi Arabia

by Mubarak Ali Algahtany

Int. J. Environ. Res. Public Health 2021, 18(12), 6623; https://doi.org/10.3390/ijerph18126623 - 20 Jun 2021

Cited by 8 | Viewed by 3111

Abstract

Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the [...] Read more.

Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the past decade; demonstrate their time trend and seasonality; and decipher age and sex differences in RTA-related THIs and their outcome. The results showed a decline in the number of RTA-related THIs between 2010 and 2019. The patients had a mean age of 26.16 ± 16.27 years, and the male-to-female ratio was 10.8:1. Head injury with multiple lesions was the most common diagnosis, followed by cerebral contusion and skull fracture (32.1%, 12.9%, and 11.2%, respectively). Subdural hematoma (SDH) and skull fracture were significantly more common in patients aged ≥60 years (standard residual > 1.96), and significantly less common in those aged ≤17 years (standard residual < 1.96), compared to other age groups. Males experienced significantly more SDHs than females (standard residual = −2.8, p = 0.029). The length of hospital stay was positively correlated with age (Spearman’s rho = 0.057, p = 0.046). No seasonal variation was found. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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2 pages, 248 KiB

Open AccessComment

Comment on Bunmaprasert et al. Reducible Nonunited Type II Odontoid Fracture with Atlantoaxial Instability: Outcomes of Two Different Fixation Techniques. Int. J. Environ. Res. Public Health 2021, 18, 7990

by Ayhan Kanat

Int. J. Environ. Res. Public Health 2022, 19(9), 5018; https://doi.org/10.3390/ijerph19095018 - 20 Apr 2022

Cited by 4 | Viewed by 1352

Abstract

I read with great interest the paper of Bunmaprasert et al. [...] Full article

(This article belongs to the Special Issue Neurotrauma and Health)

7 pages, 1044 KiB

Open AccessCase Report

Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

by Magdalena Mackiewicz-Milewska, Małgorzata Cisowska-Adamiak, Katarzyna Sakwińska, Iwona Szymkuć-Bukowska and Iwona Głowacka-Mrotek

Int. J. Environ. Res. Public Health 2021, 18(8), 4219; https://doi.org/10.3390/ijerph18084219 - 16 Apr 2021

Cited by 1 | Viewed by 2694

Abstract

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead [...] Read more.

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established. Full article

(This article belongs to the Special Issue Neurotrauma and Health)

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