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Decompressive craniectomy is a procedure commonly used to manage suffering from traumatic brain injury patients. It has shown its effectiveness in reducing intracranial pressure, increasing cerebral perfusion pressure, and improving transcranial Doppler. However, it has no clear benefit on outcome. We performed a retrospective analysis of demographic, clinical, and evolving data from 70 cases of decompressive craniectomy in patients with traumatic brain injury at Hassan II University Hospital in Fez, Morocco, from January 2017 to December 2021. Majority of patients were young (age 15-90) and male (63 out of 70). The most common etiology was a road traffic accident (53 out of 70). At initial evaluation, 27 patients (38%) were classified as having severe traumatic brain injury. Pupillary examination revealed no abnormalities for 48 patients (68%). Acute subdural hematoma was the most commonly observed lesion (37 out of 70, 52%). The Glasgow Outcome Scale (GOS) was used to assess the neurological outcome of patients, and 26 patients (37%) had an unfavorable outcome. Only a Glasgow Coma Scale score of 3-8, absent pupillary reactivity, and delayed surgical procedure (>48 hours) were associated with a poor outcome (p<0.05). [ABSTRACT FROM AUTHOR]

Résumé: La thrombophlébite cérébrale est une complication rare du traumatisme crânien. Le diagnostic est difficile dans un contexte de céphalées post-traumatiques. Nous rapportons et discutons un cas de thrombophlébite cérébrale post-traumatique chez une femme de 65 ans, révélée par un trouble de la conscience, et rappelons la difficulté de sa prise en charge. Cerebral thrombophlebitis is a rare complication of head trauma. The diagnosis is difficult in the context of post-traumatic headaches. We report and discuss a case of post-traumatic brain thrombophlebitis in a 65-year-old woman, revealed by a consciousness disorder, in order to recall the difficulty of its management. [ABSTRACT FROM AUTHOR]

Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We report the case of a 26-year-old patient who was victim of severe head trauma following a trafic road accident. Two days after trauma, she had fever, pancytopenia and multi-organ failure. The haemophagocytic lymphohistiocytosis syndrome was suspected. This diagnosis was confirmed by biologic findings (elevated serum levels of ferritin and triglycerid) and histological findings (examination of bone marrow smears showing histiocytes phagocytosing blood cells). The evolution was unfavorable despite of corticotherapy and symptomatic measures. [Copyright &y& Elsevier]

Abstract: Although many questions are still debated, some recommendations can be formulated regarding the use of neuromuscular blocking agents in the ICU. A transient curarization can be used during brief diagnostic or therapeutic procedures in order to avoid haemodynamic consequences of deep sedation. A volume controlled ventilation has to be used during the procedure. In ARDS patients, a prolonged curarization of 48h or more is beneficial regarding systemic oxygenation, even in patients well adapted to their ventilator. The use of cisatracurium should be recommended in this context. The depth of curarization has to be checked by using a train of four stimulation at the corugator supercilii with an endpoint of 2/4 responses. A recovery from curarization should be daily envisaged if possible, in order to check the depth of the underlying sedation. In brain injured patients, a curarization can be envisaged if adaptation to the ventilator remains difficult or if normothermia or moderate hypothermia, if indicated, cannot be obtained. However, these attitudes are not based on specific data at the present time. [Copyright &y& Elsevier]

Abstract: The authors reported the case of a young man who suffered a cranial traumatism and showed neurological, ophthalmic and orbital signs with orbital bruit, cranial nerve palsy and chemosis while he was in the intensive care unit. Further examinations of imagery made it possible to highlight a high-flow carotid-cavernous fistula which was the origin of these symptoms and which was successfully treated by endovascular way. The aim of this article is to remind the reader of the characteristics of this pathology, in terms of epidemiology, physiopathology, clinical and paraclinical presentation, and therapeutic care. [Copyright &y& Elsevier]

Abstract: Decompressive craniectomy was purposed for the treatment of refractory intracranial hypertension after head injury. This review discusses results obtained by this surgery in severe head trauma. Several studies have confirmed a reduction in intracranial pressure secondary to decompressive craniectomy. Mortality decreased and the proportion of good outcome of the survivors increased. These results have not been confirmed prospectively, and indications have to be clarified. The positive effects of decompressive craniectomy compared to barbiturate or hypocapnia in the "second tier therapy" in refractory intracranial hypertension could be interesting to evaluate. [Copyright &y& Elsevier]

Abstract: Objective. – To review the current data on clinical bedside use of cerebral microdialysis. Data source. – Search through Medline® database of articles in French and English (keywords: microdialysis, cerebral ischaemia, head trauma, subarachnoid haemorrhage, clinical study). Study selection. – All clinical articles published between 1995 and 2005, including original papers and some case reports. Data synthesis. – Microdialysis after occlusive stroke has shown elevated levels of glutamate and lactate. When space-occupying oedema develops, biochemistry abnormalities occur first, before ICP increases. Bedside microdialysis appears to be a sensitive and earlier indicator of space occupying oedema. Most Accurate markers to monitor ischaemia induced by vasospasm are glutamate and lactate/pyruvate ratio. These markers are earlier than clinical abnormalities or pressure measurements (sensibility 82%, specificity 89%). In the field of head trauma, the same compounds were utilised. The level of these compounds correlates with outcome in a different manner whether the area studied is close to a concussion or not. Most of biochemical events are linked to global cerebral ischaemia. We can observe some abnormalities limited to the pericontusional area, which are not detected by the global monitoring. Microdialysis appears a useful tool to investigate disease mechanisms but cannot be recommended for a widespread use after head trauma. Conclusion. – Bedside cerebral microdialysis allows clinical decisions in the setting of subarachnoid haemorrhage and ischaemic stroke. It represents a valuable tool to investigate head trauma pathophysiology. [Copyright &y& Elsevier]

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Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess late outcome and satisfaction of life of patients with severe traumatic brain injury (TBI) patients who received inpatient rehabilitation in Aquitaine.Design and patients: Seventy-nine consecutive patients out of the 158 who were hospitalized for rehabilitation in 1993 were asked for in 2000 by a phone interview including standardised scales and free talk as well.Results: The results showed that nine years on average after their injury, 65 to 85% of patients were independent for daily living, whereas 35 to 55% only were independent in social life. Most of them were satisfied with their autonomy (67%), family life (66%) and financial status (41%), but they were dissatisfied with leisure (36%), vocational adjustment (28%) and sexual life (32%).Conclusion: Return to work, leisure and sexuality are major parameters of satisfaction of life after a severe TBI, and should be emphasized in goal-directed rehabilitation programs. [Copyright &y& Elsevier]

The authors report the case of an 18-year-old man with polytrauma, who died at the third day of its accident from brain death and who presented during his stay in the intensive care unit, a deep hypophosphatemia. Two physiopathologic mechanisms were presumed : increase of renal losses and intracellular transfer of phosphorus. Consequences, as well as the indications and the therapeutic modalities of hypophosphatemia are discussed. [Copyright &y& Elsevier]

Introduction: The aim of this study was to evaluate the diagnostic value of cervical spine standard radiographs, performed in emergency, and compared with entire cervical helical CT with multiplanar reconstructions as reference.Study design: Open prospective study.Patients and methods: We conducted a six months prospective study including all patients over 15 years of age and unconscious (Glasgow Coma Scale ≤ 12). Each patient underwent standard radiographs as well as helical CT of the entire cervical spine. Three senior surgeons and one senior radiologist evaluated the standard radiographs quality. The interpretation was performed by 7 different groups of judges. Two radiologists interpreted the helical CT. For each group, the sensibility, the specificity and the count of correct diagnosis for the standard radiographs were evaluated. The results of the correct diagnosis of each group were then compared to determine the most performant group.Results: Fifty-one patients were included. Helical CT diagnosed spine injuries in 11 patients. The quality of standard radiographs was poor with less than 10% judged correct and 90% of the C7-D1 junction not visible. In the best group (radiologist), the sensibility was 50%, the specificity was 85% and the count of correct diagnosis was 78%. For the correct diagnosis, senior radiologist was significantly better than anaesthetist students, radiologist students and emergency physicians.Conclusion: The diagnostic value of standard radiographs was weak whatever the physician. Therefore, helical CT of the entire cervical spine is absolutely necessary and must be performed during the initial evaluation, if the haemodynamic conditions are required. [Copyright &y& Elsevier]

The initial management of severely head-injured patients, including infants and children, is aimed at preventing and treating secondary brain damage, which mainly result from systemic insults (hypoxaemia, hypercarbia, arterial hypotension). Orotracheal intubation, followed by continuous sedation-analgesia, is mandatory when the Glasgow Coma Scale score (GCS) is less than or equal to 8 (crush induction is recommended). The goal of mechanical ventilation is to maintain normoxaemia and normocarbia. Moreover, the maintenance of an optimal cerebral perfusion pressure, usually 50 mmHg in infants, requires volume loading (isotonic fluids and colloids), and catecholamines if arterial hypotension persists. Intravenous mannitol is used only in case of life threatening intracranial hypertension, keeping in mind the potential for aggravating an hypovolaemia. Cerebral tomodensitometry is the most relevant imaging procedure for diagnosing surgical brain lesion. However, it should be noted, that severe head trauma is frequently associated with extra-cranial traumatic injuries, which may be responsible for (avoidable) deaths if the diagnosis is not made or delayed. Therefore, infants and small children presenting with severe head trauma should be considered as multiple injured and treated accordingly. Adequate initial management of severely head-injured children may participate to improved neurological outcome. [Copyright &y& Elsevier]

We report the case of an 11 months old boy who felt from 3 m high. He had an isolated brain injury with contusion and bleeding in the right frontal lobe. A large ascite was discovered in the Intensive Care Unit 6 days after the trauma. The CT scan did not reveal any abdominal lesion. This peritoneal fluid was transudative ascitic fluid which appeared to be mediated by beta-sympathetic hyperactivity of central origin. Sequential echography showed progressive improvement and disappearance of the ascite on 19th day post trauma. [Copyright &y& Elsevier]

A real transition between intensive care and traditional rehabilitation, the post-intensive care rehabilitation service for patients with brain injuries aims to provide patients with early and intensive rehabilitation. Multi-disciplinary teams support the patients and their families on their journey towards new life projects., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

A neurosurgical nursing and nursing auxiliaries team has started using therapeutic baths. The wellbeing procured favours a re-appropriation of body awareness and a reduction in anxiety., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

As soon as their prehospital care begins, patients with a serious head injury are given intensive care to offset the systemic failures observed and minimise secondary brain damage. In intensive care, monitoring is continuous and neuroprotection optimised. While the prognosis of the patient remains uncertain, their family are included and involved in their global care., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

After a serious head trauma, the return home constitutes a key moment in the patient's reintegration. It is prepared by a multi-disciplinary team throughout the rehabilitation and re-adaptation process, taking into account the patient's prognosis for recovery., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Spinal trauma is one of the most common types of injuries among victims of traffic accidents, sports accidents, domestic accidents and workplace accidents. We conducted a 3-year retrospective study of 139 cases of spinal trauma hospitalized and treated in the Neurosurgery department of the CHUJRA, Madagascar. This study shows that 25.17% of injured patients were between 21 and 30 years of age, with a clear male predominance (69.78%; sex ratio 2.3). Falls were the dominating traumatic injury mechanism (33.09%) with risk factors including alcohol use (8.63%). Spinal injuries occurred in patients with polytrauma, of whom 34.63% had cranial trauma. Patients were admitted to the department within 1-5 hours after the trauma in 31.65% of cases, using private car as their means of transport 36.69% of cases. During the hospitalization 20 patients signed the discharge form and 6.34% of patients died. Spinal trauma is a public health problem requiring high intensity management, especially for patients with life-long disabilities. Any spine trauma requires a diligent search for cranial lesion., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts.

Head injuries are described in the literature as a rare but possible etiology of cerebral venous thrombosis although no pathophysiological link has been identified. Trauma-related venous thrombi occurring in the brain produce a broad spectrum of clinical presentations. A purely psychiatric term is exceptional, leading to misinterpretation and late diagnosis. Positive diagnosis has been greatly improved by advances in magnetic resonance imaging with venous phase angiography, currently the gold standard exploration. We report the case of a patient who presented with post-trauma cerebral venous thrombosis revealed by psychiatric disorders., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)