B Djurovic | PubMed Health

PubMed2006

Traumatic delayed epidural hematoma.

OBJECT: Traumatic delayed epidural hematoma (DEH) can be defined as a hematoma that is insignificant or not present on the initial computerized tomography (CT) scan made after trauma but subsequent CT scan shows sizeable epidural bleeding. During a 3-year period we have treated a total of 96 epidural hematomas, eight (8.3 %) of which had a delayed onset. CASE REPORT: We present here an analysis of the eight patients with traumatic DEH which had a significant mass effect in all patients and required surgical evacuation. In three patients with mild head injury (GCS > 12) neurological deterioration indicated the necessity of repeating the CT scan and preceded the detection of DEH. In only one case of the five patients with moderate (8 < GCS < 13) and severe head injury (GCS < 9) was neurological deterioration the precursor of the DEH. All patients were immediately operated on after diagnosis. Postoperative outcome was favorable in all cases. CONCLUSIONS: DEHs are highly unpredictable and continue to cause diagnostic difficulty. Close observation for signs of clinical deterioration and repeat CT scan are the most important factors for early detection of DEH. Early diagnosis and prompt operation offers excellent results for DEHs.

Accidental Falls↗

PubMed2004

Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress.

Recent studies have demonstrated that hypopituitarism, in particular GH deficiency, is common among survivors of traumatic brain injury (TBI) tested several months or yr following head trauma. We present the results of endocrine, neurological, neuropsychological and psychiatric evaluation in a group of 67 patients who suffered TBI at least one yr ago. Our study shows that decreased endocrine function is either restricted to one or more anterior pituitary hormones and is present in 34% of patients with any pituitary hormone deficit, while multiple pituitary hormone deficiencies are found in 10% of patients. GH/IGF-I axis was evaluated by GHRH+GHRP-6 test and IGF-I measurement. Severe GHD is the most frequent deficiency present in 15% of TBI patients. Gonadotrophin deficiency was present in 9% of patients with TBI, while thyrotroph and corticotroph function seemed more refractory to impairment. Patients with moderate-to-severe trauma are not necessarily more likely to have hypopituitarism than those with mild injury. Neuropsychological testing revealed a significant positive correlation of peak GH levels after GHRH+GHJRP-6 test with verbal learning and verbal short term memory (RAVLT total score p = 0.06, immediate free recall p = 0.02 and delayed free recall p = 0.04). Verbal and visual memory was significantly lower in elderly patients and in males. Visoconstructional abilities (RCF copy) were significantly lower in the elderly (p < 0.01) and undereducated (p = 0.02). Visual memory (free recall of complex figure after 30 min) significantly correlated with lower IGF-I levels (p = 0.01). Gonadotrophins and testosterone correlated significantly with visoconstructional abilities. Simple and complex conceptual tracking (TMT A and B) was significantly more impaired in older TBI patients (p < 0.01) and with longer time from trauma (TMT B only, p = 0.03). The psychiatric evaluation by using two different scales showed depression, phobic anxiety and psychoticism to be more prominent in the TBI group. Paranoid ideation and somatization negatively correlated with the peak GH responses to GHRH+GHRP-6 test (p = 0.04 and p = 0.03, respectively). Depression scale showed that nearly half of patients suffered from mild to moderate depression. The benefits of hormone replacement therapy on cognitive functioning and mental distress in TBI patients are eagerly awaited.

Adult↗

PubMed1991

Surgical treatment of epilepsy: our experiences with 34 children.

Surgical treatment of medically intractable epileptic fits in children is highly specialized, owing to the specific etiology of epilepsies in this age group and the epileptogenic property of the brain in childhood. In our series of 340 patients operated on for medically intractable epileptic seizures, there were 34 (10%) patients up to 15 years of age (the youngest was 2 years old; mean age was 11 years). This group of patients comprises four subgroups: 9 patients with temporal foci, 6 patients with extratemporal foci, 16 patients with infantile hemiplegia and epilepsy, and 3 patients with epilepsia partialis continua (Kozhevnikov's disease). Preoperatively, detectable brain lesions were present in 30 (88%) cases, a much higher frequency than in adult surgical series. Postoperative follow-up so far is 1-14 years (mean, 4 years). Surgical outcome in this group of 34 patients is as follows: 21 (62%) are seizure-free, 8 (23%) have improved, and 5 (15%) have shown no improvement.

Adolescent↗