Repeat head CT in mild traumatic brain injury is really necessary?

We pleasantly read the paper by Van Ornam et al.[1] who collected data on the management of 1126 patients with mild traumatic intracranial hemorrhage (GCS> 13). The authors highlighted a very important topic: the repeat head CT scans (RHCT) to assess for progression of traumatic injuries. There are relatively limited number of reports focused on timing of radiologic controls in MTBI with a positive initial CT scan. Consequently, clinicians are often in the difficult position between avoiding unnecessary examinations and ensuring the safest treatment of their patients.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research

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Conclusions: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores. PMID: 31908703 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
AbstractBackground/ObjectiveDesmopressin (DDAVP) has been suggested for antiplatelet medication reversal in patients with traumatic brain injury (TBI) but there are limited data describing its effect on clinical outcomes. The purpose of this study was to evaluate the effect of DDAVP on hematoma expansion and thrombosis in patients with TBI who were prescribed pre-injury antiplatelet medications.MethodsConsecutive adult patients who were admitted to our level I trauma center and prescribed pre-injury antiplatelet medications between July, 2012, and May, 2018, were retrospectively identified. Patients were excluded if their ...
Source: Neurocritical Care - Category: Neurology Source Type: research
Conclusion: Based on our findings, emergency US can play a greater role in the initial management of head trauma children, especially as a triage test. PMID: 31875207 [PubMed]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
CONCLUSIONS: Quantitative iodine-based parameters derived from follow-up dual-energy CT may predict the intensity of intracranial pressure management in patients with hemorrhagic contusions.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: FUNCTIONAL Source Type: research
ConclusionTraumatic dACA aneurysm is a rare complication of brain trauma. Delayed intracranial haemorrhage and the sudden deterioration of neurologic function were the typical characteristics in patients with traumatic dACA aneurysm. CTA is the first-line screening modality for patients who present with intracerebral haemorrhage in the corpus callosum after trauma, particularly for patients who are older, in a poorer or critical condition. When the aneurysm is located in the A4 segment or involves a small branch, surgical trapping is the preferred definitive therapy to prevent further growth and disastrous bleeding. Early ...
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research
AbstractIntroductionSymptomatic intracerebral hemorrhage (sICH) following systemic thrombolysis for ischemic stroke is often devastating, and open surgical evacuation is considered dangerous due to the increased risk of perioperative bleeding, and stereotactic placement of a catheter is too time-consuming. We therefore evaluated the feasibility of a free-hand bedside catheter technique for emergency hematoma evacuation.MethodsPatients who had a supratentorial sICH after thrombolysis, a hematoma volume  >  30 ml, and an ensuing reduction in vigilance were consecutively treated with acute minimally inva...
Source: Neurocritical Care - Category: Neurology Source Type: research
This study sought to determine the ability of FM to predict PHI after severe TBI.MethodsWe conducted a prospective, observational study including all severe TBI patients admitted in the trauma center. Between September 2011 and September 2016, we enrolled patients with severe TBI into the derivation cohort. Between October 2016 and December 2018, we recruited the validation cohort on the same basis. Study protocol included FM measurements and standard coagulation test at admission and two computed tomography (CT) scans (upon arrival and at least 6  h thereafter). A PHI was defined by an increment in size of initial le...
Source: Neurocritical Care - Category: Neurology Source Type: research
ConclusionsOur preliminary findings suggest a possible link between autoregulatory failure and traumatic edema progression, which warrants re-evaluation in larger-scale prospective studies.
Source: Neurocritical Care - Category: Neurology Source Type: research
Conclusions: CTP can detect abnormal brain perfusion before the occurrence of DCI. This may allow close monitoring and preemptive therapy for improvement in the prognosis in patients with aSAH.
Source: Neurology India - Category: Neurology Authors: Source Type: research
Conclusions: DDAVP was associated with a decreased likelihood of intracranial hemorrhage expansion during the first 24 hours. DDAVP administration did not significantly affect serum sodium and thrombotic events during the study period.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research
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