TRAUMATIC HEAD INJURY

Background and objective: The aim of this research is to study the behaviour of a human head during the event of an impact of a cricket ball. While many recent incidents were reported in relation to head injuries caused by the impact of cricket balls, there is no clear information available in the published literature about the possible threat levels and the protection level of the current protective equipment. This research investigates the effects of an impact of a cricket ball on a human head and the level of protection offered by the existing standard cricket helmet. Method: An experimental program was carried out to measure the localised pressure caused by the impact of standard cricket balls. The balls were directed at a speed of 110 km/h on a 3D printed head model, with and without a standard cricket helmet. Numerical simulations were carried out using advanced finite element package LS-DYNA to validate the experimental results. Results: The experimental and numerical results showed approximately a 60% reduction in the pressure on the head model when the helmet was used. Both frontal and side impact resulted in head acceleration values in the range of 225-250 g at a ball speed of 110 km/h. There was a 36% reduction observed in the peak acceleration of the brain when wearing a helmet. Furthermore, numerical simulations showed a 67% reduction in the force on the skull and a 95% reduction in the skull internal energy when introducing the helmet. Conclusions: (1) Upon impact, high localised pressure could cause concussion for a player without helmet. (2) When a helmet was used, the acceleration of the brain observed in the numerical results was at non-critical levels according to existing standards. (3) A significant increase in the threat levels was observed for a player without helmet, based on force, pressure, acceleration and energy criteria, which resulted in recommending the compulsory use of the cricket helmet. (4) Numerical results showed a good correlation with experimental results and hence, the numerical technique used in this study can be recommended for future applications.

A B S T R A C T Gun violence is a global phenomenon with regional variation in frequency and severity. Handguns are often used in violent deaths such as suicides and homicides. Hence, ballistic trauma is a critical subject of forensic investigations. Trauma patterns are fundamental evidence for the reconstruction of the incident and for the determination of the manner of death. This study investigated the differences in trauma patterns with a series of experiments using six different calibers (.22 LR, .38 Special, .380 ACP, 9 Â 19 mm, .40 S&W, and .45 ACP) and four different bullet types. Synbone 1 spheres (polyurethane bone proxies) were used for close range 30 cm simulated executions. The polyurethane spheres constitute an excellent proxy for human crania at the macroscopic level as suggested by other studies. The results showed that the radius of the entrance wound is positively correlated (Pearson's correlation coefficient R = 0.846, p < 0.05) with the caliber dimension. As muzzle velocity increased, endocranial beveling increased. Bullet weight, conversely, does not seem to have an effect on the size of the endocranial beveling present in Synbone 1 spheres. The ballistic experiments exhibited similarities in entrance wound morphology; radial and concentric fracture patterns, hydraulic burst effect, circumferential delamination, and endocranial beveling with that of documented forensic cases with corresponding caliber shot. Synbone spheres seem appropriate for ballistic simulations of cranial injuries; yet, more research is needed to verify these observations.

When the head is subject to non-penetrating (blunt) impact, contusion-type injuries are commonly identified beneath the impact site (the coup) and, in some instances, at the opposite pole (the contre-coup). This pattern of injury has long eluded satisfactory explanation and blunt head injury mechanisms in general remain poorly understood. There are only a small number of studies in the open literature investigating the head’s response to short duration impacts, which can occur in collisions with light projectiles. As such, the head impact literature to date has focussed almost exclusively on impact scenarios which lead to a quasi-static pressure response in the brain. In order to investigate the response of the head to a wide range of impact durations, parametric numerical studies were performed on a highly bio-fidelic finite element model of the human head created from in vivo magnetic resonance imaging (MRI) scan data with non-linear tissue material properties. We demonstrate that short duration head impacts can lead to potentially deleterious transients of positive and negative intra-cranial pressure over an order of magnitude larger than those observed in the quasi-static regime despite reduced impact force and energy. The onset of this phenomenon is shown to be effectively predicted by the ratio of impact duration to the period of oscillation of the first ovalling mode of the system. These findings point to dramatically different pressure distributions in the brain and hence different patterns of injury depending on projectile mass, and provide a potential explanation for dual coup/contre-coup injuries observed clinically.

Background Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. The burden of TBI is greatest in low-and middle-income countries (LAMIC), yet little is known about patient outcomes in these settings. Methods Complete data on 8927 patients from 46 countries from the corticosteroid randomization after significant head injury (CRASH) trial were analysed to explore whether outcomes 6 months after TBI differed between high-income countries and LAMIC. Results Just under half of patients experienced a good recovery, one-third moderate or severe disability and one-quarter died within 6 months of their injury. Univariate analyses showed that patients in LAMIC were more likely to die following severe TBI, but were less likely to be disabled following mild and moderate TBI. These results were confirmed in multivariate analyses. Compared to patients in high-income countries, patients in LAMIC have over twice the odds of dying following severe TBI (OR 2.23, 95% CI 1.51–3.30) but half the odds of disability following mild (OR 0.41, 95% CI 0.23–0.72) and moderate TBI (OR 0.53, 95% CI 0.35–0.81). There were no differences between settings in the odds of death following either mild or moderate TBI. Conclusions Reduced death rates following severe TBI in patients from high-income countries may be due to differences in medical care which may result in a higher proportion of patients surviving with a disability. Socio-cultural factors may explain the lower levels of disability after mild and moderate TBI in LAMIC.

La lesión cerebral traumática es una condición heterogénea,
que puede variar de manera significativa desde el momento de
la lesión primaria. Los neurocirujanos debemos comprender los
fenómenos que son secundarios a las consecuencias de esta
lesión. El neuromonitoreo es un proceso crítico para identificar
la evolución de esta lesión secundaria, incluyendo aspectos como  la isquemia ó la hipoxia, los cuales aparecen desde las primeras horas posteriores al trauma.

Gun violence is a global phenomenon with regional variation in frequency and severity. Handguns are often used in violent deaths such as suicides and homicides. Hence, ballistic trauma is a critical subject of forensic investigations. Trauma patterns are fundamental evidence for the reconstruction of the incident and for the determination of the manner of death. This study investigated the differences in trauma patterns with a series of experiments using six different calibers (.22 LR, .38 Special, .380 ACP, 9×19mm, .40 S&W, and .45 ACP) and four different bullet types. Synbone® spheres (polyurethane bone proxies) were used for close range 30cm simulated executions. The polyurethane spheres constitute an excellent proxy for human crania at the macroscopic level as suggested by other studies. The results showed that the radius of the entrance wound is positively correlated (Pearson&#39;s correlation coefficient R=0.846, p&lt;0.05) with the caliber dimension. As muzzle velocity increa...

Various types of tuberculosis treated in our centre between January 2005 to April 2006 were studied and subjected to statistical analysis to determine the pattern of TB presentation in our centre. A total or 6 patients were seen of which 52% were males and 48% females. The mean age was 34.17 + - 3.8 years. Pulmonary tuberculosis accounted for 87% of the cases followed by abdominal tuberculosis (3.5%) and disseminated tuberculosis (2.5%). Microbiological investigation (sputum examination for acid and alcohol fast bacilli) was the most used diagnostic tool followed by chest radiography. Thirty four percent of the patients completed treatment while 24% defaulted treatment and were lost to follow up. Effective weapons such as identification and prophylactic treatment of all contacts of patients with active tuberculosis; institution of directly observed therapy (DOT) in the management of tuberculosis cases; provision of genuine antituberculous drugs promptly to patients that report to the hospital; and improving the living standards of the populace to reduce overcrowding arc some of the factors that can lead to a reduction in the incidence of this infection.

Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia following head trauma. In a study of visual complications following head trauma, only 4.4% of patients suffered from chiasmal injuries. Complete transection of the chiasm is even more rare and best visualized using magnetic resonance imaging (MRI). We report the one year follow-up of clinical, visual field, and MRI findings of a patient with complete transection of the optic chiasm following head trauma.

Background: Children are not little adults, and the management of outcome of head injuries in general and extradural
hematoma, in particular, are not the same as in Adults.
Aim:To study the Incidence, Management and Outcome of Paediatric EDH (Extradural Hematoma in Children)
Settings and Design: This study is based on Analysis of Case Records
Materials and Methods: Patients aged 12 years and below, admitted with Extra Dural Haematoma at the Institute of Neurology, Madras
Medical College between January 2013 and July 2014 were studied. Follow up period ranges from 3months to 18 months
Statistical analysis used:Epi-Info, MS-Excel, SPSS
Results and Conclusions: Paediatric EDH is relatively common
Fall is the most common Cause of EDH in Children
Age 5 to 12 is most commonly affected among all age groups
Road Traffic Accidents Caused Extra Dural Hematomas more commonly in older age groups
The fracture was more common in Children Less than two years of age
Children, less than five years had a better outcome
Fracture did not affect the outcome of the injury
Low GCS at admission did not always accurately predict the outcome
Cases with less than 25 ml did not require surgery, cases with volume 25-30 required surgery based on serial assessment and cases more than 30
ml required surgery Patients with Posterior Fossa EDH more than 15 ml required surgery
Indications of Surgery were signs of herniation, mass effect, and volume of clot
97 % of patients had a good outcome, and 3 % died
The mortality rate is lower in children than in adults