Severe cranial neuropathies caused by falls from heights in children

Zahavi, Alon; Luckman, Judith; Yassur, Iftach; Michowiz, Shalom; Goldenberg-Cohen, Nitza

doi:10.1007/s00417-015-3199-4

Cited by 9 publications

(3 citation statements)

References 30 publications

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“…[3,9,20,21] In our series, 45.9% of the falls and 30.8% of the deaths occurred during summer. Al et al [17] and Gulatı et al [3] found that the highest number of falls occurred from 00:00 to 06:00 o'clock.…”

Section: Discussionmentioning

confidence: 50%

Falls from height: A retrospective analysis

Turgut

Sarıhan

Çolak

et al. 2018

World Journal of Emergency Medicine

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BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS:A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS:The study comprised of 292 (63.5%) men and 168 (36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0-5 years age group (28.3%). People fell mainly from 1.1-4 metres(m) level (46.1%). The causes of falls were ordered as unintentional (92.2%), workplace (8.1%) and suicidal (1.7%). Skin and soft tissue injuries (37.4%) were the main traumatic lesions.CONCLUSION: Age, fall height, fall place, lineer skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

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Section: Discussionmentioning

confidence: 50%

Falls from height: A retrospective analysis

Turgut

Sarıhan

Çolak

et al. 2018

World Journal of Emergency Medicine

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“…In this study, the olfactory, facial, and oculomotor nerves (cranial nerves III, IV, and VI) were most commonly injured and about three out of four CNI patients presented with single nerve palsies which is backed by a vast body of literature [24,26,32,34,42]. Another survey revealed cranial neuropathies affecting visual capacity and/or ocular movement in 1.9% of pediatric inpatient cases hospitalized for severe head trauma resulting from falls [52]. To some extent, investigations from other world regions showed substantially higher CNI prevalences complicating head injuries, ranging between 9.1% and 12.6% for adults and up to 22.4% in children [24,31,34].…”

Section: Discussionmentioning

confidence: 74%

Cranial Nerve Injuries In Patients With Moderate To Severe Head Trauma – Analysis of 91,196 Patients From The TraumaRegister DGU® Between 2008 And 2017

Huckhagel

Riedel

Rohde

et al. 2021

Preprint

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BackgroundTraumatic brain injury　(TBI)　constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries　(CNI)　in moderate to severe TBI are largely unknown. We aimed to determine the prevalence of CNI in a large European cohort of TBI patients as well as clinical differences between TBI cases with and without concomitant CNI (CNI vs. control group) by means of a multinational trauma registry.MethodsThe TraumaRegister DGU® was evaluated for trauma patients with head injuries ≥2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables.Results1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3±20.6 vs. 51.8±23.0 years) but did not differ regarding sex distribution (CNI 69.4%; control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p<0.001; chi-squared test) and falls more commonly in the control group (45.2% vs. 37.1%; p<0.001). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p<0.001) and skull base fractures (51.0% vs. 23.5%; p<0.001). Despite similar mean Injury Severity Score (CNI 21.8±11.3; control 21.1±11.7) and Glasgow Coma Scale score (CNI 10.9±4.2, control 11.1±4.4), there was a considerably higher rate of anisocoria in CNI patients (20.1% vs. 11.2%; p<0.001). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p<0.001).ConclusionsCNI as rare adjuncts to TBI should raise the suspicion of complicating skull base fractures and indicate higher rates of functional impairment following primary care.

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“…2 In children, unilateral CN VI palsies are rare, but bilateral palsies can be related to tumors, elevated intracranial pressure, congenital malformations, postinfectious or postvaccination inflammatory disease, post-lumbar puncture, multiple sclerosis, or genetic syndromes such as Miller Fisher syndrome and Duane retraction syndrome. [3][4][5][6][7][8][9][10][11][12][13] In both children and adults, "nonlocalizing" abducens nerve palsies have also been described, often associated with increased or decreased intracranial pressure. 14 However, Chiari malformation type 1 (CM1) has never been reported to present with isolated abducens nerve palsy in the absence of other symptoms.…”

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confidence: 99%

A child with unilateral abducens nerve palsy and neurovascular compression in Chiari malformation type 1 resolved with posterior fossa decompression: illustrative case

Kozel,

Shao,

Doberstein

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Unilateral cranial nerve (CN) VI, or abducens nerve, palsy is rare in children and has not been reported in association with Chiari malformation type 1 (CM1) in the absence of other classic CM1 symptoms. OBSERVATIONS A 3-year-old male presented with acute incomitant esotropia consistent with a unilateral, left CN VI palsy and no additional neurological symptoms. Imaging demonstrated CM1 without hydrocephalus or papilledema, as well as an anterior inferior cerebellar artery (AICA) vessel loop in the immediate vicinity of the left abducens nerve. Given the high risk of a skull base approach for direct microvascular decompression of the abducens nerve and the absence of other classic Chiari symptoms, the patient was initially observed. However, as his palsy progressed, he underwent posterior fossa decompression with duraplasty (PFDD), with the aim of restoring global cerebrospinal fluid dynamics and decreasing possible AICA compression of the left abducens nerve. Postoperatively, his symptoms completely resolved. LESSONS In this first reported case of CM1 presenting as a unilateral abducens palsy in a young child, possibly caused by neurovascular compression, the patient’s symptoms resolved after indirect surgical decompression via PFDD.

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Severe cranial neuropathies caused by falls from heights in children

Cited by 9 publications

References 30 publications

Falls from height: A retrospective analysis

Falls from height: A retrospective analysis

Cranial Nerve Injuries In Patients With Moderate To Severe Head Trauma – Analysis of 91,196 Patients From The TraumaRegister DGU® Between 2008 And 2017

A child with unilateral abducens nerve palsy and neurovascular compression in Chiari malformation type 1 resolved with posterior fossa decompression: illustrative case

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