Traumatic Intracranial Aneurysms Caused by Missiles: Their Presentation and Management

Haddad, Farid S.; Haddad, Georges F.; Taha, Jamal M.

doi:10.1227/00006123-199101000-00001

Cited by 107 publications

(40 citation statements)

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“…4,6 This argument was further strengthened by our results, as 3 of 7 TICAs were not identified on initial CTA and DSA performed at the time of admission. According to Bell et al, 5 TICAs can rupture as early as postinjury Day 4 and as late as 32 days after injury.…”

Section: Discussionsupporting

confidence: 55%

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Bodanapally¹,

Shanmuganathan²,

Boscak³

et al. 2014

JNS

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Object The authors conducted a study to compare the sensitivity and specificity of helical CT angiography (CTA) and digital subtraction angiography (DSA) in detecting intracranial arterial injuries after penetrating traumatic brain injury (PTBI). Methods In a retrospective evaluation of 48 sets of angiograms from 45 consecutive patients with PTBI, 3 readers unaware of the DSA findings reviewed the CTA images to determine the presence or absence of arterial injuries. A fourth reader reviewed all the disagreements and decided among the 3 interpretations. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were calculated on a per-injury basis and in a subpopulation of patients with traumatic intracranial aneurysms (TICAs). Results Sensitivity of CTA for detecting arterial injuries was 72.7% (95% CI 49.8%–89.3%); specificity, 93.5% (95% CI 78.6%–99.2%); PPV, 88.9% (95% CI 65.3%–98.6%); and NPV, 82.9% (95% CI 66.4%–93.4%). All 7 TICAs were correctly identified by CTA. Sensitivity, specificity, PPV, and NPV of CTA in detecting TICAs were 100%. To compare agreement with DSA, the standard of reference, confidence scores categorized as low, intermediate, and high probability yielded an overall effectiveness of 77.8% (95% CI 71.8%–82.9%). Conclusions Computed tomography angiography had limited overall sensitivity in detecting arterial injuries in patients with PTBI. However, it was accurate in identifying TICAs, a subgroup of injuries usually managed by either surgical or endovascular approaches, and non-TICA injuries involving the first-order branches of intracranial arteries.

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Section: Discussionsupporting

confidence: 55%

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Bodanapally¹,

Shanmuganathan²,

Boscak³

et al. 2014

JNS

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“…Studies from the Iran-Iraq conflict and Lebanon have suggested the risk factors for the development of intracranial pseudo-aneurysms, based on entry and exit sites, presence of intracerebral hematoma, wound profile crossing dural compartments, presence of retained fragments, absence of exit wound, presence of hematoma in the distal portion of the trajectory, and presence of delayed parenchymal bleed or SAH 2,5 . Similarly, Amirjamshidi et al have suggested angiography in patients with missile passage through Reil's triangle or transhemispheric injuries, large hematoma at the entry site and multiple shells and bone Figure 5 Comparison of discrimination ability of the individual radiologists and average score by ROC curves.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of intracranial vascular rupture after penetrating brain injury remains largely unknown due to significant mortality caused by severe trauma before admission to a hospital [1][2][3][4][5][6][7] . In those who survive, the aim of the emergent diagnostic strategy is to determine the extent of the intracranial damage and provide crucial information for therapeutic decision-making.…”

Section: Introductionmentioning

confidence: 99%

Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

et al. 2014

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“…These are usually rare and constitute less than 1% of wide intracranial aneurysm series and can be multiple. [8] Traumatic pseudoaneurysms usually rupture in the third week of the post-traumatic period and are mortal in 50%. [9,10] Pseudoaneurysms can develop in hours to years after penetrating traumas, with an average time to development of two to three weeks.…”

Section: Discussionmentioning

confidence: 99%

Penetrating head trauma with four nails: an extremely rare case

Arici¹,

Akgün²,

Kaplan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Yedi yıl önce şizofreni tanısı almış, 34 yaşındaki erkek hastanın kendi kafasına 4 adet çivi çakmasıyla gelişen nadir bir penetran kafa travması olgusu sunuldu. Fiziksel incelemede kafasının sağ temporal ve paryetal bölgesinde saçlı deri içerisinde kraniyuma çakılı 4 adet çivi vardı. Beyin omurilik sıvısı fistülü yoktu. Hastanın nörolojik incelemesinde motor ve duyu defisiti yoktu. Glasgow koma skoru 15 idi. Direkt kafa grafisinde ve beyin bilgisayarlı tomografisinde (BT) çivilerin yaklaşık 10 cm uzunluğun-da olduğu ve değişik yönlere uzandığı görüldü. BT anjiyografisinde büyük vasküler yapılarda yaralanma yoktu. Genel anestezi altında sağ temporal bölgede olan 2 çivi direkt çekilerek, sağ paryetal bölgede olan 2 çivi ise mini kraniyotomiler ile çıkarıldı. Temporal bölge gibi kemiğin ince olduğu alanlarda çivi direkt çekilip çıkarılabilir. Ancak paryetal kemik gibi kemiğin kalın olduğu bölgelerde bu yöntemle çivilerin çıkarılması her zaman mümkün olmayabilir.Anahtar Sözcükler: Çivi; penetran kafa travması; şizofreni We present a rare case of self-inflicted penetrating head trauma by a 34-year-old male who hammered four nails into his own head; he had been diagnosed with schizophrenia seven years before. On the physical examination, four nails were observed in the hairy scalp that had been driven into the cranium in the right temporal and parietal areas of the head. No cerebrospinal fluid fistulas were present. On the neurological examination, no motor or sensory deficits were present. The Glasgow Coma Scale was 15. On direct skull X-ray and cranial computerized tomography (CT), the nails were seen to be approximately 10 cm long and extending in various directions. No injury was observed in the main vasculature on CT angiography. Under general anesthesia, two nails in the right temporal area were removed by extraction, and the other two nails in the right parietal area were removed through a mini craniotomy. In areas such as the temporal area where the bone is thin, nails can be removed by extraction. However, in areas like the parietal bone where the bone is thick, removal of the nails using this method may not always be possible.

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Traumatic Intracranial Aneurysms Caused by Missiles: Their Presentation and Management

Cited by 107 publications

References 0 publications

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

Penetrating head trauma with four nails: an extremely rare case

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