Neurological health risk in children with blunt head injuries: fashion hair beads
The results of two new large scale trials show that the combination of dihydroartemisinin and piperaquine (DHA+PQP) not only is effective against uncomplicated malaria in a way which is comparable to other artemisinin-based combination therapies (ACTs), but it also protects patients against new infections for at least two months after treatment. The DHA/PQP combination is
Full Post: Combo malaria treatment dihydroartemisinin and piperaquine shows promise
An intriguing article published in the December 2008 online issue of Journal of Neurosurgery: Pediatrics may come as quite a surprise to parents, especially those with little girls.
The article, “Radiolucent hair accessories causing depressed skull fracture following blunt cranial trauma” discusses the cases of a 4-year-old and 2 ½-year-old treated for blunt head trauma. The article is posted online at: http://thejns.org/doi/full/10.3171/PED.2008.2.12.424.
Authors are Omar N. Syed, MD, Richard C. E. Anderson, MD, Neil A. Feldstein, MD, Todd C. Hankinson, MD, and William J. Mack, MD, physicians in the Department of Neurological Surgery, Columbia University Medical Center.
Blunt head trauma is commonly encountered by pediatric neurosurgeons and emergency physicians. Every year, the U.S. Consumer Product Safety Commission provides head injury statistics for patients treated at U.S. hospital emergency rooms. More than 550 product codes were included in the 2007 Product Summary Report. In 2007, an estimated 1.1 million people were treated for head injuries related to common products found inside the home. Beds are among the top five products that contribute to head injuries, with an estimated 106,513 injuries in 2007, 63,269 of which were in children age 14 and younger. Common household products that can actually penetrate the head include wires, plugs, nails, kitchen utensils, writing instruments, hair accessories, scissors, and toys, among others.
“Children younger than age 2 are at particularly high risk for neurological injury because the skull is not fully ossified and small forces may lead to penetration of the skull and dura,” stated Dr. Anderson. The complications of these injuries can be severe, including skull fracture, subdural and epidural hematoma, pneumocephalus, cerebral hemorrhage, infection, seizure, focal neurological deficits, and vascular complications.
“Hair beads are radiolucent and thus are difficult to differentiate on radiologic scans from the adjacent soft tissue - the air-filled hollow core may be mistaken for benign air that became entrapped at the time of injury. Fashion hair accessories present a hidden and often overlooked health risk in children who have suffered blunt head trauma, significant enough to cause skull fractures and complicate diagnosis and treatment,” remarked Dr. Anderson.
Injury from blunt trauma by common household objects carries the potential for significant morbidity and mortality. “The absence of an obvious foreign body on physical examination in one of these two cases, demonstrates the importance of considering fashion hair accessories in the differential diagnosis when children present with head injury following blunt trauma,” concluded Dr. Anderson.
A 4-year-old girl fell to the floor from a height of about 4 feet. She struck her head on the wooden leg of a bunk bed and then onto the carpeted floor. There was no loss of consciousness, vomiting, or seizure activity. On examination, the patient was neurologically intact. A 2.5-cm right parietal scalp laceration, moderate bleeding, and an underlying hematoma were observed. A defect in the skull could be palpated, but no foreign object was identified. Emergency room physicians closed the wound with staples. Skull radiography showed a 2-cm deformity in the right parietal bone. The CT scan revealed a right parietal skull fracture with depressed fragments. At the fracture site, a spherical radiolucency was noted. In the operating room, neurosurgeons found a 1.2-cm plastic hair bead embedded in her skull. This was easily removed, and the skull fracture was elevated. The patient tolerated the procedure and there were no complications.
A 2 ½-year-old girl fell from a bunk bed. There was no loss of consciousness, nausea, vomiting, or seizure activity. Initial examination at another hospital revealed a 1.5-cm plastic hair bead protruding from the scalp laceration in the frontal midline. The girl was transferred to Columbia University Medical Center, where the CT scan revealed a comminuted, depressed fracture of the anterior paramedian frontal bone, a small epidural hematoma, and two small foci of air, causing swelling in the soft tissue of the frontal lobes. A CT angiogram showed posterior displacement of the superior sagittal sinus but no evidence of thrombosis. The patient was brought immediately to the operating room. After the scalp was opened, the foreign body embedded in the bone was identified and easily removed, exposing the fragments of bone beneath. A small craniectomy within the fractured bone allowed identification of the dura mater, and the bone fragments were carefully dissected from the dura. The dura was found to have a split-thickness tear, but there was no evidence of bleeding or cerebrospinal fluid leak. The patient tolerated the procedure and there were no complications.
The authors report no conflict of interest.
Founded in 1944, the Journal of Neurosurgery , the official scientific journal of the AANS, has been recognized by neurosurgeons and related medical specialists worldwide for its authoritative and cutting-edge clinical articles, laboratory research papers, case reports, literature reviews, technical notes, book reviews, and more. Each successive editor-in-chief - from Louise Eisenhardt to the current editor, John A. Jane, Sr. - has played a key role in shaping a publication that stays on the cutting edge of a constantly advancing specialty. Each manuscript is reviewed by at least three editorial board members, in addition to the Editor and occasionally one or more expert reviewers.
If you will exert too much pressure on a bone, more than the threshold pressure which it can tolerate, it will break. This is usually termed as bone fracture and is a very painful thing. Fractures are considered as a major form of injury. However, whether a person can recover from them depends on a
Full Post: Symptoms of a fracture
However, their facial injuries speak volumes. Newly released research in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals, shows women who are victims of intimate partner violence tend to have different patterns of facial injury than women who experience facial trauma from other causes. Temple University facial plastic surgeon
Full Post: Women who suffer abuse at the hands of a loved one may not be so quick to talk about it
An estimated 55 million children and teens from birth to age 19 were treated in emergency departments for unintentional injuries from 2001 to 2006, according to a new report released today by the Centers for Disease Control and Prevention (CDC). The report also notes that between 2000 and 2005, unintentional injuries resulted in 73,052 deaths
Full Post: CDC report details child and teen injuries / fatalities in the U.S.
A new method for determining more accurately at which point someone needs further diagnostic tests, or when immediate treatment is warranted, has been developed by The National Osteoporosis Guideline Group in the UK. Rather than relying primarily on Bone Mineral Density (BMD) measurements, as the majority of current guidelines do, their approach takes into account
Full Post: Better targeted, more cost-effective osteoporosis treatment could soon be a reality worldwide
Australian researchers have issued a warning about the danger of “head-banging” which is usually associated with heavy-metal music. The researchers from the University of New South Wales say fans who indulge in head-banging put themselves at risk of head and neck injuries and they advise fans to either wear a protective brace or switch
Full Post: Avoid headbanging injury by switching to Celine Dion?