exudates and Hematoma--Subdural

To study the relationship pattern of intracranial hemorrhage in cases of traumatic petrous temporal bone fracture.. All head injury cases admitted to the Emergency Department, Hospital Tengku Ampuan Afzan, Pahang, Malaysia in 2008 were assessed. Computerized tomography (CT) scan of the skull base was performed in indicated cases. Patients with a petrous temporal bone fracture were included in the study. Subsequent magnetic resonance imaging (MRI) was performed. Intracranial hemorrhages incidence, management and outcome were recorded.. From 1421 cases of head injury, 49(3.4%) patients were diagnosed to have a petrous bone fracture from the CT scan. Only 46 cases underwent MRI scan and were included in this study. Of these, 36(78.3%) cases had associated intracranial hemorrhages (p<0.01). Intracranial hemorrhage was associated with the longitudinal types of petrous fracture (p<0.05). Subdural hematoma was the most prevalent type of bleed (55.6%). There was no association between the types of intracranial bleeding (extradural, subdural, subarachnoid or intracerebral hemorrhage) and the types of petrous bone fracture (longitudinal, oblique or transverse). The mortality rate was 17.4%. The mortality cases were associated with the presence of other skull bone fractures (p<0.05).. Petrous fracture is significantly associated with intracranial hemorrhage. There was no association between the types of petrous fracture and the types of intracranial hemorrhages in our material.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hematoma, Epidural, Cranial; Hematoma, Subdural; Hematoma, Subdural, Intracranial; Hospital Mortality; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Incidence; Intracranial Hemorrhages; Magnetic Resonance Imaging; Malaysia; Male; Middle Aged; Multiple Trauma; Petrous Bone; Prognosis; Skull Fractures; Survival Rate; Temporal Bone; Tomography, X-Ray Computed; Young Adult

Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not.

Topics: Accidents; Child Abuse; Craniocerebral Trauma; Decision Making; Female; Hematoma, Subdural; Humans; Incidence; Infant; Infant Welfare; Infant, Newborn; Malaysia; Male; Predictive Value of Tests; Retinal Hemorrhage; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed

A teenager college student was fatally injured by burst tyre air pressure while waiting on a public bus stand to catch a bus to reach her college at Kuala Lumpur. She accidentally came near the wheel while boarding when tube and tyre got burst .The air pressure had blown the girl in the air and she subsequently fell on a rough surface. The iron-locking rim of the wheel acted as a missile and hit the girl. She died on her way to the hospital. A medico-legal autopsy was performed which showed extensive injuries in the cranial and chest cavity. Head had large scalp laceration with diffuse separation and gaping from in the vault region; skull bones were fractured. Chest cavity had extensive rib fractures, lacerated lungs and haemo-thorax while externally there was no obvious injury. It requires intensive care management and screening of the victims. Tyre-blast injuries are not so common. This case exposes the hazard due to burst tyre.

Topics: Adolescent; Air Pressure; Blast Injuries; Contusions; Explosions; Female; Forensic Pathology; Hematoma, Subdural; Hemothorax; Humans; Lung Injury; Malaysia; Motor Vehicles; Rib Fractures; Skull Fractures; Subarachnoid Hemorrhage, Traumatic

This paper gives a detailed account of 30 cases of childhood deaths caused by physical abuse, detected by the Suspected Child Abuse and Neglect (SCAN) team, General Hospital, Kuala Lumpur. They consisted of 12 Malays, 6 Chinese, 9 Indian, and 1 Indonesian child. Three cases could not be ascertained as to their ethnic origin. There were 13 male and 17 female children. The average age of the abused children was 2 years 5 months. The most frequent causes of death were intracranial hemorrhage and intraabdominal trauma. Of the 17 cases of intracranial hemorrhage, only four had X-ray evidence of skull fracture. This suggests the possibility of whiplash injuries with/without the abuser suspecting that he/she had injured the child. Of the 22 abusers who could be identified, there was no sex differentiation. Fathers formed the largest group of perpetrators, followed by mothers and childminders. Fifteen of the natural parents of the abused children were married, four were divorced and four were never married. Five of the abusers had aggressive personalities and three were drug addicts. Only one abuser was found to be an alcoholic even though a few were also under suspicion. For most cases, trigger factors could not be identified.

Topics: Battered Child Syndrome; Cause of Death; Child; Child Abuse; Child Abuse, Sexual; Child of Impaired Parents; Child, Preschool; Developing Countries; Family Characteristics; Female; Hematoma, Subdural; Humans; Infant; Infant, Newborn; Malaysia; Male; Whiplash Injuries

Topics: Adult; Aged; Chronic Disease; Female; Hematoma, Subdural; Hospitals, General; Humans; Malaysia; Male; Middle Aged; Retrospective Studies