RESUMEN
Purpose: The purpose of this study is to highlight the importance of cranial falling bullet injuries and raise awareness about them. We studied the clinical and radiological findings, and their relation to the treatment and outcome. There are limited studies in this field.Materials and methods: Thirty patients, (aged 8-55 years) with cranial falling bullet injury were included in this study. They were followed during their hospitalization and up to 6 months thereafter. Post-resuscitation clinical findings, unenhanced brain CT scan findings, treatment and outcome (Glasgow Outcome Scale) were studied.Results: Male to female ratio was (1.73:1). Median age of all patients was: 17.5 years. 20(66.7%) patients had a GCS of 13-15, 3(10%) had 9-12, 2(6.7%) had 6-8, and 5(16.6%) had 3-5 at presentation. 23(76.7%) patients had normal pupillary reaction and symmetry whereas 7(23.3%) had poor reaction and/or asymmetry. On CT scan, 13 had a unilobar injury, six had multilobar or bihemispheric injuries, 10 had a bullet through the deep midline structures of the brain, seven had transventricular with IVH, four had SAH, none had large intracranial hematomas. All patients received medical treatment. Local wound care and/or extraction of extracranial subgaleal bullets were performed in 24 patients (80%). More extensive surgery was performed in six patients (20%). There was significant correlation (using Correlation Coefficient) between GCS, pupillary reaction/symmetry and CT imaging findings with the patient outcome. Low GCS, poor pupillary reaction and/or asymmetry, CT findings of central area injury, transventricular, IVH, or multilobar injury were associated with poor outcome.Conclusions: Cranial falling bullet injuries are uncommon, but they can cause significant morbidity and mortality. More studies are needed to document the impact of these injuries and to raise awareness among the society to support the efforts aiming at controlling the irrational use of guns in different countries of the world.
Asunto(s)
Accidentes por Caídas , Adolescente , Adulto , Niño , Femenino , Escala de Coma de Glasgow , Humanos , Irak , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía , Adulto JovenRESUMEN
PURPOSE: The existing literature on the use of dermatomal somatosensory evoked potentials in lumbosacral spinal canal stenosis is limited. The goal of this study was to evaluate the role of dermatomal against mixed tibial somatosensory evoked potential (SEP) as a complementary procedure to imaging studies in the diagnosis of lumbosacral stenosis. METHODS: Thirty patients with clinically and radiologically diagnosed lumbosacral stenosis and 20 normal individuals were enrolled in the study. The study was ethically approved, and informed consent for participation was provided. All participants underwent bilateral mixed tibial and dermatomal SEP study of the third (L3), fourth (L4), fifth lumbar (L5), and first sacral (S1) dermatomes. N45, N25, N20, and N10 tibial SEP waves were measured from four channels, whereas dermatomal waves were measured from cortical recording. Peak latency and amplitude of each wave were calculated. RESULTS: The cutoff value of the dermatomal S1 latency showed the highest sensitivity and specificity percentages (81.7 and 82.5, respectively), followed by L5 and N25. N25-N45 interpeak latency showed the lowest sensitivity and specificity. All L5, S1, L4, and N25 latency cutoff values presented highly significant differences between affected sides and controls (P < 0.0001), followed by N45 and N20. The amplitude cutoff values of SEP waves showed equivocal sensitivity and specificity percentages. CONCLUSIONS: Somatosensory evoked potential studies can be used as a supplementary test for the diagnosis of lumbosacral stenosis, with the dermatomal studies being more valuable expressing multiple root abnormalities. S1 dermatomal wave latency has the highest diagnostic value, followed by L5, N25, and then L4 latencies.