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Cranial nerve lesions caused by head-injuries
Proceedings of the Netherlands Society of Neurology S c i e n t i f i c S e s s i o n h e l d in U t r e c h t o n A p r i l 26, 1974. Theme: Head-injuries.
EPIDEMIOLOGY OF ROAD-ACCIDENTS R. Vos, The Hague An analysis was made of the road accidents in the Netherlands. About 4 9 ~ of the road-accidents included head-injuries, 1.6~o injuries of the cervical spine and 3.8Y0 other parts of the spine. It was found that the mortality of the accidents outside towns was larger than of the accidents inside towns. This was not only caused by the difference in speed of cars etc., but also by the time elapsing till the patient arrived at the hospital. The need for better and faster first-aid was stressed.
C R A N I A L NERVE LESIONS CAUSED BY HEAD-INJURIES A. R. WATTENDORF,Leiden A study concerning the incidents and outcome of injury to the optic, oculomotor, trochlear, abducens and facial nerves in 3500 cases of blunt head-injury was made. Out of 13 complete optic nerve lesions one showed complete recovery, two partial and l0 none. One of four subtotal lesions recovered. For 9 complete oculomotor lesions the figures for complete, partial and no recovery were: l, 6 and 2 resp.; for the 9 incomplete lesions: 8, nil and I. There were l0 complete trochlear nerve lesions, 8 showing complete and 2 partial recovery. 1 incomplete lesion recovered partially. 15 complete abducens lesions recovered totally in l I, partially in 2 cases, and remained complete in 2. Out of 28 incomplete facial nerve lesions, 26 recovered complztely. 16 out of 23 complete lesions showed full or satisfactory, and 7 partial and cosmetically unsatisfactory recovery. 5 cases were operated upon: in none complete severance of the nerves was found. Apart from post-traumatic anousmea these nerves are the ones most liable to indirect injury. The described frequency and prognosis are roughly in accordance with the literature, with the exception of the oculomotor nerve, the latter showing a less favourable outcome in these series.
'CEREBRAL S H O C K ' IN H E A D - I N J U R E D PATIENTS? O. G. MULDER, The Hague From 358 head-injured patients, eight with a shock within six hours after admission were studied. In all cases the shock had to be regarded - as was confirmed at operation or autopsy - as the result of an unnoticed loss of blood elsewhere in the body. This study confirms the statement that in headinjured patients who are still breathing, a shock is allways of surgical origin and mostly can be found and cured. In cases with severe brainstem lesions, which did not cause an immediate death, it is more likely that disturbances of the breathing and apnoe precede a lowering of the blood pressure.
EPIDEMIOLOGY OF ROAD-ACCIDENTS R. Vos, The Hague An analysis was made of the road accidents in the Netherlands. About 4 9 ~ of the road-accidents included head-injuries, 1.6~o injuries of the cervical spine and 3.8Y0 other parts of the spine. It was found that the mortality of the accidents outside towns was larger than of the accidents inside towns. This was not only caused by the difference in speed of cars etc., but also by the time elapsing till the patient arrived at the hospital. The need for better and faster first-aid was stressed.
C R A N I A L NERVE LESIONS CAUSED BY HEAD-INJURIES A. R. WATTENDORF,Leiden A study concerning the incidents and outcome of injury to the optic, oculomotor, trochlear, abducens and facial nerves in 3500 cases of blunt head-injury was made. Out of 13 complete optic nerve lesions one showed complete recovery, two partial and l0 none. One of four subtotal lesions recovered. For 9 complete oculomotor lesions the figures for complete, partial and no recovery were: l, 6 and 2 resp.; for the 9 incomplete lesions: 8, nil and I. There were l0 complete trochlear nerve lesions, 8 showing complete and 2 partial recovery. 1 incomplete lesion recovered partially. 15 complete abducens lesions recovered totally in l I, partially in 2 cases, and remained complete in 2. Out of 28 incomplete facial nerve lesions, 26 recovered complztely. 16 out of 23 complete lesions showed full or satisfactory, and 7 partial and cosmetically unsatisfactory recovery. 5 cases were operated upon: in none complete severance of the nerves was found. Apart from post-traumatic anousmea these nerves are the ones most liable to indirect injury. The described frequency and prognosis are roughly in accordance with the literature, with the exception of the oculomotor nerve, the latter showing a less favourable outcome in these series.
'CEREBRAL S H O C K ' IN H E A D - I N J U R E D PATIENTS? O. G. MULDER, The Hague From 358 head-injured patients, eight with a shock within six hours after admission were studied. In all cases the shock had to be regarded - as was confirmed at operation or autopsy - as the result of an unnoticed loss of blood elsewhere in the body. This study confirms the statement that in headinjured patients who are still breathing, a shock is allways of surgical origin and mostly can be found and cured. In cases with severe brainstem lesions, which did not cause an immediate death, it is more likely that disturbances of the breathing and apnoe precede a lowering of the blood pressure.