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Effects of knock-out
292
Injury, 14, 292
Printedin Great Britain
Abstracts Injuries
of the
head
and spine
Injury to the optic nerve
Four cases are described, of which one underwent decompression by microsurgical techniques within 2 days. There was considerable improvement. In the other 3 patients the interval between injury and decompression varied from 5 weeks to nearly 3 months and even in these some improvement in vision was achieved. The approach was through the ethmoid sinus. Chouard C. H., Meyer B. and Lacombe H. (1982) Traumatismes fermes du nerf optique. J. Traumatol. 2, 175.
Missed injuries of spinal cord
Of 353 men admitted consecutively to a spinal injury unit, I5 had not at first had injuries of the spinal cord recognized. Of these, I I were cervical and 4 dorsal. Delay in diagnosis ranged from 12 hours to 10 days but was mostly l-3 days. At least IO became worse before the correct diagnosis was made and only 9 of the I5 improved while under treatment in the spinal injury unit. Such errors may be increasing; they had occurred in 5 of 64 more recent admissions. The ususal causes of oversight were radigraphic-poor quality of films, inadequate examination and incorrect interpretation of adequate films. Six had sustained head injury, 5 had multiple injuries, 4 had little or no paralysis and 3 were drunk. Unrecognized tetraparesis outnumbered paraparesis by 3 to 1. Ravichandran G. and Silver J. R. (1982) Missed injuries of the spinal cord. Br. Med. J. 284,953.
Effects of knock-out
Ten professional boxers were studied by detailed neurological examination, EEG and CT scan shortly after being knocked out in the ring. Their previous boxing history was also examined. Only one revealed any abnormality on clinical examination, but 5 were shown to have a degree of cerebral atrophy on CT scan. In general, but not always, this occurred in those boxers who had had the most bouts. It is recommended that these findings be heeded by those medical officers who examine and advise professional boxers.
Casson I. R., Sharn R. A. J., Campbell E. A. et al. (1982) Neurological and CT evaluation of knockedout boxers. J. Neural. Neurosurg. Psychiatty 45, 170-4.
Auscultatory
percussion of the head
The forehead is tapped with a finger in the midline above the frontal sinuses and the sound emitted is listened to through a stethoscope applied to the sides of the head from the level of the tops of the ears (in the seated subject) upward. The presence of a spaceoccupying lesion within the skull gives rise to a dull note. The findings of this test were compared with those obtained by computerized tomography. Fiftyone patients had abnormal tomograms and 44 of these had positive findings on percussion. All patients with subdural haematomas yield positive results on percussion. Two of 27 with normal tomograms gave positive results on percussion. Guarino J. R. (1982) Auscultatory percussion of the head. Br. Med. J. 284, 1075.
Inter-hospital
transfer
of head-injured
patients
‘Head injuries travel well’: this oft-stated opinion receives another telling blow from the findings of this study of I50 persons moved from one hospital to another while in coma. Sixty-one suffered incidents that aggravated secondary damage to the brain and injuries of other parts of the body received less than adequate care in 2 I cases. Nearly one-quarter of the patients were found to be hypoxaemic on arrival at the second hospital-a neurosurgical unit. The cause was usually choking on blood, vomitus and inhaled secretions. Over onequarter had no apparatus to ensure easy breathing and nearly half those without an endotracheal tube travelled supine. Eighteen stopped breathing and in 3 of these the heart stopped later. These adverse occurrences were associated with markedly worse final results. With increasing resort to computerized tomography, the hazards of transference need to be widely recognized and no less widely prevented. Gentleman D. and Jennett B. (198 1) Hazards of inter-hospital transfer of comatose head injured patients. Lance?2, 853.
Injury, 14, 292
Printedin Great Britain
Abstracts Injuries
of the
head
and spine
Injury to the optic nerve
Four cases are described, of which one underwent decompression by microsurgical techniques within 2 days. There was considerable improvement. In the other 3 patients the interval between injury and decompression varied from 5 weeks to nearly 3 months and even in these some improvement in vision was achieved. The approach was through the ethmoid sinus. Chouard C. H., Meyer B. and Lacombe H. (1982) Traumatismes fermes du nerf optique. J. Traumatol. 2, 175.
Missed injuries of spinal cord
Of 353 men admitted consecutively to a spinal injury unit, I5 had not at first had injuries of the spinal cord recognized. Of these, I I were cervical and 4 dorsal. Delay in diagnosis ranged from 12 hours to 10 days but was mostly l-3 days. At least IO became worse before the correct diagnosis was made and only 9 of the I5 improved while under treatment in the spinal injury unit. Such errors may be increasing; they had occurred in 5 of 64 more recent admissions. The ususal causes of oversight were radigraphic-poor quality of films, inadequate examination and incorrect interpretation of adequate films. Six had sustained head injury, 5 had multiple injuries, 4 had little or no paralysis and 3 were drunk. Unrecognized tetraparesis outnumbered paraparesis by 3 to 1. Ravichandran G. and Silver J. R. (1982) Missed injuries of the spinal cord. Br. Med. J. 284,953.
Effects of knock-out
Ten professional boxers were studied by detailed neurological examination, EEG and CT scan shortly after being knocked out in the ring. Their previous boxing history was also examined. Only one revealed any abnormality on clinical examination, but 5 were shown to have a degree of cerebral atrophy on CT scan. In general, but not always, this occurred in those boxers who had had the most bouts. It is recommended that these findings be heeded by those medical officers who examine and advise professional boxers.
Casson I. R., Sharn R. A. J., Campbell E. A. et al. (1982) Neurological and CT evaluation of knockedout boxers. J. Neural. Neurosurg. Psychiatty 45, 170-4.
Auscultatory
percussion of the head
The forehead is tapped with a finger in the midline above the frontal sinuses and the sound emitted is listened to through a stethoscope applied to the sides of the head from the level of the tops of the ears (in the seated subject) upward. The presence of a spaceoccupying lesion within the skull gives rise to a dull note. The findings of this test were compared with those obtained by computerized tomography. Fiftyone patients had abnormal tomograms and 44 of these had positive findings on percussion. All patients with subdural haematomas yield positive results on percussion. Two of 27 with normal tomograms gave positive results on percussion. Guarino J. R. (1982) Auscultatory percussion of the head. Br. Med. J. 284, 1075.
Inter-hospital
transfer
of head-injured
patients
‘Head injuries travel well’: this oft-stated opinion receives another telling blow from the findings of this study of I50 persons moved from one hospital to another while in coma. Sixty-one suffered incidents that aggravated secondary damage to the brain and injuries of other parts of the body received less than adequate care in 2 I cases. Nearly one-quarter of the patients were found to be hypoxaemic on arrival at the second hospital-a neurosurgical unit. The cause was usually choking on blood, vomitus and inhaled secretions. Over onequarter had no apparatus to ensure easy breathing and nearly half those without an endotracheal tube travelled supine. Eighteen stopped breathing and in 3 of these the heart stopped later. These adverse occurrences were associated with markedly worse final results. With increasing resort to computerized tomography, the hazards of transference need to be widely recognized and no less widely prevented. Gentleman D. and Jennett B. (198 1) Hazards of inter-hospital transfer of comatose head injured patients. Lance?2, 853.