• The Journal of the Korea Contents Association
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• v.16 no.5
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• pp.58-67
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• 2016

Pragmatic language impairment is closely related to the executive function difficulties in patients with acquired brain injury(ABI). This study was designed to explore the correlation between two domains following ABI. Thirty-five participants with ABI were grouped into 21 aphasics due to stroke and 14 TBIs. All subjects were over 55 years old. Measures of two domains were administered to all participants. As a result, figurative language comprehension and functional/symbolic language were significantly correlated with the activating task in aphasic group. All tasks were significantly correlated in TBI group. Aphasic patients' figurative language comprehension significantly predicted the activating task. In TBI group, figurative language expression and functional/symbolic language were the predictable tasks of planning and activating, respectively. Current study demonstrates the evidence of a significant association between pragmatic language and executive function, and provides appropriate tasks used for cognitive-linguistic intervention of individuals with ABI.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.244-250
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• 2010

Objective : Adequate management of increased intracranial pressure (ICP) is critical in patients with traumatic brain injury (TBI), and decompressive craniectomy is widely used to treat refractory increased ICP. The authors reviewed and analyzed complications following decompressive craniectomy for the management of TBI. Methods : A total of 89 consecutive patients who underwent decompressive craniectomy for TBI between February 2004 and February 2009 were reviewed retrospectively. Incidence rates of complications secondary to decompressive craniectomy were determined, and analyses were performed to identify clinical factors associated with the development of complications and the poor outcome. Results : Complications secondary to decompressive craniectomy occurred in 48 of the 89 (53.9%) patients. Furthermore, these complications occurred in a sequential fashion at specific times after surgical intervention; cerebral contusion expansion ($2.2{\pm}1.2$ days), newly appearing subdural or epidural hematoma contralateral to the craniectomy defect ($1.5{\pm}0.9$ days), epilepsy ($2.7{\pm}1.5$ days), cerebrospinal fluid leakage through the scalp incision ($7.0{\pm}4.2$ days), and external cerebral herniation ($5.5{\pm}3.3$ days). Subdural effusion ($10.8{\pm}5.2$ days) and postoperative infection ($9.8{\pm}3.1$ days) developed between one and four weeks postoperatively. Trephined and post-traumatic hydrocephalus syndromes developed after one month postoperatively (at $79.5{\pm}23.6$ and $49.2{\pm}14.1$ days, respectively). Conclusion : A poor GCS score ($\leq$ 8) and an age of $\geq$ 65 were found to be related to the occurrence of one of the above-mentioned complications. These results should help neurosurgeons anticipate these complications, to adopt management strategies that reduce the risks of complications, and to improve clinical outcomes.

• Journal of Korean Neurosurgical Society
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• v.49 no.6
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• pp.355-358
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• 2011

Objective : Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. Methods : From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. Results : The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). Conclusion : GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG and the group without SDG. Analysis of radiological factors indicated that a midline shifting exceeding 5 mm, SAH, delayed hydrocephalus, compression of basal cisterns, and tearing of the arachnoid membrane were significantly more common in patients with SDG.

• Journal of Trauma and Injury
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• v.33 no.1
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• pp.48-52
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• 2020

Composite skull defects in patients with severe head injuries are very challenging to manage. The dilemma when deciding whether to perform a definitive reconstruction is how long to wait for physiological recovery before an intervention complicates the situation. The inability of such patients to tolerate prolonged anesthetic exposure is a driving factor for performing the minimal intervention necessary to facilitate recovery. Herein, we present a case involving the successful immediate reconstructive treatment of a severely head-injured adolescent with a composite scalp defect secondary to trauma. A 14-year-old boy sustained a severe head injury from a motor vehicle accident with a composite scalp defect in the right fronto-parietal region. The frontal lobe was exposed, and the right eye was crushed and devitalized. The patient was deeply unconscious for 3 days, without any significant improvements before reconstructive surgery was proposed due to fear of possible meningitis resulting from the exposure of brain structures. We successfully managed the patient with a fronto-parieto-occipital flap, after which the patient promptly recovered consciousness.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.16-21
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• 2007

Objective : Civilian gunshot injuries to the brain are relatively rare and study of these injuries has been neglected in South Korea. We present our experience with penetrating gunshot injuries to the brain and review the outcome of surgical management, as well as other clinical predictors influencing the prognosis. Methods : We present a retrospective analysis of 13 patients with penetrating gunshot injuries to the brain who were treated at our hospital over a period of 22 years. Results : The Glasgow Coma Scale[GCS] score on admission was recorded to be : 3-5 in 1 patient, 6-8 in 3 patients, 9-12 in 2 patients and 13-15 in 7 patients. There were 11 patients who underwent surgical treatment, and the surgical mortality rate was 0%. The admission GCS score was the most valuable prognostic factor. The best results were found to be in patients admitted with an initial GCS higher than 13. There were no favorable outcomes in patients admitted with a GCS of 8 or lower. There was a correlation between the presence of a transventricular or bihemispheric trajectory and poor outcome. The patients admitted with unilobar wounds resulted in better outcome than those with bilobar or multilobar wounds. Retained deep intracranial bone or metal fragments were the most common postoperative complication. However, retained fragments did not increase the risk of infection or seizure. Conclusion : Our results suggest that a less aggressive approach, consisting of minimal local debridement and removal of the bone and metal fragments that are easily accessible, can be successfully used in civilian gunshot wounds to the brain.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.5
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• pp.3344-3352
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• 2015

The purpose of this study is to investigate the effects of Korean computer-based cognitive rehabilitation program (CoTras) on frontal-executive functions in patients with traumatic brain injury (TBI). This study was performed at C hospital in Changwon, Gyeongsangnam-do, Korea from August 2013 to March 2014. Ten patients with TBI were randomly divided into two groups. The experimental group had been given CoTras once a day, five times a week for four weeks, whereas the control group had performed self-cognitive training under the same conditions. To verify the effect of intervention, the following executive function measures were used: Korean Montreal Cognitive Assessment (K-MoCA), Executive Clock Drawing Test (ECDT), Trail Making Test (TMT), Rey-Complex Figure Test (RCFT). Intervention group showed significant increase in K-MoCA, TMT, RCFT-delayed recall (p<.05). However, control group showed no significant change in any test. There was significant difference of changed scores (post test-pre test) between two groups in K-MoCA, TMT and RCFT-delayed recall (p<.05). This study showed that CoTras is effective to improve frontal-executive functions in patients with traumatic brain injury.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.177-182
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• 2021

Purpose: Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries. Methods: We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients' demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records. Results: A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3). Conclusions: For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient's hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.209-216
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• 2012

Purpose: The objectives of this study are to classify chronic subdural hematomas based on brain computerized tomographic scan (CT scan) findings and to determine the mechanism of evolution and treatment methods. Methods: One hundred thirty-nine patients who were diagnosed with a chronic subdural hematoma and who available for follow up assessment 6 months post-surgery were analyzed retrospectively. The presence of trauma and past medical history were reviewed and evaluation criteria based on brain CT scan findings were examined. Results: Initial brain CT scans revealed a chronic subdural hematoma in 106 patients, a subdural hygroma in 24 patients, and an acute subdural hematoma in 9 patients. In all cases where the initial acute subdural hematoma had progressed to a chronic subdural hematoma, final was a hypo-density chronic subdural hematoma. In case where the initial subdural hygroma had progressed to a chronic subdural hematoma, the most cases of hematoma were hyper-density and mixed-density chronic subdural hematoma. In total, 173 surgeries were performed, and they consisted of 97 one burr-hole drainages, 70 two burr-hole drainages and 6 craniotomies. Conclusion: This study demonstrates that rebleeding and osmotic effects are mechanisms for enlarging of a chronic subdural hematoma. In most cases, one burr-hole drainage is a sufficient for treatment. However, in cases of mixed or acute-on-chronic subdural hematomas, other appropriate treatment strategies are required.

• Journal of Trauma and Injury
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• v.36 no.1
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• pp.8-14
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• 2023

Purpose: The aim of this study was to assess the agreement between intraoperative transcranial sonography (TCS) and postoperative computed tomography (CT) in patients with traumatic brain injuries. Methods: We performed a retrospective cross-sectional study of 35 patients who underwent TCS during surgery, among those who presented to a regional trauma center and underwent decompressive craniectomy between January 1, 2017 and April 30, 2020. Results: The mean difference between TCS and CT in measuring the midline shift was -1.33 mm (95% confidence interval, -2.00 to -0.65; intraclass correlation coefficient [ICC], 0.96; P<0.001). An excellent correlation was found between TCS and CT in assessing contralateral subdural hematomas (ICC, 0.96; P<0.001) and focal hematoma lesions (ICC, 0.99; P<0.001). A very good correlation between TCS and CT was found for measurements of ventricle width (ICC, 0.92; P<0.001). Conclusions: TCS during surgery is considered an effective diagnostic tool for the detection of intraoperative parenchymal changes in patients with traumatic brain injuries.