Objectives: Head injury is a devastating condition in developing countries like South Africa, contributing significantly to mortality and morbidity. The various factors affecting outcome like age, gender, mechanism of injury, clinical, radiological findings and treatment is reported. Their relation to outcome (Glasgow Outcome Score) of treatment in Chris Hani Baragwanath Academic hospital is analyzed. Methods: This is a retrospective, descriptive and demographic profile study. The sample group consists of moderate to severe head injury patients admitted in the neurosurgical unit of Chris Hani Baragwanath Academic hospital from January 2011 to June 2012. The data includes age, gender, nature of head injury (scalp, skull, intracranial), mode of injury (fall from height, road traffic accident, fire arm injury, assault, blast injury), condition at presentation [Glasgow Coma Scale (GCS)], pupillary reaction, Computed Tomography (CT) scan findings, treatment received and outcome [Glasgow Outcome Score (GOS)] of treatment. Results: A total of 292 patients was enrolled in the study, 258 males (88.3%) and 34 females (11.6%). In the age distribution 50 patients were below 19 years, 161 patients were between 20 to 39 years, 60 patients 40 to 59 years and 21 patients above 60 years. The various mechanisms of injury noted were assault in 127 patients, pedestrian vehicular accident in 50 patients, motor vehicular accident in 33 patients, motor bike accidents in 4 patients, train accidents in 2 patients, gunshot injury in 6 patients, fall from height in 35 patients and struck by heavy object in 5 patients.123 patients had a GCS between 3-5, 72 patients GCS between 6-8 and 97 patients GCS 8-12. 192 patients had equal and reacting pupils after the head injury, 52 patients unilateral fixed pupils and 10 patients bilateral fixed pupils. The Computed tomography (CT) of the brain showed 287 patients with focal intracranial findings, 107 with diffuse brain injury and 168 patients with features of raised intracranial pressure. 129 patients (44.1%) were surgically treated and 163 patients (55.8%) treated conservatively with medical treatment. The variables age, mechanism of injury, GCS, pupillary reaction, raised intracranial pressure and type of management was compared to GOS and found to be statistically significant. Conclusions: The outcome of patients with moderate to severe head injury has no effect on gender but has a significant relationship between age and mortality. The mechanism of head injury has a direct effect on the prognosis with gunshot head having the worst outcome. The important prognostic factors affecting the outcome include: age of patients, severity of head injury (GCS), pupillary reactivity to light and the pathology of the brain CT scan. The unfavorable prognostic factors are: old age, non-reacting pupils to light, severe head injury (low GCS) and raised ICP after head injury. Medical or surgical management have similar mortality rate. / Submitted in fulfillment for the requirements of the degree of Master of Medicine in Neurosurgery Faculty of Health Science University of Witwatersrand

No description available.

This thesis is submitted in partial fulfillment of the requirements for the degree of Master of Science in Emergency Medicine( Msc Med EM), Division of Emergency Medicine, University of Witwatersrand , Faculty of Health Sciences , School of Clinical Medicine, Department of Family Medicine, 2012 / 1. BACKGROUND AND SETTING The study was conducted at Vryheid district hospital in the Kwazulu- Natal province. The increasing number of traumatic brain injuries seen at the hospital has prompted me to describe traumatic brain injuries in the community. Data was collected from the records of casualty department and the hospital wards. 2. AIM This thesis describes traumatic brain injuries at Vryheid district hospital during 2009. 3. METHODS It is a retrospective cohort study with a total sample size of 596 participants; retrieved from patients’ registers at the hospital’s casualty department and hospital wards. 4. RESULTS - The peak age of occurrence of traumatic brain injuries (TBI) at Vryheid is between 20 and 30 years with 75% of injuries happening in younger than 35 years and a mean age of 29 years. - 78% of traumatic brain injuries occurred in female patients but it is important to note that females are in greater number than males at Abaqulusi municipality. - Blacks are the most affected by the traumatic brain injuries at Vryheid: 97% versus 2.4% in white and 0.3 in Asians. - Blunt traumatic brain injuries are the most common type of TBI at Vryheid: 97%. - Assault injuries constitute the major cause of traumatic brain injuries ( 57 %) followed by motor vehicle accidents (40%) - Mild traumatic brain injuries represent 75% of traumatic brain injuries presenting at Vryheid during 2009. - The majority of TBI patients at Vryheid were discharged either from casualty department or from the wards and only as small number of patients died or was transferred out. Moreover, 60% of patients were treated as ambulatory patients. - 94% of TBI at Vryheid hospital had a good prognosis and only a small percentage was associated with bad prognosis. - The mean hospital length stay at Vryheid was 2.2 days with a minimum of less than a day (62%) and a maximum of 129 days. 5. CONCLUSION In 2009, traumatic brain injuries were found to be common at Vryheid hospital in the black population and were mainly due to assault injuries and motor vehicle accidents. Moreover, motor vehicle accidents were associated with high mortality. Although, the majority of traumatic brain injuries at Vryheid hospital were mild, 10% were severe. Thus, TBI at Vryheid constitutes a public health concern that needs to be addressed by the SA government in consultation and collaboration with various stakeholders.

Thesis (doctoral)--København, 1980.

Diss. (sammanfattning) Stockholm : Karol. inst., 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2002. / Bibliography: leaves113-128.

Thesis (M.Sc. (Physiology))--Mahidol University, 1982.

Thesis (doctoral)--Rijksuniversiteit te Groningen.

Made available in DSpace on 2013-08-07T19:08:18Z (GMT). No. of bitstreams: 1 000449211-Texto+Parcial-0.pdf: 158484 bytes, checksum: 16db88bea9b358e2895521faa0ba81c3 (MD5) Previous issue date: 2013 / TBI individuals may present great functional disability. Most of these dysfunctions is related to clinical manifestations of cognitive impairment, which creates several losses in different areas, such as work, autonomy and, as a consequence, on the quality of life of individuals and their relatives. In this context, studies have discussed the heterogeneity of clinical manifestations in TBI, which challenges research of clinical trials and characterization studies as a whole. One of the main issues in the field of clinical and cognitive neuropsychology is the understanding of executive functions (EF) post-TBI and their neural correlates. For this reason, it is of great interest to integrate neuropsychological evaluation, classical methods of clinical neuropsychology and neuroimaging. This dissertation aimed to investigate EF in TBI individuals by means of two studies. The first study investigated the profile of executive functioning in a sample of TBI individuals. This study included an extensive neuropsychological evaluation with a primary focus in FE. Results showed three different profiles of FE: Cluster 1 was characterized by difficulties in processing speed, phonemic verbal fluency and inhibition; Cluster 2 was formed by multiple deficits in FE, such as processing speed, working memory, planning, cognitive flexibility and verbal fluency; finally Cluster 3 had no or very mild difficulties on the EF examined.The second study investigated the two cases of adults with mild TBI with different education levels on EF performance and brain structures volumetry and cortical thickness. The patient with high education surpassed the patient with low education in four variables of FE and different structures of brain volume and cortical thickness. The results suggest that education seems to be a feature of cognitive reserve in mild TBI. Together, these studies contribute for answers to an important question about heterogeneity of TBI and clinical studies. Our findings reinforce the importance of group interventions constituted according to sociocultural variables and cognitive profiles, rather than sociocultural, individual and clinical variables. However, when considering case analysis, sociocultural variables seem to be important for cognitive performance and brain reorganization in mild TBI. / Os indivíduos que sofrem TCE podem ter grande incapacidade funcional. A maior parte dessas disfunções tem relação com manifestações clínicas de prejuízos cognitivos, o que cria diversas perdas em diferentes áreas, tais como, trabalho, autonomia e como conseqüência uma qualidade de vida não apenas o indivíduo, mas também todos aqueles que estão envolvidos com ele. Neste contexto, os estudos têm discutido a heterogeneidade das manifestações clínicas do TCE, ainda um grande desafio em ensaios clínicos e estudos de caracterização como um todo. A maior lacuna na área de neuropsicologia clínica e cognitiva é a compreensão das funções executivas (FE) pós-TCE e de seus correlatos neurais. É de grande interesse integrar a avaliação neuropsicológica, os métodos clássicos clínicos da neuropsicologia, e técnicas avançadas de neuroimagem. A presente dissertação visou ainvestigar FE no contexto clínico do TCE. Dois estudos foram realizados nesta dissertação. O primeiro estudo avaliou o perfil de funcionamento executivo de uma amostra de TCE. Este panorama executivo foi baseado em uma extensa avaliação neuropsicológica com foco principal em FE. Os resultados apontaram três perfis diferentes de FE: o Cluster 1 foi caracterizado por dificuldades em velocidade de processamento, fluência verbal fonêmica e inibição; o Cluster 2 foi formado por múltiplos déficits em FE, tais como, de velocidade de processamento, memória de trabalho, planejamento, flexibilidade cognitiva e fluência verbal; finalmente o Cluster 3 não apresentou dificuldades executivas objetivamente examinadas. O segundo estudo investigou o desempenho em tarefas de FE e índices de volumetria e de espessura cortical em regiões de interesse por seu correlato com FE em dois casos de adultos com TCE leve com diferentes escolaridades.O paciente com alta escolaridade superou o paciente de baixa escolaridade em quatro variáveis das FE e em diferentes estruturas de volume cerebral e espessura cortical. Os resultados sugerem que a educação parece ser uma característica de reserva cognitiva no TCE leve. Juntos, esses estudos contribuem com respostas a uma pergunta importante sobre possíveis soluções para a heterogeneidade neuropsicológica do TCE. Nossos achados reforçam a relevância de intervenções em grupo constituído de acordo com variáveis socioculturais e perfis cognitivos. Para a formação de subgrupos clínicos de TCE, seu funcionamento executivo parece ser sido a principal variável, na medida em que não houve diferenças quanto a fatores socioculturais,m individuais nem clínicos. No entanto, quando se considera análise de casos, variáveis socioculturais parecem importantes para o desempenho cognitivo e para a reorganização cerebral no TCE leve.