Incidence of cranial nerve injury in mild head injury

Dhandayuthapani, V (2013) Incidence of cranial nerve injury in mild head injury. Masters thesis, Madras Medical College, Chennai (3 Years Course).


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INTRODUCTION: Head injury affects up to 2% of the population per year and constitutes the major cause of death and severe disability among young people. Road traffic accidents play a significant role in world wide mortality rate, which is about 2.1%14. About 85% of the road traffic accidents occur in the developing countries being a major share of global burden. India accounts for about 10% of road accident fatalities worldwide. An injury to head may cause various types of impact over the brain and calvarium like brain contusions, subarachnoid bleed, subdural haematomas, extradural haematomas, calvarial fractures, cranial nerve injury, scalp and facial injuries. Although cranial nerves injuries is not of prime concern in emergency department, cranial nerves injuries should be given adequate importance to avoid neurological morbidities that lead to compromise in quality of life, which requires long-term management, repeated surgical procedures or reconstructive measures. The cranial nerves deficit has significant social and occupational impact over the patient. So, greater attention is to be paid for the earlier diagnosis and appropriate treatment at the right time. AIM OF THE STUDY: 1. Is to document the occurrence of cranial nerve injuries in patients with mild head injury. 2. To correlate cranial nerve injury in mild head injury with radiological findings, to assess the outcome of patients with respect to initial clinical presentation. 3. To study the value of meticulous clinical examination in head injury patients. MATERIALS AND METHODS: It is a prospective analytical study; study period was from August 2010 to February 2013 in the Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. Thousand consecutive patients admitted in our hospital trauma ward with mild head injury were studied for the incidence, type, mode and outcome of various cranial nerve injuries. Categorization of severity of head injury was based on Glasgow coma scale (GCS) score, GCS 13-15- mild, GCS 9-12-moderate, GCS 3-8-severe. Inclusion Criteria: Regardless of age and sex, patients who were willing to participate in the study with GCS 13, 14 and 15 were included. Exclusion Criteria: • Patients with GCS 12 and less. • Patients with pre-existing cranial nerve injuries and other non traumatic causes of cranial nerve palsies like bell`s palsy. • Patient who did not come for regular follow up were excluded. CONCLUSION: 1. The incidence of cranial nerve injury in mild head injury is around 15%. 2. In olfactory nerve injury CSF rhinorrhea (dural tear) is the single most negative prognostic factor in this study. 3. In optic nerve injury visual evoked potential is the most important indicator for optic nerve recovery. 4. Cranial nerve injury (III, IV&VI) associated with skull bone fracture had a relatively poor outcome and was found to be statistically significant. 5. Trigeminal nerve injury is relatively uncommon. 6. The commonest cranial nerve involved is seventh cranial nerve (facial nerve) which was about 32.4 percent of cranial nerve injured. 7. Oblique type of temporal bone fracture is commonly associated Vestibulocochlear nerve injury with poor prognosis. 8. Lower cranial nerve (Nine, ten, eleven and twelve) injuries were very rarely mild head injury. 9. Road traffic accidents are the prime mode of injury and middle age male population were commonly injured. 10. This study also emphasizes the value of meticulous clinical examination in head injury patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Incidence, cranial nerve injury, mild head injury.
Subjects: MEDICAL > Neuro Surgery
Depositing User: Kambaraman B
Date Deposited: 02 Jan 2018 10:38
Last Modified: 12 Feb 2020 01:11

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