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The relationship of chronic subdural hemorrhage to head injury is not always clear In many elderly persons there is no history of trauma, but in other cases a head injury, often trivial, precedes the onset of symptoms by several weeks The clinical presentation is usually with mental changes such as slowness, drowsiness, headache, confusion, memory disturbances, personality change, or even dementia Focal neurologic deficits such as hemiparesis or hemisensory disturbance may also occur but are less common CT scan is an important means of detecting the hematoma, which is sometimes bilateral Treatment is by surgical evacuation to prevent cerebral compression and tentorial herniation There is no clear evidence that prophylactic anticonvulsant therapy reduces the incidence of posttraumatic seizures Normal-pressure hydrocephalus may follow head injury, subarachnoid hemorrhage, or meningoencephalitis Other late complications of head injury include posttraumatic seizure disorder and posttraumatic headache

And get the table data:

Vincent JL et al Primer on medical management of severe brain injury Crit Care Med 2005 Jun;33(6):1392 9 [PMID: 15942361] Winter CD et al A review of the current management of severe traumatic brain injury Surgeon 2005 Oct;3(5):329 37 [PMID: 16245652]

Treatment of the injury consists of immobilization and if there is cord compression decompressive laminectomy and fusion Early treatment with high doses of corticosteroids (eg, methylprednisolone, 30 mg/kg by intravenous bolus, followed by 54 mg/kg/h for 23 hours) has been shown to improve neurologic recovery if commenced within 8 hours after injury Various other therapies are being investigated Anatomic realignment of the spinal cord by traction and other orthopedic procedures is important Subsequent care of the residual neurologic deficit paraplegia or quadriplegia requires treatment of spasticity and care of the skin, bladder, and bowels

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Tator CH Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations Neurosurgery 2006 Nov;59(5):957 82 [PMID: 17143232] Thuret S et al Therapeutic interventions after spinal cord injury Nat Rev Neurosci 2006 Aug;7(8):628 43 [PMID: 16858391]

Table<OrderDetails> orderDetails = db.GetTable<OrderDetails>( );

History of preceding trauma Development of acute neurologic deficit Signs of myelopathy on examination

Destruction or degeneration of gray and white matter adjacent to the central canal of the cervical spinal cord leads to

.

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cavitation and accumulation of fluid within the spinal cord The precise pathogenesis is unclear, but many cases are associated with Arnold-Chiari malformation, in which there is displacement of the cerebellar tonsils, medulla, and fourth ventricle into the spinal canal, sometimes with accompanying meningomyelocele In such circumstances, the cord cavity connects with and may merely represent a dilated central canal In other cases, the cause of cavitation is less clear There is a characteristic clinical picture, with segmental atrophy and areflexia and loss of pain and temperature appreciation in a cape distribution owing to the destruction of fibers crossing in front of the central canal Thoracic kyphoscoliosis is usually present With progression, involvement of the long motor and sensory tracts occurs as well, so that a pyramidal and sensory deficit develops in the legs Upward extension of the cavitation (syringobulbia) leads to dysfunction of the lower brainstem and thus to bulbar palsy, nystagmus, and sensory impairment over one or both sides of the face Syringomyelia, ie, cord cavitation, may also occur in association with an intramedullary tumor or following severe cord injury, and the cavity then does not communicate with the central canal In patients with Arnold-Chiari malformation, there are commonly skeletal abnormalities on plain x-rays of the skull and cervical spine CT scans show caudal displacement of the fourth ventricle MRI or positive contrast myelography may demonstrate the malformation itself Focal cord enlargement is found at myelography or by MRI in patients with cavitation related to past injury or intramedullary neoplasms Treatment of Arnold-Chiari malformation with associated syringomyelia is by suboccipital craniectomy and upper cervical laminectomy, with the aim of decompressing the malformation at the foramen magnum The cord cavity should be drained, and if necessary an outlet for the fourth ventricle can be made In cavitation associated with intramedullary tumor, treatment is surgical, but radiation therapy may be necessary if complete removal is not possible Posttraumatic syringomyelia is also treated surgically if it leads to increasing neurologic deficits or to intolerable pain.

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Greitz D Unraveling the riddle of syringomyelia Neurosurg Rev 2006 Oct;29(4):251 63 [PMID: 16752160]

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