Introduction: Before the CT scan was widely used for imaging, intraventricular hemorrhage (IVH) was a rare diagnosis and in most cases proved fatal. Currently, thanks to the CT scan IVH is easily diagnosed. Prognosis of IVH is very poor and almost always is accompanied with other intracranial traumatic lesions and pure traumatic IVH is very rare. Material and Methods: This descriptive study done on 28 patients with IVH. During a year 742 patients were admitted to the Neurosurgical Intensive Care Unit of Shahid Kamyab Hospital.Results: In 28 cases the leading cause of admittance was motor vehicle accidents, Most of the patients were between the age of 21-30., Out of 28 cases had IVH, 5 patients (18%) had pure IVH and the remaining others had intera cranial legions like, parenchyma hemorrhage, sub-arachnoids hemorrhage , brain contusions, subdural hemorrhage and acute hydrocephalus in one patient (3.6%). 82% of patients had a very low-conscious level at admittance, which measured by the Glasgow Coma Scale, lower than 8. Mortality was higher than 61%. Four patients had surgical treatment and all died. Eight cases did not have any surgical procedure.Conclusion: Traumatic IVH is very rare in severe blunt head injuries and is associated with other brain lesions and had a poor prognosis. Mortality rate is different and depends on other accompanying intracranial lesions. Surgical intervention does not have a significant effect for a successful out come.

Introduction: Brain injury is one of the most common causes of death among victims of trauma in various accidents. The type of accident and outcome could be different in children from adults. Therefore, we aimed to investigate the epidemiology of traumatic head injury in children. Materials and Methods: In this cross-sectional study, 114 patients (age≤ 15 years) with head trauma, who were admitted to trauma ward of Imam Reza hospital in 2018 were enrolled in the study. Data regarding the demographic characteristics, mechanism of trauma, season of trauma, hemodynamic findings and outcome of the patients were collected. Results: The mean age amongst victims of trauma was 6. 52± 3. 95 years and majority of them (70. 2%) were male. Most of traumatic accidents took place in the spring (27. 2%) and summer (32. 5%). Traffic accidents (pedestrians or passenger) (55. 3%) and falling (39. 5%) were the most common mechanism of trauma. Also, epidural hematoma (EDH) and brain contusion were the most encountered type of brain injury (1. 75%). Nine patients (7. 89%) underwent brain surgery. Eventually, eight patients (7. 17%) died. Conclusion: Falling and vehicle accidents are the main causes of head injury among children. Increasing the parents’ awareness toward these types of accidents and proper preventive measures can reduce traumatic brain injury.

Background: Head injury (HI) is preventable and knowledge of the epidemiology of children’s HI is essential for developing preventive strategies.Objectives: The aim of this study was to survey pediatric HI patients admitted to emergency wards at Poursina Hospital in Rasht, Iran, from 2009 to 2010, and to identify the cause of HI in these children.Patients and Methods: In this retrospective study, all HI patients under the age of 18 who were admitted to emergency wards between March 2009 and March 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed.Results: A total of 668 patients were included in this study. The mean age was 10.4 ±5.3 years. The most frequent cause of HI was traffic accidents. The mean Glasgow Coma Scale (GCS) score was 14.5 ±1.6. The ratio of boys to girls was approximately 3 to 1. The ratio of boys to girls increased with increasing age (P<0.01). Moreover, an association was found between age at injury and etiology of HI as well as a significant association between age at injury and the place of event (P<0.01).Conclusions: The incidence of childhood HI due to traffic accidents is high (81% of pediatric trauma cases). Thus, motorcyclist education and improvement in traffic engineering for pedestrians and bicyclists should be included in prevention programs.

Introduction: Electrolyte imbalance usually happens in I.C.U patients. Magnesium is one of the most important ions disturbance of this ion, causes hemodynamic instability, Cardiovascular dysfunction, Seizure, muscle weakness, Failure of weaning and influence other ions concentration. Objective: The onset time of magnesium imbalance after trauma and how does trauma mechanism interfere it, is the aim of this observational study. The aim of our study was survey the influence of kind of injury on magnesiume imbalance.Materials and Methods: In this Analytical study serum Magnesium (Mg) in patients with head trauma compared with patients with extremities trauma at admission time in ICU.We studied 30 head injury and 30 patients with extremities trauma during 1380. Two groups were same in age and sex and had no medical history. (PS I, II) 24 hour after trauma patients was admitted in I.C.U and blood sample was taken for evaluating serum Mg. [with calorimetric spectrophotometry (Reagent: Xylidylblue)]. Our Statistical Analysis was Chi- square. Results: Results showed that mean serum Mg of head trauma patients was 1.84 0.19 meq / L which was significantly lower than extremities trauma (2.23 ±‏ 0.29meq/ L, P < 0.02).Conclusion: This study showed that serum Mg in patients with head trauma decreases sooner and more sever than extremities trauma and concerning this on the first course of treatment in ICU and proper correction should be in mind.

Objective: To investigate the relationship between salivary amylase level and computed tomoraphy (CT scan) findings in patients with isolated mild traumatic Brain Injury (mTBI) referred to the emergency department of Shahid Hasheminejad Hospital. Methods: Patients with isolated mTBI and indication for brain CT scan who referred to the trauma center of Shahid Hasheminejad Hospital, Mashhad, Iran in 2019 were included in a cross-sectional study. In the initial examination, the patient’, s level of consciousness was measured using the Glasgow Coma Scale (GCS), and saliva samples were taken at the emergency department to determine the level of salivary amylase. A brain CT scan was performed for all patients. Age, gender, cause of trauma, the trauma severity and CT scan results were recorded. Statistical analysis was performed on the data. Results: One-hundred fifty patients were enrolled in this study (men=101, women=49). The trauma causes were included accidents (n=88,58%), falls (n=37,25%) and miscellaneous factors (e. g., quarrels,n=25,17%). GCS was 15 in 142 patients and 14 in the rest. In all patients, the trauma severity was mild to high risk (Minor). CT scan results unfolded pathology in 10 cases (7%), while the residues (93%) had normal CT scans with no pathological evidence. Salivary amylase level in the patients’,saliva samples was between 137 to 8000 units per liter. Using the t-test to evaluate the relationship between salivary amylase levels and CT scan results uncovered a significant relationship. Spearman correlation revealed no significant relationship between the amylase and GCS levels. Conclusion: Data statistical analysis from 150 patients with isolated head trauma manifested that salivary amylase levels were significantly higher in the patients with pathological findings on CT scans. However, no significant relationship was found between salivary amylase level and age, gender, cause of trauma, and level of consciousness.

Background: Seizure is common after head trauma and neurosurgery. Phenytoin is the most common anti-convulsant drug used in epileptic patients and for prevention of seizure in patients with head trauma and stroke. This drug has unique pharmacokinetic and pharmacodynamic characteristics. Phenytoin administration along with enteral nutrition in ICU patients may be accompanied by decreased phenytoin absorption and inadequate therapeutic concentration. The present study was performed to assess the effect of enteral nutrition on the pharmacokinetic therapeutic parameters of phenytoin given to our patients.Materials and Methods: In a clinical trial, the study group was divided into two groups of 15 patients each. After obtaining steady-state phenytion serum concentration, two blood samples were obtained from each patient on 2 consecutive days and then analyzed. The mean was assessed on the basis of serum albumin level of the patient. Clearance and maximum metabolic capacity were also calculated.Results: Serum phenytoin level was below the therapeutic range (10- 20 mg/l) in 70% of patients in group 1 and was higher than the therapeutic range in 70% of patients in group 2 who received oral phenytoin (by dissolving in water) 2h after enteral nutrition. Mean phenytion concentration was 6.3±4mg/l and 24.7±9.4mg/l in group 1 and group 2, respectively.Conclusion: We found oral phenytoin administration with enteral nutrition (gavage solutions) to result in a significant decrease in absorption and blood concentration of phenytoin. We recommend administration of phenytoin with water only.In addition, monitoring of phenytoin serum concentration is necessary for assessment of therapeutic concentration and prevention of side effects.

Background/Objective: To determine the frequency of computed tomography (CT) findings in patients with mild head trauma.Patients and Methods: In this cross-sectional study conducted between September 2005 and April 2006, 708 patients with mild head trauma as defined by a Glasgow Coma Score (GCS) of 13–15, were underwent standard clinical examination and cranial CT.Results: The mean±SD age of our patients was 26.8±19.03 years (range: 1 month to 89 years). 489 (68.9%) patients were male and 219 (30.8%) were female. GSC was 13 in 1%, 14 in 4.6% and 15 in 94.4% of patients. The most common mechanism of trauma was car accident and falling down, each of which happened for 132 patients (18.6%).The most common findings on CT were subgaleal hematomas in 213(30%) and intracranial lesions were seen in 41 patients (5.8%); among them 37 were male. Among intracranial lesions, the most common finding was epidural hematoma in 18 patients followed by hemorrhagic contusion in 13 patients. Intracranial lesions were observed in 28.6% of patients with GCS of 13; in 15.2% with GCS of 14 and in 5.1% with GCS of 15 (P=0.002).Conclusion: Many of patients with GCS equal to 15 after head trauma have considerable intracranial lesions and minor focal neurologic signs revealed by careful physical examination could be a good marker of these lesions.