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Eighty two (82) consecutive patients who presented with mechanical brain injury to the Accident and Emergency department of our hospital and were assessed with cranial Computerized Tomographic Scan between November 2005 and April 2006 were included in the study. Demographic data were obtained at admission. Clinical severity of head injury was assessed by the Glasgow Coma Scale Score just before cranial CT while morphologic severity was assessed using features on the same post-resuscitation cranial CTwith which theTCDB (Traumatic Coma Databank) grade and CT-HISAS (computerizedTomographic-Head injury Severity Assessment Scale) score were assessed. Both the TCDB and CT-HISAS scores were correlated with short-term outcomes using the Glasgow outcome score. Pearson's correlation coefficient, ANOVA and regression models were used as appropriate for statistical tests of significance.The age range of Patients was between 3 months and 86 years with a mean of 26.8 years and median of 25.9 years +/- 1.9 years (95% CL). There were more males (74.4%) than females (25.6%). There was a negative correlation between Post resuscitation GCS and CT-HISA score (p = -0.0141). However, although patients with non-functional outcome based on Glasgow Outcome score had higher CT-HISA scores, this relationship was not statistically significant. From our study, brain morphology on cranial CT using the CT-HISA Scale predicts clinical severity and outcome.We believe this study that CT-HISA may find useful application in assessment of teleradiologically transferred CT images of patients as well as research in mechanical brain trauma.

Background: Traumatic extradural haematoma is a rare condition and treatment in a majority of cases is by operative evacuation. Outcome from treatment is influenced by several factors., Objective: To evaluate the operative treatment of traumatic extradural haematoma in our centre and assess the impact on outcome of some of the historical factors., Methods: A retrospective study of cases managed January 1993-February 2004 using records from the Emergency Room, Wards, Theatre and Radiology Unit. Only the cases definitively diagnosed as extradural haematoma resulting from trauma and had operative evacuation, were recruited. The Glasgow Coma Scale was used to measure the severity of injury; whereas postoperative outcome was considered good in those with minimal or no neurological deficits. Collated data were analyzed and the patients were divided into 3 groups--good, moderate and fatal (poor) based on the outcome; the impact of the various historical factors was compared among the groups. Statistical analysis was done using the chi-square test and p-value of 0.05 or less was considered significant., Results: Majority of the patients were young, with mild head injury and good outcome, and a surprisingly long mean preoperative time lag of 123.1 hours. Outcome was good in 24 (64.9%), moderate 6 (16.2%) and fatal 7 (18.9%). There were skull fractures in 26 (70.3%), but there was no significant difference in outcome among those with and those without fractures., Conclusion: Age of the patient and severity of head injury (a reflection of concomitant brain injuries), more than other factors appear to dominantly prognosticate outcome from operative evacuation in our service.

Maxillofacial injuries are fairly common and they are usually found in association with multiple injuries. The proximity of the face to the craniospinal axis results in significant association between maxillofacial trauma and craniospinal injuries. Previous studies have enumerated this association but the injury types, classifications and influences of the concomitant injuries on the outcome of management are sketchy. In this study, road traffic accident was the commonest cause of maxillofacial and concomitant c raniospinal injuries: mild closed head injuries was the commonest concomitant injury occurring in almost 60% of the cases whilst mandibular fracture was the maxillofacial injury frequently encountered. The average duration of hospitalization in patients with maxillofacial trauma and concomitant mild head injury was 19 days but it was much higher (average 34.9 days) in patients with concomitant spinal injuries. The high incidence of head injury would suggest that maxillofacial units are best cited in hospitals with functional neurosurgical services.

Head injury is an important cause of mortality worldwide. The objective of the present study was to analyse the pattern of fatal head injury among patients seen in University College Hospital, Ibadan. The study was based on retrospective investigation of cases of fatal head injury referred by the coroner to the Department of Pathology, University College Hospital, between 1991 and 2000. Pertinent clinical and postmortem findings were extracted from available coroner's autopsy records. There were 529 cases (402 males and 127 females). Their ages ranged from <1 year to 90 years (mean=33 years), the average age of females (27.8) being less than that of males (34.6) (p=0.00003). 83.8% were road traffic accidents, 8.9% falls from a height, 3.8% assault, and 3% gunshot injuries. 79.1% had a GCS of 8 or less at presentation. The mean survival period of children aged less than 15 years was 2 days while that of adolescents and adults aged 15 years and above was 5.6 days (p=0.02). Subdural (62.4%), subarachnoid (24.6%), epidural (10.2%), and intracerebral (10%) haemorrhages were the major causes of death. Skull fractures occurred in 38.2%, while cerebral contusions occurred in 22.1%. Intracranial infection was relatively uncommon in these patients. The present study has shown that young adults, predominantly males in their most productive years of life, are especially prone to fatal head injury.

The records of 457 head trauma patients who underwent plain cervical spine radiography following head injury between January 1991 and December 1991 inclusive were reviewed. Seventy-six patients (17%) all above ten years of age had abnormalities; forty five were clinically suspected to have cervical spine injury because of cervical tenderness and/or neurological deficits and in the remaining thirty-one patients the cervical spine injuries were detected first on plain radiograph. The 31 vertebral injuries consisted off fracture-dislocations 12 fractures, 4 dislocations and one odontoid fracture. None of the 235 patients below the age of 10 years had cervical vertebral or cord injury. It is recommended that plain cervical spine radiography be performed on all patients with head injury associated with altered level of consciousness and who are above ten years of age.