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Bizhan Aarabi, Dale C. Hesdorffer, Edward S. Ahn, Carla Aresco, Thomas M. Scalea, and Howard M. Eisenberg

with secondary decompression following a primary surgery for evacuation of an intracranial hematoma. Nine of 53 patients with diffuse swelling were excluded from our analysis because they had undergone lobectomy or contusionectomy at the time of decompressive craniectomy. Prehospital Management Prehospital management was completed according to the standards of the Maryland Institute for Emergency Medical Services Systems, which is compatible with the Brain Trauma Foundation Guideline for Prehospital Management of Traumatic Brain Injury. 40 On admission to

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Bizhan Aarabi, David Chesler, Christopher Maulucci, Tiffany Blacklock, and Melvin Alexander

ICP, suggesting an important role for lymphatic drainage. 7 , 8 , 30 , 31 , 35 , 50 Incidence of SDGs In patients with a closed-head injury who have not undergone a DC, the reported incidence of SDG varies from 5 to 21%. 5 , 22 , 33 , 39 , 40 , 53 Ohno and colleagues 53 have reported 43 SDGs (6%) in 715 patients, and in the Kaufman et al. study 33 the incidence of an SDG was 38 (4%) in 881 patients with a closed-head injury. Born and associates 5 have described 16 patients (15%) with SDGs among 109 with blunt traumatic brain injury. The incidence of an SDG

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Bizhan Aarabi, Stuart Mirvis, Kathirkamanthan Shanmuganathan, Alexander R. Vaccaro, Cassandra J. Holmes, Noori Akhtar-Danesh, Michael G. Fehlings, and Marcel F. Dvorak

, paresthesia, and weakness, or any combination, was prevalent among patients with isolated, nondisplaced facet fractures. Seventeen (68%) of the 25 patients complained of mild to severe pain. The pain perception was at the level of the neck, shoulder, arm, or chest. Fourteen patients (56%) complained of paresthesia, usually along a specific nerve root. Ten patients (40%) complained of muscle weakness. Evidence of multiple injuries was observed in 13 patients (52%): internal carotid and vertebral arteries in 5 patients, traumatic brain injury in 6, pulmonary in 3, and

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Elizabeth Le, Bizhan Aarabi, David S. Hersh, Kathirkamanthan Shanmuganathan, Cara Diaz, Jennifer Massetti, and Noori Akhtar-Danesh

) a penetrating cervical spine and spinal cord injury, 2) AIS Grade E, 3) traumatic brain injury, 4) only 1 MRI scan or only CT myelograms, 5) a nontraumatic central cord syndrome, and 6) neurological worsening during the study period. Institutional Review Board Approval This study was approved by the institutional review board of the University of Maryland School of Medicine. Management Process Emergency Medical, Prehospital, Trauma Center, and Critical Care Management Emergency medical, transportation, trauma resuscitation unit, and inpatient

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Bizhan Aarabi, Babak Tofighi, Joseph A. Kufera, Jeffrey Hadley, Edward S. Ahn, Carnell Cooper, Jacek M. Malik, Neal J. Naff, Louis Chang, Michael Radley, Ashker Kheder, and Ronald H. Uscinski

critical care and neurosurgical management at 1 of the 9 trauma centers; 74 (38.5%) survived acute care and were discharged to have traumatic brain injury (TBI) rehabilitation. Thirty of 74 patients (40.5%) underwent neurosurgical management. Overall, 712 (91%) of the 786 patients in this series eventually died. Of the 69 patients who were admitted to the STC, 46 (66.7%) died; 21 were dead on arrival; and 25 died during their acute care. Of the 23 patients discharged, 6 were lost to follow-up and 17 had a follow-up of at least 3 months (mean 40.6, range 3–136 months

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Uttam K. Bodanapally, Kathirkamanathan Shanmuganathan, Alexis R. Boscak, Paul M. Jaffray, Giulia Van der Byl, Ashis K. Roy, David Dreizin, Thorsten R. Fleiter, Stuart E. Mirvis, Jaroslaw Krejza, and Bizhan Aarabi

I ntracranial arterial injuries in penetrating traumatic brain injury (PTBI) are caused by direct impact, by transfer of kinetic energy from the projectiles with resultant shock wave and cavitation, or by both means. 15 As a result, arteries can be damaged even in the absence of direct contact with the projectile. Bone fracture fragments and missile fragments can form secondary projectiles that can cause additional damage. 7 The true incidence of intracranial arterial injury after PTBI remains largely unknown; because of significant mortality associated

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Anthony A. Figaji, A. Graham Fieggen, and Jonathan C. Peter

, and would support a similar trial in children. Although Taylor et al. 3 reported modest benefit in the craniectomy group in their trial, their surgical approach was relatively conservative. The results of a more aggressive surgical approach would be interesting. References 1 Figaji AA , Fieggen AG , Peter JC : Early decompressive craniotomy in children with severe traumatic brain injury . Childs Nerv Syst 19 : 666 – 673 , 2003 2 Hatashita S , Koike J , Sonokawa T , Ishii S : Cerebral edema associated with craniectomy and arterial

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Bizhan Aarabi, Melvin Alexander, Stuart E. Mirvis, Kathirkamanathan Shanmuganathan, David Chesler, Christopher Maulucci, Mark Iguchi, Carla Aresco, and Tiffany Blacklock

Stage 2; 3 2) spinal cord injury without cord compression on MR imaging studies; 3) acute disc prolapse; 33 4) admission ASIA motor scores of 96–100; 17 5) patients who died or were unable to complete 12 months of follow-up; 6) patients with traumatic brain injury or baseline dementia; and 7) ASIA Impairment Scale Grades A, B, or E. 17 Patient Population From January 1, 2000, until April 30, 2008, 914 patients with symptomatic cervical spinal cord injuries were admitted to the R. Adams Cowley Shock Trauma Center, 211 of whom demonstrated the clinical

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Charles H. Tator, Robin Hashimoto, Annie Raich, Daniel Norvell, Michael G. Fehlings, James S. Harrop, James Guest, Bizhan Aarabi, and Robert G. Grossman

spinal cord injury . Exp Neurol 225 : 219 – 230 , 2010 44 Lee JS , Han YM , Yoo DS , Choi SJ , Choi BH , Kim JH , : A molecular basis for the efficacy of magnesium treatment following traumatic brain injury in rats . J Neurotrauma 21 : 549 – 561 , 2004 45 Lee SM , Yune TY , Kim SJ , Park DW , Lee YK , Kim YC , : Minocycline reduces cell death and improves functional recovery after traumatic spinal cord injury in the rat . J Neurotrauma 20 : 1017 – 1027 , 2003 46 Mami AG , Ballesteros J , Mishra OP

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Robert G. Grossman, Ralph F. Frankowski, Keith D. Burau, Elizabeth G. Toups, John W. Crommett, Michele M. Johnson, Michael G. Fehlings, Charles H. Tator, Christopher I. Shaffrey, Susan J. Harkema, Jonathan E. Hodes, Bizhan Aarabi, Michael K. Rosner, James D. Guest, and James S. Harrop

of the patients had a severe traumatic brain injury defined as having a GCS score of 8 or lower; 19% sustained a moderate or a mild traumatic brain injury. The prevalence of 1 or more preexisting medical morbidities among all patients was 66%. The leading morbidities were hypertension, alcohol or drug abuse, and diabetes. Aspects of Medical and Surgical Therapy: Corticosteroid and Surgical Therapy Administration of corticosteroids and surgical decompression of the spinal cord and stabilization of the vertebral column are commonly used therapies that can