Posterior Fossa Trauma
Traumatic brain injury remains one of the leading causes of residual neurological and neuropsychological deficits in every age group independent from socioeconomic status. Posterior fossa trauma affects structures within the posterior fossa, that is, brai
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€rsdorf, Dagmar Timmann, and Matthias Maschke, Maria Mo Uwe Dietrich
Abstract
Traumatic brain injury remains one of the leading causes of residual neurological and neuropsychological deficits in every age group independent from socioeconomic status. Posterior fossa trauma affects structures within the posterior fossa, that is, brainstem and cerebellum. It consists of intra-axial lesions such as contusions, hematoma or diffuse axonal injury, and extra-axial lesions such as epidural and subdural hematoma as well as subarachnoid hemorrhage. Imaging should guide surgical and conservative treatment. CT imaging is the method of choice since it is easier to conduct than MRI and readily available. However, in some cases, MRI is necessary to detect subtle lesions within the brainstem and to visualize long-term complications such as olivary pseudohypertrophy or superficial siderosis of the CNS. In spite of advances in intensive care management, especially control of raised intracranial pressure, and neurosurgical methods, mortality of posterior fossa trauma remains high and a high proportion of surviving patients exhibit substantial neurological deficits.
M. Maschke (*) Department of Neurology, Krankenhaus der Barmherzigen Br€ uder, Nordallee 1, 54292 Trier, Germany e-mail: [email protected] M. M€orsdorf Department of Neuroradiology, Bruederkrankenhaus Trier, Nordallee 1, 54292 Trier, Germany e-mail: [email protected] D. Timmann Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany e-mail: [email protected] U. Dietrich Department of Neuroradiology, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany e-mail: [email protected] M. Manto, D.L. Gruol, J.D. Schmahmann, N. Koibuchi, F. Rossi (eds.), 2055 Handbook of the Cerebellum and Cerebellar Disorders, DOI 10.1007/978-94-007-1333-8_95, # Springer Science+Business Media Dordrecht 2013
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M. Maschke et al.
Introduction Traumatic brain injury (TBI) is one of the major health problems that affect every age group and society and causes a substantial socioeconomic burden. In recent years, patterns of injury have been changing, with more injuries, especially contusions, occurring in older patients (Maas et al. 2008). The heterogeneity of TBI is one of the most significant barriers for goal-directed therapeutical interventions. Thus, correct classification of TBI in an individual patient is one of the mainstays of rapid installment of neurosurgical or conservative treatment (Saatman et al. 2008). Primary (direct) or secondary (indirect) traumatic injuries of brain structures localized within the posterior fossa (i.e., cerebellum and brainstem) have been named “posterior fossa trauma” (Fisher et al. 1958; Tsai et al. 1980). Primary traumatic injuries are commonly subdivided into closed/open head injuries, and intra- or extra-axial lesions. Intra-axial brain lesions are defined by intraparenchymal cerebellar or brainstem damage caused by concussion and contusion, diffuse axon
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