Traumatic Conditions

The pathological anatomy of traumatic deformities of the upper cervical vertebrae and articulations is based on the nature and mechanism of injury. Their treatment on the other hand, depends quite substantially on the presence and features of neurological deficits and pathological dislocations which can be hazardous to neural structures. The common traditional management of fractures and dislocations of the upper cervical spine are external immobilization or operative posterior fusion, or both. 

Forces which can cause odontoid fracture are combinations of flexion, extension and rotation of the craniocervical junction. The actual shape and position of the fracture and the final dislocation of the odontoid will be determined by the resultant of the different vectors of forces on the actual position of the neck and head when the impact took place. 

The odontoid can be sheared from the C2 vertebra by its ligaments or may be distracted from it by its apical ligament. The three main types of odontoid fractures are illustrated by Anderson and d Alonzo (1974). 

The optimal treatment remains controversial. Most of the patients can effectively be treated by immobilizing them in a halo device and only few, especially the long-standing ones, require posterior surgical fusion (Prols et al. 1973, Apuzzo et al. 1978, Ekong et al. 1981, Tator et al. 1982). 

Others suggest, that in so called type two fractures (fracture at the junction of the odontoid with the body of the axis) early posterior cervical fusion (wiring and onlay bone graft) is more effective (Maiman and Larson 1982). Schiess et al. (1982) believe that surgical fusion should be considered as the initial treatment of all types of odontoid fractures. 

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The neuroprotective properties of mild hypothermia have been demonstrated in numerous experimental animal models. Research in this area has been conducted for many years, yet the mechanisms of cerebral protection by mild hypothermia remain unclear and continue to be the subject of intense investigation. The neuroprotective effects of mild hypothermia have been attributed to alterations in metabolic rate (24), neurotransmitter release (25-27), activity of protein kinases (28), resynthesis of cellular repair proteins (29), cerebral blood flow (30), preservation of the blood-brain barrier (BBB) (31), attenuation of inflammatory processes (32,33), and decreases in free radical production (34). Although these may all be components of a complex cascade leading to neurologic injury, it has become increasingly clear that the primary mechanism of action of hypothermia may be different at various temperatures as well as under different ischemic and traumatic conditions. 

Methocarbamol is an aromatic glycerol ether that is a close chemical relative to mephenesin carbamate. Methocarbamol is approved in the USA for parenteral administration to horses as an adjunct to the treatment of acute inflammatory and traumatic conditions of the skeletal muscles and to reduce muscular spasm. Its mechanism of action has not been established, but it may act by central nervous system depression. It has no direct action on the contractile mechanism of striated muscle, the motor end plate or the nerve fiber (Plumb... 

Aneurysms of the posterior cerebral artery (PCA) are relatively rare compared with those in other locations. Extremely rare are singular berry aneurysms of the PCA. Often, this type of aneurysm is either associated with the incidence of multiple aneurysms or with other vascular disorders like ar-terious-venous-malformations, moyamoya disease or ipsilateral internal carotid occlusion for various reasons. Other rare causes are infectious and post-traumatic conditions. Some authors figured out that the incidence of PCA aneurysms is approximately... 

Narcotic medicines contain substances causing addiction. Many opioid preparations show strong analgetic action, which can alleviate even the strongest pain. Therefore, they are used in acute, post-traumatic conditions post-traumatic shock, as prevention and in cancer. Based on chemical criteria, these drugs are divided into morphine and its products, morphinan derivatives, benzomorphan derivatives, piperidine derivatives and diphenylpropylamine derivatives. 

Among the biochemical reactions that anino acids undergo is decarboxylation to fflnines. Decar boxylation of histidine, for example, gives histamine, a powerful vasodilator nonnally present in tissue and fonned in excessive fflnounts under conditions of traumatic shock. 

Other conditions of coma in patients with loss of consciousness (metabolic, traumatic)... 

Post-traumatic stress disorder (PTSD) is a severe condition with a lifetime prevalence of about 12.5% in women and 6.2% in men (Pigott, 1999). About one in four individuals exposed to trauma develop the syndrome. Drug treatments are still being developed, mostly using antidepressants. Few systematic data are available on the pharmacoeconomics of the condition. 

Acute intraabdominal contamination, such as after a traumatic injury, may be treated with a very short course (24 hours) of antimicrobials.25 For established infections (i.e., peritonitis or intraabdominal abscess), an antimicrobial course limited to 5 to 7 days is justified. Under certain conditions, therapy for longer than 7 days would be justified, e.g., if the patient remains febrile or is in poor general condition, when relatively resistant bacteria are isolated, or when a focus of infection in the abdomen still may be present. For some abscesses, such as pyogenic liver abscess, antimicrobials may be required for a month or longer. 

The terror of this experience with her father along with her mothers refusal to help her, forced young Cathy to dissociate from these events by creating an entirely new personality, to deal with her father. Traumatic events in one s life can create a repressed memory or a condition of shock so severe that the victim becomes incapable of living with it on their own. In O Brien s case she discovered her family s perverted and abusive sexual history during her upbringing, but since that was all she knew, the acceptance of ritual abuse was sadly became the norm. 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

Features of central sensitization are pain in response to normally innocuous tactile stimuli, and the spread of pain sensitivity beyond the site of tissue injury. Central sensitization plays a major role in acute post-traumatic pain, and also in migraine, neuropathic pain (see below) and some diffuse chronic pain syndromes, such as fibromyalgia and irritable bowel syndrome. In these conditions, which have no detectable peripheral trigger, an autonomous central sensitization may be the pathology, increasing the gain in neuronal activity in the CNS and thereby producing abnormal responses to normal inputs. 

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

There is extensive clinical evidence that NE plays a role in hiunan anxiety. Well-designed psychophysiological studies have been conducted that have documented heightened autonomic or sympathetic nervous system arousal in combat veterans with chronic PTSD. Because central noradrenergic and peripheral sympathetic systems function in concert (Aston-Jones et al. 1991), the data from these psychophysiology investigations are consistent with the hypothesis that noradrenergic hyperreactivity in patients with PTSD may be associated with the conditioned or sensitized responses to specific traumatic stimuli. 

Development of characteristic symptoms following an extreme traumatic event Chronic excessive anxiety and worry about a number of events or activities Symptoms of anxiety that are judged to be a direct physiological consequence of a general medical conditions... 

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