CT scan findings in mild head trauma: a series of 2,000 patients Achados tomográficos no trauma cranioencefálico leve: análise de 2000 casos

The present study describes the cranial computed tomography (CT) scan findings of 2,000 cases of mild head trauma (HT) in Curitiba, Southern Brazil. The mean age of the entire series was 30.8 <FONT FACE=Symbol>&plusmn;</FONT>19 years. The overall male to female ratio was 2:1. The most common causes of head injury were interpersonal aggression (17.9%), falls (17.4%), automobile accidents (16.2%), falls to the ground (13.1%) and pedestrian injuries (13 %). Alcohol intoxication was associated with HT in 158 cases (7.9%). A normal CT scan was seen in 60.75% (1215) and an abnormal CT scan in 39.25% (785) of patients. Out of 785 abnormal CT scan, 518(65.9%) lesions were related to HT. The most common CT scan HT related findings were: soft tissue swelling (8.9 %), skull fractures (4.3 %), intracranial and subgaleal hematomas (3.4% and 2.4 %), brain swelling (2 %) and brain contusion (1.2%). Out of 785 abnormal CT scans, 267 (34.1%) lesions were not related to head trauma. Incidental CT scan findings included brain atrophy (5.9%), one calcification (5.2%) several calcifications (2.4%) (probably neurocysticercosis in most cases), ischemic infarct (1.9%) and leukoaraiosis (1.3%). These findings showed the importance of CT scan examination in mild head injuries. Further studies to identify mild HT patients at higher risk of significant brain injury are warranted in order to optimize its use.<br>São descritos os achados de tomografia computadorizada craniana (TC) de 2000 casos de trauma cranio-encefálico (TCE) leve em Curitiba, Paraná. A idade média de toda série de pacientes foi 30,8 <FONT FACE=Symbol>&plusmn;</FONT> 19 anos. A razão homem/mulher foi 2:1. A causas mais comuns de TCE foram agressão interpessoal (17,9%), quedas de nível (17,4%), acidentes automobilísticos (16,2%), queda ao solo (13,1%) e atropelamento (13%). Intoxicação por álcool foi um importante fator associado ao TCE e esteve presente em 158 casos (7,9% de 2000 pacientes). Uma TC normal ocorreu em 60,75% (1215) e uma TC anormal em 39,25% (785) dos pacientes. Das 785 TC anormais, os achados tomográficos mais comuns relacionados ao TCE foram: aumento de partes moles (8,9%), fraturas de crânio (4,3%), hematoma intracraniano e subgaleal (3,4% e 2,4%), "swelling" cerebral (2%) e contusão cerebral (1,2%). Os principais achados incidentais das TC anormais foram: atrofia cerebral (5,9%), uma calcificação (5,2%), múltiplas calcificações (2,4%), lesões isquêmicas vasculares (1,9%), leucoaraiose (1,3%). Achados mais incomuns foram calcificação de gânglios da base (0,8%), lesão ocupando espaço-neoplasia (0,4%) e cisto aracnóideo (0,5%). Estes achados mostram a importância da TC no TCE leve. Estudos para avaliar pacientes com TCE leve e com alto risco de lesão cerebral significativa são ainda necessários para otimizar o uso da TC

A Systematic Review of the Treatment of Fears and Phobias Among Children with Autism Spectrum Disorders

Research indicates that fears and phobias are significantly more prevalent and emerge in response to a greater variety of stimuli, among children with autism spectrum disorders (ASD) than among their developmentally disabled or typically developing peers. Such findings are problematic given the difficulty of assessing and identifying fears or phobias among the ASD population and the challenge of identifying effective treatments for those with core diagnostic deficits in comprehension, communication, and attentional skills. The current review aimed to evaluate the literature describing interventions to treat fears, specific phobia, or social phobia among children with ASD and to identify evidence-based practice in this area. The review indicated that a variety of interventions, described as both traditional and novel, were successful in treating fearful or phobic behavioral responses to stimuli. The findings also suggest that behavioral intervention, including reinforcement, modeling, and exposure, may be considered evidence-based practice in the treatment of fears and phobias among children with ASD. However, the current research base is limited by the predominant focus on the behavioral element of the fear response, and the lack of research examining the cognitive or physiological responses during assessment or treatment