Acta neurochirurgica
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Acta neurochirurgica · Jan 1992
Cerebral blood flow and intracranial pressure during experimental subarachnoid haemorrhage.
The relationships of intracranial pressure (ICP), systemic blood pressure (SBP) and cerebral blood flow (CBF) during experimental subarachnoid haemorrhage were investigated in cats. Continuous monitoring of regional cerebral blood flow (rCBF) was done by a thermal diffusion method using a Peltier stack. During haemorrhage ICP rose within 5.4 +/- 0.97 minutes from 10.5 +/- 4.9 to 176.1 +/- 27.8 mmHg. ⋯ The Cushing response during the haemorrhage could not improve the cerebral circulation, but in contrast caused a further increase of ICP. After the haemorrhage the cerebral blood flow normalised within minutes. It is concluded, that the Cushing response during a subarachnoid haemorrhage should be regarded as a deleterious rather than a beneficial mechanism.
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Non-missile penetrating injuries of the spine accounted for 7% of all spinal injuries admitted to this Institute during the last 10 years. Young males were most commonly affected and 73% of the injuries involved the upper dorsal und cervical spine. They presented with varying degrees of neurological deficit. ⋯ Surgery remained the mainstay of treatment and improved neurological function in 7 out of 9 cases. Conservative management resulted in complications such as persistent CSF fistula, uncontrolled fulminant meningitis and septicaemia, with 100% mortality. Early surgical intervention is, therefore, recommended in all penetrating injuries of the spine.
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Acta neurochirurgica · Jan 1991
Case ReportsFracture of the lumbar vertebral ring apophysis imitating disc herniation.
Three cases of fracture of the lumbar ring apophysis representing type I, II, and III are described in detail and the natural history of these fractures is discussed. The symptoms of apophyseal fractures are usually low back pain, sciatica, tension signs, and neurological deficits, thus imitating the symptoms of lumbar disc herniation. ⋯ An explanation of the different types of fractures, based on the osteogenesis of the human vertebra, is proposed. Recognition of these fractures is essential for proper planing of surgery, and apophyseal ring fractures must be suspected when children and young adults show signs of lumbar disc herniation.
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Acta neurochirurgica · Jan 1991
Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called "normal pressure hydrocephalus" syndrome.
Fifty-four shunt-responsive patients were selected from a prospective protocol directed to study patients with suspected normal pressure hydrocephalus (NPH). Patients with gait disturbances, dementia, non-responsive L-Dopa Parkinsonism, urinary or faecal incontinence and an Evans ratio greater or equal to 0.30 on the CT scan were included in the study. As a part of their work-up all patients underwent intracranial pressure monitoring and hydrodynamic studies using Marmarou's bolus test. ⋯ An exponential correlation was found when plotting beta waves against the sum of conductance to outflow and compliance calculated by PVI method (r = 0.79). Patients with the so-called normal pressure hydrocephalus syndrome have different ICP and CSF dynamic profiles. Additional studies taking into consideration these differences are necessary before defining the sensitivity, specificity and predictive value of ICP monitoring and CSF studies in selecting appropriate candidates for shunting.
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Acta neurochirurgica · Jan 1991
Comparative StudyA comparative study of the Reaction Level Scale (RLS85) with Glasgow Coma Scale (GCS) and Edinburgh-2 Coma Scale (modified) (E2CS(M)).
In this work a new coma scale for the assessment of responsiveness in acute brain disorders, constructed near the year 1985 by Scandinavian investigators, the Reaction Level Scale (RLS85), is compared with two other coma scales namely: (i) the Glasgow Coma Scale: (GCS); (ii) the Edinburgh-2 Coma Scale, after modification: (E2CS(M)). The study proceeded in the form of a statistical analysis of assessments made on 46 patients according to RLS85 and GCS (i.e., when comparison was with GCS) and on 28 patients according to RLS85 and E2CS(M). In all 74 cases two physicians participating as "observers" carried out the assessments. ⋯ Those corresponding to RLS85 are considerably higher. In particular the overall value based on 74 pairwise assessments amounted to kappa = 0.733 associated with a standard error sigma(kappa) = 0.061. This was a satisfactory result regarding the features of RLS85. (4) As far as coverage is concerned, again--by the "sign" test--the predominance of RLS85 versus GCS (EMY profile) was accepted.