Journal of neurosurgery
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Journal of neurosurgery · Nov 1987
Randomized Controlled Trial Clinical TrialThe effect of nutritional support on outcome from severe head injury.
Fifty-one brain-injured patients with peak 24-hour admission Glasgow Coma Scale (GCS) scores of 4 to 10 were prospectively randomly assigned to receive total parenteral (TPN) or enteral (EN) nutrition. Patients were studied from hospital admission to 18 days postinjury. Outcome was assessed by the Glasgow Outcome Scale at 3 months, 6 months, and 1 year postinjury. ⋯ In conclusion, more calories and protein usually can be administered to acute brain injury patients via the TPN route than by EN feedings via nasogastric or nasoduodenal routes. Traditional parameters for nutritional assessment are not useful in studying the efficacy of nutritional support during the first 2 weeks after head injury. Neurological recovery from head injury occurs more rapidly in patients with better early nutritional support.
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Journal of neurosurgery · Nov 1987
Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients.
A consecutive series of 330 severely head-injured patients was studied prospectively. All of the patients were treated with the same protocols by the same physicians and staff in the same intensive care unit. All of the patients had intracranial pressure (ICP) monitoring. ⋯ Pediatric patients with normal ICP had a higher percentage of good outcomes (70%) than the adult patients with normal ICP (48%) (p less than 0.05). There was no significant difference in outcome in pediatric and adult patients with mass lesions or with increased ICP, regardless of whether or not the pressure was reducible. There was a much higher incidence of surgical mass lesions in adult patients (46%) than in pediatric patients (24%) (p less than 0.001).
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Journal of neurosurgery · Oct 1987
Relationships between intracranial pressure, ventricular size, and resistance to CSF outflow.
In 230 patients with normal-pressure hydrocephalus, high-pressure hydrocephalus, or benign intracranial hypertension, measurements of the intracranial pressure (ICP), ventricular size, and cerebrospinal fluid (CSF) outflow resistance (Ro) have revealed a linear relationship between ICP and Ro. It is shown that on average the CSF formation rate tends to decrease with increasing ICP. It is also shown that the size of the ventricles increases as the ICP levels off toward normal values. The clinical implication of this is that a small or normal ventricular size in acute or subacute phases does not preclude defective CSF resorption.
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Forty-three patients with intractable pain received intrathecal morphine delivered by implanted continuous-infusion (Infusaid) or programmable (Medtronic) devices. In 35 patients the pain was due to cancer, and eight patients had chronic nonmalignant pain. The origin of the nonmalignant pain included lumbar arachnoiditis, multiple sclerosis, severe osteoporosis resulting in a thoracic compression fracture, and intractable pain as a consequence of cancer therapy in individuals cured of their disease. ⋯ Tolerance occurred infrequently and could be managed effectively. The results of this study support earlier studies on the application of chronic intrathecal morphine for intractable cancer pain. These findings also indicate that, in carefully selected patients, nonmalignant pain may be managed satisfactorily with this technique.
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Journal of neurosurgery · Aug 1987
Case ReportsDissecting aneurysms of the anterior circle of Willis arteries. Report of two cases.
Two cases of spontaneous dissecting aneurysm extending from the supraclinoid portion of the internal carotid artery to the middle cerebral artery are reported in two teenaged patients. Both patients collapsed with a headache on the right side, left hemiparesis, and altered consciousness due to cerebral ischemia. One patient became alert in 2 days; however, his condition rapidly deteriorated 4 days later and he died on the 8th day from massive cerebral infarction. ⋯ He improved gradually and is able to walk without help. Cerebral angiograms 3 months after the operation disclosed progressive attenuation of the MCA and dilatation of the anastomosed STA. Artificial collateral flow demonstrated in the postoperative angiogram may have been useful in preventing massive cerebral infarction.