Neurological research
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Neurological research · Mar 2001
ReviewUse of sedative and analgesic agents in neurotrauma patients: effects on cerebral physiology.
Sedation and analgesia is used primarily in the intensive care unit (ICU) to limit the stress response to critical illness, provide anxiolysis, improve ventilatory support, and facilitate adequate ICU care. However, in the neurotrauma ICU there are many other reasons for the use of these agents. The primary aim is to prevent secondary cerebral damage by maintaining adequate cerebral perfusion pressures. ⋯ Concerns surrounding the use of these agents include time to awakening after discontinuation, effect on the cerebrovasculature, and the effect on patient outcome. There are many different pharmacological agents available, each with their distinct advantages and disadvantages. The purpose of this review is to evaluate the pharmacokinetic and pharmacological effects of each of these agents when used in neurotrauma patients.
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Neurological research · Mar 2001
ReviewBedside invasive monitoring techniques in severe brain-injured patients.
In patients with severe brain injury, brain edema, elevated intracranial pressure, and cerebral ischemia are accountable for a significant morbidity and mortality. New invasive methods of monitoring attempt to foresee the physiopathological mechanisms responsible for the production of secondary brain injuries. The available methods for monitoring severely brain-injured patients, their potential usefulness, advantages, and disadvantages are reviewed.
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The purpose of our study was to describe the outcomes of persons with penetrating brain injury resulting from a gunshot wound to the head. It is a prospective study of 442 patients admitted with gunshot wounds to the head over a 7 year period to our University Trauma Center Emergency Department, an urban trauma center and an inpatient rehabilitation hospital with a specialized brain injury unit. Measures and factors described include initial Glasgow Coma Scale score, Revised Trauma Score, the Disability Rating Scale, Functional Independence Measure, levels of cognitive functioning, patient demographics, length of stay, hospital charges, and discharge disposition. ⋯ The remaining 38% were discharged to programs providing varying levels of care depending upon their level of functioning and care needs. Patients sustaining severe injuries following gunshot wound(s) to the head have high early mortality. Survivors able to participate in an inpatient rehabilitation program have good potential for functional improvement.
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Neurological research · Jan 2001
Case ReportsMagnetoencephalographic investigation of somatosensory homunculus in patients with peri-Rolandic tumors.
In order to investigate functional topography of the hand somatosensory cortex in five patients with peri-Rolandic tumors (four frontal lobes and one parietal lobe), we recorded somatosensory evoked fields (SEFs) using magnetoencephalography (MEG) after stimulation of the median nerve (MN) and the five digits. The results obtained were compared with those of five normal healthy subjects. In all five patients, SEFs following MN and digit stimulation showed the previously described respective N20m and N22m components of primary sensory response. ⋯ The cortical representations of the hand were identical to those of normal subjects, arranging in an orderly somatotopic way from lateral inferior to medial superior in the sequence thumb, MN, index, middle, ring, and little fingers. This sensory homunculus was confirmed by cortical recording of the somatosensory evoked potentials (SEPs) at the time of surgery. Thus, we demonstrate that SEFs, recorded on MEG in conjunction with source localization techniques, are useful to non-invasively investigate the functional topography of the human hand somatosensory cortex in pathological conditions.
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Neurological research · Jan 2001
The influence of ruptured cerebral aneurysm localization on the blood flow velocity evaluated by transcranial Doppler ultrasonography.
The relationship between changes of blood flow velocities in cerebral arteries measured by transcranial Doppler ultrasonography and aneurysm localization was investigated in a group of 165 patients after aneurysmal subarachnoid hemorrhage (SAH). Mean blood flow velocities (MFV) in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) were registered. In patients with aneurysm of internal carotid artery and MCA (group A) statistically significant higher values of MFV from the 1st to the 5th day and on the 12th, 13th, 14th, 15th, and 19th day after SAH were found compared to patients with aneurysm of the anterior communicating artery, ACA, and pericallosal artery (group B). ⋯ MFV differences between group A and group B in 38 patients subjected to delayed surgery were not observed. The influence of aneurysm localization was observed between the 7th and 14th day after SAH. Critical MFV values for vasospasm in the MCA should be 120 cm sec-1 and in the ACA 90 cm sec-1.