Brain injury : [BI]
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To review evidence that there exists a substantial sub-population of patients with endocrine disorders as a result of traumatic brain injury (TBI) and to underscore the importance of screening patients with TBI considered most at risk for hypopituitarism with the goal of attaining beneficial effects in terms of morbidity and quality of life. ⋯ To attain maximal improvement in mental and physical functioning as well as in quality of life for victims of TBI, it is crucial that anterior pituitary hormonal function be assessed. Appropriate hormone replacement therapy for those patients with both TBI and TBI-induced pituitary function impairment could, for the first time, allow treatment and correction of underlying causes of TBI sequelae rather than merely symptomatic treatment.
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Brain injury : [BI] · Jan 2005
Multicenter StudyEvents and decision-making in the long-term care of Dutch nursing home patients in a vegetative state.
To clarify characteristics of long-term care and treatment of patients in a vegetative state. ⋯ There is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.
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Rehabilitation centres provide therapeutic intervention to both patients with traumatic brain injury (TBI) and spinal cord injury (SCI). Patients with a dual diagnosis of TBI and SCI present a challenge to the rehabilitation professional. Previous studies indicate an incidence of concomitant TBI and SCI to be between 24-59%. ⋯ This article will focus on the implications of dual diagnosis encountered during the rehabilitation process. A case study is used to highlight the challenges presented by the cognitive impairments of a TBI in combination with the motoric deficits of SCI. Management strategies utilised by the rehabilitation team are discussed.
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Brain injury : [BI] · Aug 2004
Review Case ReportsPleural effusions appearing in the rehabilitation ward after ventriculoperitoneal shunts: a report of two adult cases and a review of the literature.
This study presents two adult patients who experienced pleural effusion during hospitalization for stroke rehabilitation therapy after ventriculoperitoneal shunt placement for normal pressure hydrocephalus associated with aneurysmal subarachnoid haemorrhage. The pleural effusion appeared without migration of the catheter into the thoracic cavity. Because of respiratory insufficiency, which prevented progress in their rehabilitation programme, thoracentesis was repeated for recurrent pleural effusions, the composition of which differed significantly from that of cerebrospinal fluid. ⋯ In the literature, there have been only 23 reports of pleural effusion associated with a ventriculoperitoneal shunt. Among those reports, four involved pleural effusion without migration of the distal catheter; however, all of those cases were in children. Thus, this study reports the first adult cases of pleural effusion without migration of the catheter into the pleural cavity and discusses a putative mechanism.
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Brain injury : [BI] · Jun 2004
Case ReportsFrontal lobe and cingulate cortical metabolic dysfunction in acquired akinetic mutism: a PET study of the interval form of carbon monoxide poisoning.
A middle-aged man suffering from acute carbon monoxide intoxication was clinically assessed to be in an akinetic and mute state. In order to elucidate regional cerebral disturbances, brain metabolism was investigated with fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) 5.5 months after intoxication. Significantly reduced metabolic rates of glucose were revealed in selected brain regions, especially in both the frontal and anterior cingulate cortices, as well as in the subcortical white matter. ⋯ This lesion topography is discussed in relation to the development of akinetic mutism in the present case and in comparison with recent reports on the topic. Considering a plausible pathophysiology, akinetic mutism appears to be based on a different structural neuropathology when compared with the locked-in syndrome and the vegetative state. It is suggested that akinetic mutism is regarded as a specific condition characterized by injury of the frontal neuronal systems which promote executive functions.