British journal of neurosurgery
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A statistically significant elevation was observed in serum and CSF neuron-specific enolase (NSE) levels in patients with major head injury, relative to control individuals. No correlation was noted between serum NSE and either APACHE II, Injury Severity Score (ISS), Glasgow Outcome Score (GOS) or Glasgow Coma Scale (GCS). A significant correlation was noted between CSF NSE levels and GCS, but not between CSF NSE and APACHE II, ISS or GOS. ⋯ In nine patients with major head injury, changes in CSF levels reflected changes in serum NSE levels. In all nine patients, serum NSE decreased to reach normal values, regardless of the outcome as predicted by the GOS. Therefore, while NSE would appear to be a marker of neuronal cell damage, other markers are also essential.
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The prognosis for patients in poor neurological grade (WFNS grades IV and V) after subarachnoid haemorrhage (SAH) is grave. Previous reports of such patients have analysed outcome without defining either the cause or the course of the depressed level of consciousness. We report a retrospective study of the outcome of 62 consecutive patients in poor grade after SAH analysed with respect to their clinical course and the predominant computed tomographic feature. ⋯ Patients harbouring an intracerebral haematoma had a significantly poorer prognosis when compared with the other groups. Patients in poor neurological grade after SAH are a heterogenous group both clinically and neuroradiologically. Management approaches must consider the cause of clinical deterioration and the related CT findings.
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We performed a retrospective study of 2484 consecutive patients with mild head injury (Glasgow Coma Scale score 13-15) who were seen during a period of 18 months. Of these, 2351 (94.6%) patients scored 15 points, 88 (3.5%) scored 14 points and 45 (1.3%) 13 points. A multivariate analysis showed that advanced age, a lower GCS (13-14) and the presence of skull fracture, and focal signs, significantly increased the incidence of abnormal computed tomography (CT) findings. ⋯ Such a policy makes skull radiography unnecessary in this subgroup. By contrast, skull radiographs may be useful for the triage of patients with a GCS of 15 that represent most of the mild head injury cases; radiographs should be obtained in patients presenting with initial loss of consciousness or posttraumatic amnesia (27.9% of the total cases) as these two findings were associated with a significantly higher incidence of fracture. Patients without these two findings (72.1% of the cases) showed a very low incidence of skull fracture (0.9% in this study) and may be discharged home with a warning sheet.