British journal of neurosurgery
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Traumatic brain injury (TBI) and acute ischaemic stroke are major causes of mortality and morbidity and there is an urgent demand for new neuroprotective strategies following the translational failure of neuroprotective drug trials. Oxygen therapy--especially normobaric, may offer a simple and effective therapeutic strategy which we review in this paper. Firstly we review mechanisms underlying the therapeutic effects of hyperoxia (both normobaric and hyperbaric) including mitochondrial rescue, stabilisation of intracranial pressure, attenuation of cortical spreading depression and inducing favourable endothelial-leukocyte interactions, all effects of which are postulated to decrease secondary injury. ⋯ Thirdly, we present clinical studies of the efficacy of normobaric hyperoxia on TBI and stroke, emphasising their safety, efficacy and practicality. Finally we consider safety concerns and side effects, particularly pulmonary pathology, respiratory failure and theoretical risks in paediatric patients. A neuroprotective role of normobaric hyperoxia is extremely promising and further studies are warranted.
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Comparative Study
Chronic subdural hematoma--craniotomy versus burr hole trepanation.
The authors present a series of more than 200 surgical procedures for chronic subdural hematoma in a 5-year-period. Clinical presentation and neurosurgical treatment were regarded with a special focus on the surgical technique. Between March 2003 and July 2008, 193 patients (113 male and 80 female, mean age 72.5 yrs [range 26-97 yrs]) suffering from chronic subdural hematoma were retrospectively analyzed. ⋯ Chronic subdural hematoma is a disease of the elderly. A craniotomy seems to possess a higher rate of recurrence of the chronic subdural hematoma so that a burr hole evacuation should be preferred. Craniectomy might be a good therapeutic option in complicated recurrent chronic subdural hematomas.
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This study was performed to determine the usefulness of repeated brain computed tomography (CT) within 24 hours of blunt head trauma in patients with traumatic intracranial haemorrhages (ICH) and who were initially treated nonsurgically. Factors associated with the worsening of lesions on repeat CT were evaluated. Medical records of all blunt head trauma patients with traumatic ICH admitted to our hospital from January 2003 to December 2006 were retrospectively reviewed. ⋯ After repeat CT, 28 (47%) of the patients in Group 2 underwent neurosurgical interventions. Of the 28 surgically treated patients from Group 2, 6 (10%) exhibited neurological worsening and 22 (37%) appeared neurologically stable. According to our data, we suggest that routine repeat CT within 24 hours after blunt head trauma might minimize potential neurological deterioration in patients with either a GCS lower than 12 or with an epidural haematoma or multiple lesions as indicated on initial CT.
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A true human tail is a rare occurrence and is defined as a caudal, vestigial, midline protrusion with skin covering connective tissue, muscle, vessels and nerves. We report a case of true human tail in a child, which is a very rare happening in humans.
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National guidelines exist for the investigation and early management of head injury. Alcohol-related head injury is relatively common in clinical practice, and intoxicated patients can be difficult to fit into guidelines for imaging. ⋯ We demonstrate that in normal clinical practice in a major trauma centre, a GCS15 patient with alcohol-related head injury selected to undergo imaging by the Emergency Department team, is more likely to have an abnormality on CT than a sober patient (p = 0.014). Despite the potential for guidelines to lead to many further (and possibly inappropriate) CT investigations to be performed in the intoxicated patient group, this is not demonstrated to be the case in our centre.