British journal of neurosurgery
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A 35-year-old man became symptomatic 26 months after a head injury. CT showed an occipital-suboccipital chronic extradural haematoma (EDH). ⋯ This unusually long interval between trauma and onset of symptoms suggests that delayed expansion of a chronic EDH should be kept in mind if planning conservative management. An EDH can be considered 'cured' only after disappearance of the membrane and haematoma on CT.
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We report a prospective investigation of a bedside test to evaluate the role and safety of lumbar puncture in raised intracranial pressure in patients with subarachnoid haemorrhage. Fourteen patients who underwent aneurysm clipping following subarachnoid haemorrhage were studied. All patients had intraventricular drains and needed high volume cerebrospinal fluid (CSF) drainage to maintain the normal intracranial pressure. ⋯ In all patients, the opening lumbar pressure was close to the ventricular pressure. In 13 of 14 patients, CSF drainage resulted in an equivalent and simultaneous fall of ventricular pressure. We concluded that simultaneous measurement of lumbar and ventricular CSF pressure before and after lumbar CSF drainage allows identification of candidates with differential cranial and lumbar pressures and therefore indicates safety or risk of lumbar CSF drainage.
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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.