Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewManagement of head injury. Treatment of abnormal intracranial pressure.
Intracranial hypertension is recognized as a fundamental pathophysiologic process in brain injury. Although the exact pressure level defining intracranial hypertension remains to be firmly established, the majority of evidence available currently suggests that ICP should generally be treated when it exceeds 20 mm Hg. We suggest that lesions in the temporal lobe be treated at 15 mm Hg owing to the special relationship of this region to the brain stem. ⋯ The basic mechanisms of raised ICP are slowly becoming elucidated. Clinical clues with which to subdivide patients with intracranial hypertension are being defined. New agents with efficacy in lowering raised ICP are appearing, and determination of their mechanisms of action may provide insight into the underlying disorder.
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewManagement of head injury. Intracranial pressure monitoring.
The role of intracranial pressure monitoring as an adjunct to the clinical examination, CT scanning, and other diagnostic modalities has become increasingly recognized. This article presents a brief overview of the present status of this technique and touches on prospects for further developments.
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Gunshot wounds to the head are a common problem in the United States. A review of the literature and a survey of neurosurgeons suggests some differences of opinion regarding treatment. But the series upon which these opinions are based may be quite different. ⋯ Angiography should be used in cases in which bullets have passed near major vessels. We suggest an aggressive approach, with evacuation of clots and monitoring of intracranial pressure and treatment of elevations, as well as the routine use of anticonvulsants and antibiotics. Vocational rehabilitation is also important.
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewNeurophysiologic monitoring of patients with head injuries.
Despite new technologic developments designed to analyze the brain's electrical activity, monitoring the electroencephalogram or evoked potentials has not yet provided important information with regard to acute management of patients with head injury. Measurement of cerebral blood flow as well as jugular oxygen saturation is of more practical importance. Particularly when monitored continuously, these measures can provide useful information about the use of hyperventilation and control of elevated systemic arterial pressure.
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Although head injury is a common occurrence in childhood, most of the brain injury that occurs is mild and uncomplicated. There are some differences between adults with head injuries and children with head injuries, and some of these differences are reviewed. Specific circumstances unique to childhood head injury are presented, including the importance of recognizing child abuse.