Nō to shinkei = Brain and nerve
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Serial changes of EEG, BR and BAEP recordings were obtained over a period of two days on two patients who had suffered massive cerebral hemorrhage while their clinical condition evolved from coma with evidence of preserved cerebral and brainstem functions to a state meeting the criteria of brain death. As clinical evidence of deteriorating brainstem function became apparent in case 1, first wave IV and V components of BAEP disappeared while waves I to III were normal. Finally, when clinical criteria of brain death were fulfilled, the BAEP response was restricted to wave I with small amplitude to stimulation of left ear only. ⋯ The changes of BAEP was not parallel to the progressive deterioration of EEG and BR. After meeting clinical criteria of brain death, complete abolition of waves II and I was sequential in that order, and then Babinski sign besides withdrawal and deep tendon reflexes may revive in the extremities. Monitoring of serial electrophysiological changes is helpful in the course of impending brain death to determine whether revival of Babinski sign is due to recovery of cerebral-brainstem dysfunction or due to establishment of spinal autonomy.
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Electrophysiological neuromonitoring of brainstem auditory evoked potentials (BAEP), short-latency somatosensory evoked potentials (SSEP) and compressed spectral array (CSA) EEG can provide precise and immediate information concerning functional integrity of the brain, brainstem and upper spinal cord of severely brain-damaged patients. We applied this neuromonitoring system in the cases of 154 severely brain-damaged patients in order to evaluate its reliability in the diagnosis of brain death. In particular, this study considers the relationships between BAEP and neurological findings, conventional EEG findings and factors affecting final BAEP findings. ⋯ The one demonstrated loss of all BAEP waves 17 days after her accident, with recovery of waves I to V three months later. The temporal relationships in group B patients of the course of BAEP findings and the time of neurological brain death diagnosis are shown in Table 2 and Fig. 1. All but two of the 61 patients were followed up until final loss of BAEP waves (Fig. 1).(ABSTRACT TRUNCATED AT 400 WORDS)
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Traumatic subarachnoid hemorrhage (TSAH) is a frequent occurrence resulting from acute severe head injury. Computerized tomography (CT) accurately identifies the region, extent and nature of TSAH following trauma. But, to our knowledge, there have been few series detailing the characteristics of TSAH in acute severe head injury. ⋯ TSAH therefore appears to be seen in all age groups, but especially in middle age groups. The GCS on admission was 8 or less in all cases; the GCS was 8 in 10 cases, 7 in 7 cases, 6 in 15 cases, 5 in 16 cases, 4 in 23 cases, 3 in 26 cases. The lower GCS scores, the more frequently TSAH was identified, and 67% of the patients had a GCS of 6 or less.(ABSTRACT TRUNCATED AT 250 WORDS)
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In the diagnosis of brain death, it is generally accepted that respiratory function has to be absent, however, spinal reflexes can be preserved. We presented a patient who showed a complex movements of upper limbs (Lazarus' sign) and respiratory like movement during the apnea test for the determination of brain death. This 72-year old female admitted to our hospital in a semicomatous state due to severe subarachnoid and ventricular hemorrhage. ⋯ These movements ceased immediately after connecting the respirator. These two types of movements were reproducible except for in the final test. Blood pressure gradually decreased, and cardiac arrest occurred one hour after.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case of sphenoidal ridge meningioma complicating chronic subdural hematoma and a case of malignant astrocytoma producing not only intracerebral hematoma but also acute subdural hematoma were reported, and the mechanism of subdural hematoma formation was discussed according to the literature. Malignant glioma often produces intracranial hemorrhage, but scarcely produces subdural hematoma. ⋯ The reason for it is probably due to the difference of the place where each tumor grows originally. Rupture of the bridging veins or the intratumoral abnormal vessels due to twisting of the brain from trivial head trauma or without trauma might produce subdural hematoma.