Zentralblatt für Neurochirurgie
-
Zentralbl. Neurochir. · Jan 1994
Randomized Controlled Trial Multicenter Study Clinical Trial"Ultrahigh" dexamethasone in acute brain injury. Results from a prospective randomized double-blind multicenter trial (GUDHIS). German Ultrahigh Dexamethasone Head Injury Study Group.
In a prospective randomized double-blind multicenter trial, the efficacy and safety of a 51-hour ultra-high intravenous dexamethasone dosing regimen was investigated in patients with moderate and severe head injury. 300 patients between 15 and 55 years of age were randomized to receive either placebo or dexamethasone: 500 mg intravenous infusion within 3 h after trauma initially, followed by 200 mg after 3 h, thereafter 8 times 200 mg at 6 hourly intervals, resulting in a total administered dose of 2,3 g in 51 hours. Primary end points for assessment of efficacy were: Modified Glasgow Coma Scale (grading 3-16) on Day 5, modified Glasgow Outcome Scale (grading 1-6) 10-14 months after injury, and the time interval until consciousness improved above a level of modified GCS > or = 8. ⋯ Results were surprisingly favourable in both groups: Lethality in the dexamethasone and placebo group was 14.3 and 15.4%, respectively, and 61.7 and 57.4%, respectively, achieved social and professional rehabilitation after 10-14 months (outcome scale 6). No statistical difference was seen between the dexamethasone and the placebo group in any of the primary end points of efficacy and safety (incidence of upper gastrointestinal bleeding, infection, and thrombosis).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Zentralbl. Neurochir. · Jan 1994
Case ReportsExtradural hematoma complicating arachnoid cyst--case report.
A 37-year-old man is reported with post-traumatic extradural hematoma complicating an arachnoid cyst in the middle cranial fossa. While subdural and intracystic hemorrhages are well-known complications from this malformation, the association with extradural hematoma has only been reported in three cases in the literature. We describe a case occurring after head injury and discuss the etiology and treatment.
-
Zentralbl. Neurochir. · Jan 1994
[Acute subarachnoid hemorrhage after aneurysm rupture: results of early surgery].
The introduction of early aneurysm surgery in subarachnoid hemorrhage in the beginning of the eighties diminished the frequency of rebleeding. However, there are some objectives against early surgery due to its supposed higher morbidity. The present retrospective data elucidates the advantage of early aneurysmal surgery. ⋯ Overall it can be established, that there are no definite disadvantages of early aneurysmal surgery. The benefits of early surgery are a minimized risk of rebleeding, some effects of ameliorated conditions for intensive care treatment still have to be proven. Not only patients in good clinical condition (I and II by Hunt and Hess) show a good prognosis, even for patients with poor grade aneurysms (III to V by Hunt and Hess) a very good or at least good result can be achieved in 61%.