Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Jan 1984
Case Reports[Craniocerebral injuries caused by animal anesthesia equipment].
A consequence of the rareness of bullet injuries in the GDR are the uncertainties in the recognition and assessment of injuries caused by cattle anaesthetising devices which have become evident in connection with the relevant expertises of the respective cases. In view of this situation, the design and the mode of functioning of these devices as well as selected clinical aspects of such injuries are described. Besides the local findings, the computer tomography is of paramount importance in the diagnosis for both the recognition of the typical calvarial bursting and the representation of the shot channel with a demonstration of the imprimatum. Whenever possible, the therapy should consist in an early surgical procedure according to the principles to be applied to open craniocerebral injuries.
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On the basis of 191 patients with epidural haematomas in an observation period of 15 years, an analysis of the patient group with non-classical symptoms was carried out. The opinions and theories regarding the generation of long-lasting lucid intervals found in the literature are mentioned and discussed on the basis of 3 typical examples. Owing to improved examination methods and early recognition, the mortality rate of the patients with epidural haematomas could be reduced from 54 per cent in the years 1961 to 1965 to about 10 per cent in the years 1975 to 1980.
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Zentralbl. Neurochir. · Jan 1979
[The influence on water-electrolyte balance through osmotherapy for decreasing intracranial pressure].
On the basis of a group of neurosurgical patients showing a differing composition, various procedures of the dehydrating therapy in the pre- and postoperative phases for decreasing the increased intracranial pressure were studied. In addition to the continuous recording of the intracranial pressure, the electrolyte and water balance was measured by recording the plasma, urinary, and cerebrospinal-fluid electrolytes and their osmolarities and the urinary output was determined. ⋯ On the basis of the intracranial pressure/volume relationship, the effectiveness of the dehydration should not only be assessed by the reduction of the intracranial pressure since the extent of the alteration of the electrolyte and water balance and the haemodynamically active changes are quite different. Finally, disease pictures should be taken into consideration in which the basic morphological and functional conditions have been lost and the limits of the therapeutic procedure are exceeded.
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On the basis of observations in 144 patients operated on because of severe cerebral concussions, the importance of primary and secondary removal of the concussion focus is stressed. The diagnosis is made by means of EEG, angiography, and echo encephalography. Examinations of the concussion region with clearance etc. showed that the immediate vicinity of the cerebral lesion exhibits a considerably reduced blood flow which, due to the stimulus of the concussion, will further decrease within the following days. ⋯ The enlargement of the zone of necrosis intensifies the intracranial increase in pressure and can only be avoided by the removal of the concussion. Resection is carried out subpial in order to isolate the cerebral tissue from the dura mater. Lethality: With solitary concussion foci 22%, in case of combination with intracranial haematoma 60%, with multiple foci 67%, total 46%.