Articles: traumatic-brain-injuries.
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Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. ⋯ In this critical review, we discuss the ascending arousal system, brain herniation, and shortcomings of our current management including the neurological exam, intracranial pressure monitoring, and neuroimaging. We present a rationale for the development of nurse-friendly-continuous, automated, and alarmed-evoked potential monitoring, based upon the clinical and experimental literature, advances in the prognostication of cerebral anoxia, and intraoperative neurophysiological monitoring.
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After traumatic brain injury (TBI), hemorrhagic progression of contusions (HPCs) occurs frequently. However, there is no established predictive score to identify high-risk patients for HPC. ⋯ A simple HPC Score was developed for early risk stratification of HPC in patients with moderate or severe TBI.
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Chin. J. Traumatol. · Feb 2017
Randomized Controlled TrialThe effect of tranexamic acid in traumatic brain injury: A randomized controlled trial.
Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients. ⋯ It has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.
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Multicenter Study
Increased peri-operative crystalloid transfusion is associated with better outcomes after spontaneous hypertensive putamen hemorrhage: A retrospective study.
The appropriate amount of transfused fluids, and which types of fluids should be transfused during the peri-operative period, is a matter of controversy among neurosurgeons. Thus, a retrospective study was conducted to assess whether crystalloid transfusion is associated with better outcomes after spontaneous hypertensive putamen hemorrhage (HPH). ⋯ Increased perioperative crystalloid transfusion was independently associated with better outcome across a spectrum of surgical risk profiles after spontaneous HPH.
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Case Reports
Surgical Treatment of Traumatic Intracranial Aneurysms: Experiences at a Single Center over 30 Years.
Traumatic intracranial aneurysm (tIA) is rare and is associated with high rates of morbidity and mortality. We describe our experiences with tIA at our institution. ⋯ tIA is an uncommon complication of head trauma. tIA should be considered when unexpected new symptoms develop in patients with head trauma. Early diagnosis and prompt treatment could help to improve final clinical outcomes.