Articles: brain-injuries.
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A comprehensive review is presented on current international trends regarding research and management of severe acute brain trauma. Controversial issues are thoroughly discussed and an attempt is made to clarify questionable aspects from pertinent publications in the international literature. A proposition is made to manage not only intracranial pressure and perfusion pressure, but also cerebral hemometabolic parameters in these critically ill patients. Currently available management guidelines are not evidence-based.
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Clin Neurol Neurosurg · Sep 2000
Case ReportsDiffusion-weighted imaging demonstrates transient cytotoxic edema involving the corpus callosum in a patient with diffuse brain injury.
Reversible T2 hyperintense signal abnormality in the corpus callosum, although frequently seen after diffuse brain injury, has not been well clarified. With some accumulated evidence, we report a case of diffuse brain injury in a 24-year-old man. Magnetic resonance imaging (MRI) demonstrated T2 hyperintense signals in the trunk and the splenium of the corpus callosum 12 days postinjury. ⋯ Follow-up MRI at 6 months showed complete resolution of the T2 signal abnormalities and of the corresponding decreased diffusion. Considering that diffusion-weighted imaging showed transient decreased diffusion, the lesion in the corpus callosum indicated the existence of cytotoxic edema. Also, transient DWI hyperintensity, namely cytotoxic edema, in the trunk and the splenium of the corpus callosum does not necessarily reveal callosal deficits.
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A critical evaluation was done about the guidelines and effects of the hyperventilation maneuver on prevention and treatment of increased intracranial pressure (ICP) that follows severe traumatic brain injury (TBI). The prophylactic use of hyperventilation should be avoided after severe TBI acute phase, unless high venous O2 values are recorded at jugular bulb blood (SjO2), or to allow time when there are evidences of neurologic deterioration with posturing. ⋯ Then, hyperventilation may be used as a screening therapeutic test in acute severe TBI, since BBB impairment is the pointer that other available clinical procedures for high ICP control (sedation, paralysis and osmotic diuretics) are not workable. A new pathogenetic hypothesis about traumatic brain edema and its therapeutic approach is presented.
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J Clin Neurophysiol · Sep 2000
ReviewThe role of evoked potentials in anoxic-ischemic coma and severe brain trauma.
The early recognition of comatose patients with a hopeless prognosis-regardless of how aggressively they are managed-is of utmost importance. Median somatosensory evoked potentials supplement and enhance neurologic examination findings in anoxic-ischemic coma and severe brain trauma, and are useful as an early guide to outcome. The key finding is that bilateral absence of cortical evoked potentials, generated by thalamocortical tracts, reliably predicts unfavorable outcome in comatose patients after cardiac arrest, and correlates strongly with death or persistent vegetative state in severe brain trauma. ⋯ The majority of patients with normal central conduction times had a good outcome, whereas a delay in central conduction times increased the likelihood of neurologic deficit or death. This report includes a systematic review of the literature concerning adults in anoxic-ischemic coma and severe brain trauma, in which somatosensory evoked potentials were used as an early guide to predict clinical outcome. Greater use of somatosensory evoked potentials in anoxic-ischemic coma and severe brain trauma would identify those patients unlikely to recover and would avoid costly medical care that is to no avail.
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Journal of neurosurgery · Sep 2000
Maturation-dependent response of the piglet brain to scaled cortical impact.
The goal of this study was to investigate the relationship between maturational stage and the brain's response to mechanical trauma in a gyrencephalic model of focal brain injury. Age-dependent differences in injury response might explain certain unique clinical syndromes seen in infants and young children and would determine whether specific therapies might be particularly effective or even counterproductive at different ages. ⋯ These results demonstrate that, for this particular focal injury type and severity, vulnerability to mechanical trauma increases progressively during maturation. Because of its developmental and morphological similarity to the human brain, the piglet brain provides distinct advantages in modeling age-specific responses to mechanical trauma. Differences in pathways leading to cell death or repair may be relevant to designing therapies appropriate for patients of different ages.