Articles: brain-injuries.
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Ann Fr Anesth Reanim · Apr 2000
Review[Management of severely head-injured patients during the first 24 hours. Which specific therapeutics?].
Intracranial and systemic mechanisms of the secondary brain lesion are the targets of specific therapy for the head-injured patient. Recommendations for good clinical practice have recently defined the role of the main therapeutic measures. There is no indication for corticosteroids in head injury. ⋯ The place of hypothermia remains to be defined. Although controversial, optimized hyperventilation, induced systemic hypertension and vasoconstrictive therapy are optimally used under multimodal monitoring. New therapeutic perspectives, aimed at controlling biochemical disorders at a cellular level, are under investigation, but are still inconclusive at the present time.
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Curr. Opin. Pediatr. · Apr 2000
ReviewCerebral hypothermia for prevention of brain injury following perinatal asphyxia.
The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Early studies using short periods of cooling had limited and contradictory results. ⋯ These encouraging results must be balanced against the well-known adverse systemic effects of hypothermia. Randomized clinical trials are in progress to test the safety and efficacy of cerebral hypothermia.
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Neurological research · Apr 2000
ReviewA neuromodulation strategy for rational therapy of complex brain injury states.
We review initial efforts at neuromodulation in the vegetative state and organize several aspects of recent studies of the underlying neurobiology of catastrophic brain injuries. An innovative strategy for patient and target selection for neuromodulation of impaired cognitive function is outlined. Scientific and ethical issues that will attend future efforts to appropriately risk-stratify patients and initiate interventions with therapeutic intent are considered.
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J Neurosurg Anesthesiol · Apr 2000
The use of hyperventilation in the treatment of plateau waves in two patients with severe traumatic brain injury: contrasting effects on cerebral oxygenation.
We present the case reports of two patients with severe traumatic brain injury who, in the absence of external stimuli, developed episodes of acute elevation of intracranial pressure (plateau waves) associated with jugular bulb oxyhemoglobin (SjO2) desaturation, severe reduction of cerebral tissue PO2 (PbrO2), and deterioration of neurological status. In all of these episodes hyperventilation was successful in extinguishing plateau waves, but in one patient it was associated with an improvement of both the global (increased SjO2) and local (increased PbrO2) cerebral perfusion, while in the other patient it was associated with a reduction of both SjO2 and PbrO2. In both patients the effects of hyperventilation (and other pharmacological treatments) were short-lived; plateau waves reappeared and the patients had to be submitted to decompressive craniotomy (first patient) and cerebrospinal fluid (CSF) drainage (second patient). We conclude that hyperventilation can be useful as a temporary measure to treat plateau waves, but cerebral oxygenation should always be monitored to avoid iatrogenic cerebral ischemia.
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Ann Fr Anesth Reanim · Apr 2000
Review[Management of severe head injuries during the first 24 hours, in the emergency department, in neurosurgery].
In France, the role of the neurosurgeon in the emergency department depends on local health care policies and geographical constraints. Some departments include a neurosurgical team with a dedicated operating room. In others, a neurosurgeon can be reached by phone, possibly with an image transfer. ⋯ The management of a haematoma of the posterior fossa or a bleeding dural venous sinus would be difficult for a surgeon not qualified in neurosurgery. The optimal situation is the presence of a neurosurgeon in the medical team admitting patients with a severe head or spine trauma, for assessment of the neurological status, or interpretation of radiological explorations, insertion of an intracranial pressure monitoring device. Besides the extradural haematoma, other injuries such as an acute subdural haematoma, a haematoma associated with a contusion, an acute hydrocephalus, a depressed fracture of the skull, or a craniocerebral wound, also require an emergency decompressive procedure.