Articles: brain-injuries.
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Journal of neurotrauma · Nov 1998
Gunshot wounds in brains of children: prognostic variables in mortality, course, and outcome.
A retrospective study of 51 children presenting with craniocerebral gunshot lesions was carried out to identify predictors of outcome. The patients ranged in age from 2 months to 17 years, with a mean of 14.5 years. ⋯ Statistical analysis showed prognostic significance of the admission Glasgow Coma Score (GCS), computerized tomographic findings of intraventricular hemorrhage and midline shift, and metabolic abnormalities, including hypokalemia and hyperglycemia. These prognostic factors may have implications regarding counseling of families, utilization of resources, and organ transplantation.
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Journal of neurotrauma · Nov 1998
Fentanyl infusion preserves cerebral blood flow during decreased arterial blood pressure after traumatic brain injury in cats.
Hypotension after traumatic brain injury (TBI) has been associated with significant reductions in cerebral blood flow (CBF) in experimental animals. In humans, posttraumatic hypotension is associated with significantly worsened outcome, possibly because of cerebral hypoperfusion. The existence of opioid receptor-mediated cerebrovascular dilatory effects in humans has been theorized. ⋯ In this study, fentanyl after TBI significantly decreased MAP but not CBF. Fentanyl administration was associated with preservation of CBF despite hypotension. Further research is necessary to evaluate the effects of fentanyl on cerebral autoregulation after TBI.
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The American surgeon · Nov 1998
Resource utilization in traumatic brain injury: the role of magnetic resonance imaging.
Cerebral CT scanning is routine in the acute evaluation of traumatic brain injury (TBI) patients. MRI has been reported to identify cerebral lesions better than CT scan. The purpose of this study was to determine whether MRI influenced the acute diagnosis and management of TBI patients. ⋯ The performance of MRI resulted in additional charges of $75,640 or $3,152/patient identified with a new lesion. Although MRI identifies lesions not evident on CT scan, MRI does not alter management plans and is of limited value in the acute management of TBI. MRI may be of medicolegal benefit in cases of child abuse.
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Multicenter Study Comparative Study Clinical Trial
A multicenter study to improve emergency medicine residents' recognition of intracranial emergencies on computed tomography.
Cranial computed tomography (CT) has assumed a critical role in the practice of emergency medicine for the evaluation of intracranial emergencies. Several recent studies have documented a deficiency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of emergency medicine residents to interpret cranial CTs, and to test a novel method of cranial CT interpretation designed for the emergency physician in training. ⋯ Emergency medicine residents are deficient in their ability to interpret cranial CT scans. A novel educational course was demonstrated to significantly improve this ability.
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Clinical studies have demonstrated that patients sustain prolonged behavioral deficits following traumatic brain injury, in some cases culminating in the cognitive and histopathological hallmarks of Alzheimer's disease. However, few studies have examined the long-term consequences of experimental traumatic brain injury. In the present study, anesthetized male Sprague-Dawley rats (n = 185) were subjected to severe lateral fluid-percussion brain injury (n = 115) or sham injury (n = 70) and evaluated up to one year post-injury for cognitive and neurological deficits and histopathological changes. ⋯ Immunohistochemistry using multiple antibodies to the amyloid precursor protein and/or amyloid precursor protein-like proteins revealed novel axonal degeneration in the striatum, corpus callosum and injured cortex up to one year post-injury and in the thalamus up to six months post-injury. Histologic evaluation of injured brains demonstrated a progressive expansion of the cortical cavity, enlargement of the lateral ventricles, deformation of the hippocampus, and thalamic calcifications. Taken together, these findings indicate that experimental traumatic brain injury can cause long-term cognitive and neurologic motor dysfunction accompanied by continuing neurodegeneration.