Articles: brain-injuries.
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Arch Phys Med Rehabil · Jul 1998
Multicenter StudyBrain injury as a result of violence: preliminary findings from the traumatic brain injury model systems.
To identify possible risk factors that may predispose individuals to violent traumatic brain injury (TBI) and to determine the effect of etiology of injury on outcomes. ⋯ Survivors of violent and nonviolent TBI have similar functional outcomes; however, they differ in preinjury and postinjury socio-economic characteristics, injury severity, and postinjury community integration. Socio-economic factors appear to play a large role in the risk for violent injury and in community integration following injury.
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The injured brain may be damaged by primary impact, secondary injury from secondary damage due to initiation of destructive inflammatory and biochemical cascades by the primary injury or secondary ischemic injury following secondary insults that initiate or augment these immunological and biochemical cascades. Cerebral ischemia will arise whenever delivery of oxygen and substrates to the brain fall below metabolic needs. Many factors lead to the development of secondary insults to the injured brain during initial resuscitation, transport, surgery, and subsequent intensive care. ⋯ After brain trauma, systemic hypotension, compromised CPP, raised ICP, elevated temperature, hypoxemia, and jugular bulb venous desaturation are associated with poor prognosis. Clinical trials of moderate hypothermia following brain trauma are ongoing. Following adult brain trauma maintenance of CPP above at least 65 mmHg (probably > 40 mmHg in children below 8 years) seems important to improve outcome indicating the need for continuous ICP monitoring during intensive care of brain-injured patients.
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Mayo Clinic proceedings · Jul 1998
Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury.
To ascertain the incidence and timing of fever in patients at risk for temperature modulation of brain injury resulting from ischemia or trauma. ⋯ In these hospitalized patients at risk for ongoing brain injury, the incidence of temperature increases within the range reported to worsen neurologic outcome (elevations of 1.0 degree C or more) was very high. The characterization of these potentially injurious, randomly occurring, and traditionally undertreated temperature increases may have implications for the design of future protocols aimed at providing cerebral protection.
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Pediatric head injury is a public health problem that exacts a high price from patients, their families and society alike. While much of the brain damage in head-injured patients occurs at the moment of impact, secondary injuries can be prevented by aggressive medical and surgical intervention. Modern imaging devices have simplified the task of diagnosing intracranial injuries. ⋯ The cornerstones of treatment remain hyperventilation and osmotherapy. Despite maximal treatment, however, the mortality and morbidity associated with pediatric head injury remains high. Reduction of this mortality and morbidity will likely depend upon prevention rather than treatment.
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To determine the rate and clinical outcome of discrepancies in interpretation by radiology residents and staff neuroradiologists of posttraumatic cranial computed tomographic (CT) scans. ⋯ A low discrepancy rate was found between interpretations made by radiology residents and those made by staff neuroradiologists of posttraumatic cranial CT scans. There were no adverse clinical outcomes.