Articles: brain-injuries.
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Among the pathological processes initiated by traumatic brain injury are excessive neuroexcitation and target cell deafferentation. The current study examines the contribution of these injury components, separately as well as their combined effect, on postinjury alterations in the capacity for long-term potentiation and the immunolocalization of N-methyl-D-aspartate receptors and GABA. Adult rats underwent central fluid percussion traumatic brain injury, electrolytic bilateral entorhinal cortex lesions, or a combined injury of both procedures separated by 24 h. ⋯ Both N-methyl-D-aspartate receptor and GABA immunobinding following combined injuries were also reduced relative to those observed following entorhinal lesions alone. The present results suggest that a process of receptor plasticity, possibly involving reactive synaptogenesis, may contribute to postdeafferentation enhancements of long-term potentiation, and that a traumatic brain insult will attenuate these enhancements. This interaction of different injury components suggests that recovery of function following brain injury may be enhanced by pharmacological reduction of neuroexcitation during postinjury intervals of reactive receptor plasticity.
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Multicenter Study
Magnetic resonance imaging: utilization in the management of central nervous system trauma.
To determine the availability, use, and perceived value of magnetic resonance imaging (MR) in the management of acute central nervous system (CNS) trauma in United States Level I (or equivalent) trauma centers (TCs). ⋯ Most trauma directors consider MR important in the acute evaluation of spinal trauma and, to a lesser extent, for traumatic brain injury. Despite these opinions, the vast majority of these centers reported only "rare" to "occasional" use of MR in the setting of acute CNS trauma. Our results show that most TCs have on-site and continuously available MR facilities capable of cardiac and pulmonary monitoring. Other factors such as the higher relative cost of MR may be responsible for the discrepancy between the perceived value and the actual utilization of MR imaging in the setting of CNS trauma.
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Various surgical procedures in neurosurgery end with cranial vault defects. It is generally believed that the reason for repair of the skull defect is cosmetic or protective. ⋯ In the sinking scalp flap syndrome the deterioration has been thought to be related to the concavity of the skin flap and underlying brain tissue secondary to atmospheric pressure and also to the in-and-out displacement of the brain through the skull defect. Five cases of symptomatic patients after craniectomy are reported, of which all had a neurologic deterioration that was improved by cranioplasty.
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Journal of neurosurgery · Mar 1997
Comparative StudyCerebral autoregulation following minor head injury.
The purpose of this study was to determine whether patients with minor head injury experience impairments in cerebral autoregulation. Twenty-nine patients with minor head injuries defined by Glasgow Coma Scale (GCS) scores of 13 to 15 underwent testing of dynamic cerebral autoregulation within 48 hours of their injury using continuous transcranial Doppler velocity recordings and blood pressure recordings. Twenty-nine age-matched normal volunteers underwent autoregulation testing in the same manner to establish comparison values. ⋯ A significant correlation between lower blood pressure and worse autoregulation was found by regression analysis in head-injured patients (r = 0.6, p < 0.001); however, lower blood pressure did not account for the autoregulatory impairment in all patients. Within this group of head-injured patients there was no correlation between ARI and initial GCS or 1-month Glasgow Outcome Scale scores. This study indicates that a significant number of patients with minor head injury may have impaired cerebral autoregulation and may be at increased risk for secondary ischemic neuronal damage.
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Cranioplasty is among the oldest surgical procedures. Trauma, infections, tumors and compression caused by brain edema are some of the reasons for the removal of bone. ⋯ However, there are many theories suggesting that an underlying physiological alteration may occur which may require the correction of the bone defect; many patients improve after surgery. We discuss the physiopathological basis of the "syndrome of the trephined" and try to achieve a better understanding of the present status of cranioplasty and its possible therapeutic role.