Articles: brain-injuries.
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The value of routine skull radiography as a method of predicting intracranial injury is controversial. We aimed to assess the effectiveness of skull radiography by prospectively studying head-injured children admitted to a children's hospital that serves an urban population. ⋯ In children, severe intracranial injury can occur in the absence of skull fracture. Skull radiography is not a reliable predictor of intracranial injury and is indicated only to confirm or exclude a suspected depressed fracture or penetrating injury, and when non-accidental injury is suspected, including in all infants younger than 2 years. Clinical neurological abnormalities are a reliable predictor of intracranial injury. If imaging is required, it should be with CT and not skull radiography.
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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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Intensive care medicine · Mar 1997
How reliable is the predictive value of SEP (somatosensory evoked potentials) patterns in severe brain damage with special regard to the bilateral loss of cortical responses?
In patients sustaining severe brain damage (SBD), prediction of later outcome is often very difficult, in particular under conditions of therapeutic management like relaxation and intravenous phenobarbital. Somatosensory evoked potentials (SEP) correlated best with later prognosis and expected neurological deficit. In detail, the primary bilateral loss of cortical responses (BLCR) is regarded to be a reliable marker for poor prognosis. The goal of the following prospective study was to reassess the prognostic value of early serial median nerve SEP recording in severe brain damage in comparison to other neurophysiological, clinical, and neuroradiological parameters and, additionally, to test the hypothesis, that the BLCR-pattern is always associated with a poor prognosis and is never reversible. ⋯ SEP allow an early reliable assessment of both poor and good prognosis in SBD, in particular when applied serially. BLCR does not always imply a fatal diagnosis, as a circumscribed contusional lesion rarely may lead to selective reversible blockage of ascending somatosensory pathways in the brainstem. In contradiction to this lesional etiology, a hypoxia-induced BLCR pattern seems to correlate strictly with a poor prognosis, reflecting a different pathogenesis with diffuse destruction of cortex and thalamocortical pathways.