Articles: brain-injuries.
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This study characterizes physiological, histological and behavioral effects of traumatic brain injury (TBI) produced by a controlled pneumatic impactor striking the entire right sensorimotor cortex of the anesthetized rat. Damage to both the fore- and hindlimb sensorimotor areas resulted in a hemiparetic animal which allowed us to use four sensitive behavioral/neurological tests to track the recovery sequelae after injury. Initial experiments measured cardiovascular and respiratory effects after cortical impact which depressed the dura to varying depths. ⋯ Significant axonal degeneration occurred bilaterally around the deep cerebellar nuclei. Degenerating fibers extended into the folia and terminated in the cerebellar granule cell layer. Thus the entire sensorimotor control system appeared to have been affected by a cortical injury.
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Comparative Study
Approach to head trauma in childhood in a district general hospital.
The authors compared the management of children with head trauma in a general hospital in two different periods (1984-85 and 1988-90). In the first period 233 cases were retrospectively evaluated; no guidelines were available at that time. In the second period 709 paediatric patients were treated following a protocol with indications for hospital admission and diagnostic procedures. ⋯ From our data and from the literature it emerges that it is necessary to clearly distinguish the children from 10 to 14 years of age from the rest of the paediatric population for major risk of intracranial complications, as in this group the presence of a skull fracture represents a high risk factor, predictive of an intracranial haematoma. In the children under 10 years, the history and the clinical status have greater importance in establishing the diagnostic procedure to be followed. The asymptomatic cases (S0) or those with mild symptoms (S1) can be sent home with an instruction sheet explaining the symptoms of possible complications, without any further diagnostic procedures.
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To test the hypothesis that brain injury impairs control of vascular tone during compensation from hemorrhagic shock, Sprague-Dawley rats underwent fluid-percussion brain injury (or sham injury control) followed by a stepwise hemorrhage period to 1/2 baseline mean arterial pressure (1/2 MAP), a shock period holding at 1/2 MAP for 30 min, and a resuscitation period. Aortic blood flow (ABF) was measured and vascular conductance (ABF/MAP) was calculated. No differences occurred between groups during the stepwise hemorrhage period. ⋯ In contrast, brain-injured animals increased conductance from .21 +/- .07 to .24 +/- .06 (p < .05) during the shock period and required repeated fluid replacements (3.0 +/- 1.3 cc lactated Ringer's (LR), p < .05) to maintain 1/2 MAP. Following resuscitation, conductance appropriately increased to .31 +/- .05 in controls but did not change (.25 +/- .04, p < .05) in brain-injured animals. We conclude that brain injury adversely affects control of vascular tone during shock and resuscitation in this model.
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Arch Phys Med Rehabil · Sep 1996
Multicenter Study Comparative Study Clinical Trial Controlled Clinical TrialFunctional outcomes of older adults with traumatic brain injury: a prospective, multicenter analysis.
To investigate improvement rates and medical services costs in older brain injured adults relative to younger patients. ⋯ Although older persons demonstrated functional changes, the cost of change was substantially higher than for younger patients, coincident with longer lengths of stay. These higher overall charges and slower rates of change may effect changes in referral and management patterns.
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Journal of neurosurgery · Sep 1996
Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients.
The investigators undertook a retrospective analysis of ventriculostomy infections to evaluate their relationship to monitoring duration and prophylactic catheter exchange. In 1984, the results of an epidemiological study of ventriculostomy-related infection were published. One of the conclusions of the paper was that the incidence of ventriculostomy-related infections rose after 5 days of monitoring. ⋯ There is a rising risk of infection over the first 10 days, but infection then becomes very unlikely despite a population that continues to be at risk. Patients in whom catheters were replaced prior to 5 days did not have a lower infection rate than those whose catheters were exchanged at more than 5-day intervals. Based on these data, it is recommended that ventriculostomy catheters for intracranial pressure monitoring be removed as quickly as possible, and in circumstances in which prolonged monitoring is required, there appears to be no benefit from catheter exchange.