Articles: brain-injuries.
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Comparative Study
Psychiatric disorders and functional disability in outpatients with traumatic brain injuries.
This study examined psychiatric sequelae of traumatic brain injuries in outpatients and their relation to functional disability. ⋯ Depression and anxiety are common in outpatients with traumatic brain injuries. Patients with depression or anxiety are more functionally disabled and perceive their injury and cognitive impairment as more severe. Depressed patients report more increasingly severe postconcussion symptoms.
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The current study investigates the effects of sufentanil on cerebral blood flow velocity and intracranial pressure (ICP) in 30 patients with intracranial hypertension after severe brain trauma (Glasgow coma scale < 6). ⋯ The current data show that sufentanil (3 micrograms/kg intravenous) has no significant effect on middle cerebral artery blood flow velocity and ICP in patients with brain injury, intracranial hypertension, and controlled MAP. However, transient increases in ICP without changes in middle cerebral artery blood flow velocity may occur concomitant with decreases in MAP. This suggests that increases in ICP seen with sufentanil may be due to autoregulatory decreases in cerebral vascular resistance secondary to systemic hypotension.
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Neuropathol. Appl. Neurobiol. · Oct 1995
The response of neurons and microglia to blast injury in the rat brain.
Rats subjected to a single non-penetrative blast were examined for possible neuronal damage and glial reaction by immunohistochemistry and electron microscopy. The most dramatic feature in rats killed between 1 and 14 days after the blast was the widespread response of microglial cells in various parts of the brain in which the cells were hypertrophied and their surface antigens, like complement type three receptors (CR3), were upregulated. The blast wave also induced the vigorous expression of major histocompatibility complex (MHC) class I and II (Ia) antigen. ⋯ Microglial cells were closely associated with some of the 'darkened' dendrites. Results in this study show that a non-penetrative blast in rats provokes a widespread microglial activation suggesting increased endocytosis and immunological responses. However, it remains uncertain whether such a drastic response was a direct activation of the cells by the blast wave or elicited indirectly by some chemical factors released from the damaged brain tissues.
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Six patients with diffuse axonal injury, ranging in age 8 to 29 years, hospitalized in emergency in our Polyclinic with a Glagow coma score under 8, were examined. Patients were intubated and connected to an automatic respirator. They underwent serial cranial CT and transcranial Doppler sonography recordings using the temporal window with insonation of the two middle cerebral arteries. ⋯ In 5 patients over 6 (80%) increased blood flow, variously sensitive to barbiturates, was detected associated to increased resistance index secondary to intracranial hypertension. Based on Doppler findings four patients underwent surgical treatment: ventriculostomy for monitoring of intracranial pressure or decompressive craniectomy. According to this experience, the use of transcranial Doppler US is mandatory for a correct identification of the hemodynamic injury associated to diffuse axonal injury, for planning the medical and/or surgical approach and for assessment of the successful results of therapeutic management.