Articles: brain-injuries.
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Ann. N. Y. Acad. Sci. · Sep 1995
ReviewClinical potential for the use of neuroprotective agents. A brief overview.
"Stroke treatment seems to be entering a golden age ...." Fisher's observation not only applies to ischemic stroke, but to all the conditions described above, and in the future, possibly (and quite speculatively), to other neurologic diseases, such as multiple sclerosis, amyotrophic lateral sclerosis, even radiation therapy and Bell's palsy. Physicians must sharpen their criteria for decisions regarding therapy and must" ... be prepared to accept what is actually known from scientific data ... rather than to rely on instinct, clinical impression, or the need to do something rather than nothing."
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Although the majority of head injuries in children and adults involve dynamic loading conditions, some patients suffer static loading. Static loading occurs when forces are applied slowly to the head, and it produces a much different pattern of injuries. Crush injuries are usually described in the context of industrial accidents, but in our experience, these injuries are not rare in children. ⋯ There was one cervical spine injury but no major vascular injuries. One child had pituitary transection, four had cranial nerve palsies, and another developed a delayed cerebrospinal fluid rhinorrhea 18 months after injury. All children made good cognitive recoveries, with some having relatively mild fixed focal deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Phys Med Rehabil · Sep 1995
Comparative StudyInfluence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.
To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [CT] findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). ⋯ Information readily available on rehabilitation admission, particularly the FIM motor score, may be useful in predicting discharge FIM scores as well as utilization of medical rehabilitation resources. Earlier transfer to rehabilitation may result in higher functional status and lower rehabilitation charges, as well as lower acute hospitalization charges. The presence of extremity fractures encountered during a motor vehicle crash is associated with a more favorable outcome in TBI as evidenced by higher discharge FIM cognitive scores.
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Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < or = 20 mm Hg.