Articles: brain-injuries.
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A consecutive unselected series of 1812 children (up to 15 years old) admitted for head injuries over a period of 8.5 years was studied. The cases were divided up according to five categories of pathology: benign injury, extradural haematoma, subdural haematoma, open brain laceration and brain contusion in a broad sense. All cases of benign injury were from the Geneva area (57000 children) and 52% of the cases of severe injury were referred from other places. ⋯ Falling was the most frequent cause of injury. Benign injuries were more frequent in group I. Only 1 of 25 patients with extradural haematomas died, and there were only 8 patients with subdural haematomas, 4 in subgroup I a (babies aged less than 1 year).
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Fluid and sodium restriction have been advocated after brain injury as a means of controlling intracranial pressure (ICP). Recent clinical data showing no significant relationships between the amount of fluid infused or sodium administered (Na) and ICP question this practice. ⋯ These data suggest that both the volume of fluid infused and the fluid balance do affect the ICP, but the amount of Na infused does not. The lack of a significant correlation between any of the independent variables and CWC suggests that their effect on ICP is not related to cerebral edema formation. These findings, combined with the observed significant positive correlation between free H2O infused and ICP, and the significant negative correlation between serum osmolarity and ICP, suggest that HSL resuscitation increases intracranial compliance after brain injury while LR decreases it. The data also suggest that free water restriction is warranted in patients with head injuries.
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Journal of neurosurgery · Nov 1994
Influence of major depression on 1-year outcome in patients with traumatic brain injury.
The authors examine those factors that contributed to deterioration in social functioning, activities of daily living, or intellectual functioning during a 1-year period after traumatic brain injury (TBI). Fifty-two patients suffering an acute TBI were evaluated for existence and severity of mood disorders and impairment during their hospital stays and at 3-, 6-, and 12-month follow-up examinations. Patients whose scores on intellectual function, social function, or daily activities deteriorated during the 1-year period after trauma were considered to have a poor outcome. ⋯ Seven of 52 patients had a poor outcome in daily activities, which was associated with a major depression of more than 6 months' duration and severity of Hamilton Depression Rating Scale scores. Eleven of these patients had a poor outcome in cognitive function, which was associated with cognitive impairment immediately after TBI. A major depression lasting more than 6 months was associated with deterioration of social functioning and activities of daily living during the 1-year period after TBI.
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The case report of a 54-year-old patient with a right frontal intracerebral abscess 48 years after a missile injury is presented. Treatment included surgical evacuation and antibiotic therapy. The patient was discharged without neurological deficit.