Articles: brain-injuries.
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Neurosurg. Clin. N. Am. · Oct 1994
ReviewIntegrated multimodality monitoring in the neurosurgical intensive care unit.
The selection of variables for continuous monitoring in the neurosurgical intensive care unit is based upon the requirement for constant perfusion and oxygenation of the brain and knowledge of the frequency and prognostic significance of abnormal values. Both arterial and intracranial pressure must be considered in the form of cerebral perfusion pressure. Body temperature and arterial oxygen saturation are essential to monitoring. Measurement of jugular venous oxygen saturation and cerebral blood flow velocity provide information of value in determining the source of raised intracranial pressure, the most appropriate means of treating it, and the safety of therapy.
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The sources of fever and infection in neurosurgical patients in the intensive care unit are varied and complex. Benign postoperative fever due to atelectasis of the lungs or from central nervous system sources are difficult to define. Distinguishing between these "benign" sources and true nosocomial bacterial infections can be a difficult clinical process. Empiric antibiotic regimens are outlined, and some guidelines are proposed for the management of infected catheters.
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Journal of neurotrauma · Oct 1994
Lateral cortical impact injury in rats: pathologic effects of varying cortical compression and impact velocity.
Direct lateral cortical impact through the intact leptomeninges using a pneumatically driven piston produces increasingly severe pathophysiologic derangements with increasing cortical deformation. We studied the histopathologic correlates of cortical impact injury produced by 2 mm, 2.5 mm, and 3 mm deformation in the rat at 5 m/sec. Additionally, the effect of impact velocity at a 2.5 mm deformation was assessed at 1 m/sec, 3 m/sec, and 5 m/sec. ⋯ Impact velocities of 1, 3, and 5 m/sec produced neuronal loss of 18.25%, 33.75%, and 48.3%, respectively. Hippocampal CA1 neuronal loss was also seen and paralleled cortical deformation and impact velocity. Cortical deformation and impact velocity are critical parameters in producing cortical contusion and must be considered when comparing results using this model.
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Brain injury : [BI] · Oct 1994
Family functioning, social support and depression after traumatic brain injury.
Functional outcome after traumatic brain injury (TBI) is thought to be dependent upon effective social support and avoidance of depressive episodes. Research indicates that post-injury changes often occur in the family's functioning, hence impacting the family's ability to provide the needed social support. Social support, in turn, has been hypothesized to work as a buffer between significant life event and levels of depressive symptoms. ⋯ Thirty-nine persons who had sustained TBI were interviewed to assess their family functioning, perceived social support, and current depressive symptomatology. The results showed that the effective use of problem-solving and behavioural coping strategies by the family in response to TBI was significantly related to lower levels of depression in the person who sustained the TBI. However, perceived social support was not predictive of depression.
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Hypothermia is of proven benefit in cerebral ischemia, and may be of benefit in blunt head injury. Peritoneal dialysis is a fast, effective method of inducing generalized hypothermia. ⋯ Hypothermia was associated with prompt control of temperature and intracranial pressure. Peritoneal dialysis is a useful method for inducing hypothermia in the blunt head-injured patient.