Articles: brain-injuries.
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Kinderärztliche Praxis · Dec 1993
[Use of the Glasgow Coma Scale in pediatric craniocerebral trauma].
Over five years the applicability of a modified Glasgow Coma Scale was analysed in 38 children (mean age 7.2 +/- 3.8 years) with head and associated injuries (47.4%). The score was estimated after the accident and in the course of intensive therapy. At the beginning of the treatment on the intensive care unit, the cases were staged according to the severity of the head injuries (Glasgow Coma Scale: 4-8, 9-12 and 13-19 points). ⋯ Over 13 points, all patients had a shorter duration of treatment (10.8 +/- 8.8 days) and a quick and good recovery. The Glasgow Coma Scale has the advantage of an examination with a quantitative analysis and resulting effective diagnostic and therapeutic measures. Even the inexperienced physician can use the Glasgow Coma Scale with success at the site of the accident.
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Aktuelle Traumatologie · Dec 1993
[Subacute and chronic epidural hematoma after craniocerebral trauma].
During an 8-year period, fifteen patients with subacute or chronic epidural haematoma were seen among 110 treated cases of extradural haematoma corresponding to a frequency of 13.6%. Increasing headache, nausea, vomiting, mild drowsiness and cranial nerve palsy were the symptoms resulting in the correct diagnosis in most cases. ⋯ The most important factors are cerebral atrophy, age, source of bleeding and location. By means of early CT (computed tomography) diagnosis of haematoma, fatal outcome could be prevented in most of the cases.
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Surgical therapy for intracranial extracerebral haemorrhages is one of the oldest surgical techniques. The low mortality and morbidity in recent years have come about through of the emergency service, modern neurosurgical techniques, widespread use of the CT scanner, and adequate intensive care. The treatment target in the case of head injuries is to provide the optimal milieu for recovery from the primary injury and to prevent secondary damage to the brain. ⋯ Twist drill evacuation of the fluid (= chronic haematoma) in local anaesthesia is now accepted as the treatment of choice. An extradural haematoma is a potentially lethal lesion with a mortality rate of 5%. Emergency surgical intervention is appropriate before neurological signs appear.
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Transcranial Doppler sonography (TCD) is a simple, noninvasive bedside procedure that can be repeated any time for the measurement of cerebral blood flow velocity in the great basal cerebral arteries. It is practicable in most severely head-injured patients in critical care. Flow patterns and pulsatility index (PI) resulting from maximal systolic and diastolic flow velocities and representing cerebrovascular resistance give quite an accurate impression of potential intracranial hypertension and the dependent cerebral perfusion pressure (CPP). ⋯ Under continuous TCD monitoring of the middle cerebral artery, increases in maximal flow velocity (from 4% up to 102%, on average 27%) and mean flow velocity (from 18% up to 153%, on averaged 73%) were always observed after osmotherapy. In addition, a variable increase in negative frequencies was noted, probably due to increased turbulences. After barbiturate administration (thiopentone bolus of 0.3 g) a flow reduction was always seen [from -2% up to -25% (on average -13%) for maximal flow velocity and from -9% up to -30% (on average -19%) for mean flow velocity].(ABSTRACT TRUNCATED AT 250 WORDS)