Articles: brain-injuries.
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As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. ⋯ Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.
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Journal of neurotrauma · Jan 1993
Lactated Ringer's solution alleviates brain trauma-precipitated lactic acidosis in hemorrhagic shock.
To determine the influence of brain trauma on blood acid-base and lactate-pyruvate responses to hemorrhage, and the effect of lactated Ringer's solution on these responses, 30 anesthetized rats were assigned to four groups: hemorrhage (n = 7), hemorrhage following fluid percussion brain trauma (trauma-hemorrhage group) (n = 7), hemorrhage treated with lactated Ringer's solution (hemorrhage-resuscitation group) (n = 8), and hemorrhage following brain trauma treated with lactated Ringer's solution (trauma-hemorrhage-resuscitation group) (n = 8). The hemorrhage group showed no significant changes in pH, HCO3, and base excess after hemorrhage. Base excess and pH were significantly reduced after the hemorrhage in the trauma-hemorrhage group but were raised after resuscitation in the hemorrhage-resuscitation group. ⋯ Lactate rose significantly after hemorrhage in the hemorrhage group and was even higher in the trauma-hemorrhage group, but there were no differences between the hemorrhage versus hemorrhage-resuscitation or trauma-hemorrhage-resuscitation groups. Both brain trauma and lactated Ringer's solution increased pyruvate with marked reduction in the ratio of lactate to pyruvate. These data indicate that brain trauma precipitates blood lactate accumulation and metabolic acidosis after hemorrhage, and infusion of lactated Ringer's solution can relieve these disturbances.
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Top Magn Reson Imaging · Jan 1993
ReviewNeuroradiologic evaluation of pediatric craniocerebral trauma.
Although cranial computed tomography (CT) remains the initial diagnostic test in the evaluation and triage of the pediatric head-injury patient, magnetic resonance imagining (MRI) has become the next step in the diagnostic evaluation of those with focal or diffuse neurologic deficits. MRI is better able to demonstrate the extent and location of both hemorrhagic and nonhemorrhagic injury, thereby providing prognostic information. In nonaccidental head injury, MRI has proved valuable in detecting subtle subacute contusions and even not so subtle chronic subdural hematomas that may be difficult to see on CT or that can mimic enlargement of the subarachnoid space on CT.
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We report two patients in whom bullets in the brain migrated into the adjacent lateral ventricle and moved freely as a consequence of gravity. A review of the literature suggests that the spontaneous migration of intracerebral bullets is influenced by cerebral softening, the specific gravity of the bullet compared with brain tissue, and the sink function of the cerebral ventricles. In patients undergoing the surgical removal of intracerebral or intraventricular bullets, it is recommended that an x-ray be obtained after the final positioning of the head.