Articles: brain-injuries.
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Journal of neurosurgery · May 1994
Randomized Controlled Trial Multicenter Study Clinical TrialA multicenter trial of the efficacy of nimodipine on outcome after severe head injury. The European Study Group on Nimodipine in Severe Head Injury.
Between January 1, 1989, and June 30, 1991, 852 severely head-injured patients were entered into a prospective placebo-controlled trial of the efficacy of nimodipine administration. The patients could not obey commands at the time of entry into the trial, which was within 12 hours after the start of the inability to obey commands and within 24 hours of injury. The main hypothesis that nimodipine would increase the percentage of patients with a favorable outcome (moderate disability or good recovery) from 50% to 60% was rejected. ⋯ The effect was statistically significant in those patients who complied with all protocol requirements. This finding is consistent with the effect of nimodipine on secondary ischemia following spontaneous SAH. The results of the study warrant a clinical trial of the efficacy of nimodipine in severely head-injured patients who show traumatic SAH on the initial CT scan.
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Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. ⋯ For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.
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J Neurosurg Anesthesiol · Apr 1994
Soluble fibrin and D-dimer as detectors of hypercoagulability in patients with isolated brain trauma.
To test the hypothesis that hypercoagulability after brain trauma was related to the severity of injury and also to outcome, new coagulation markers were used in 20 patients with isolated brain trauma. In addition to routine coagulation tests, soluble fibrin (SF), D-dimer, and antithrombin (AT) levels were assessed. Thirteen of 20 patients had a Glasgow coma score (GCS) of < or = 7 on admission and severe disability (SD) or worse on the Glasgow outcome scale (GOS). ⋯ Six of 13 patients with a significant drop in AT levels had a bad outcome (D or V) whereas only two of seven patients without AT consumption did poorly. Routine coagulation studies were often pathologic, i.e., reduced platelet count, but there was no relation to outcome. Increased SF and D-dimer levels at admission followed by a secondary decrease in AT concentration and platelets seem to be good markers of the posttraumatic hypercoagulation often seen after brain injury.(ABSTRACT TRUNCATED AT 250 WORDS)