Articles: brain-injuries.
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An unusual postoperative complication of percutaneous thermocoagulation of the gasserian ganglion is reported. Computed tomography and magnetic resonance imaging of the brain disclosed an intracerebral lesion following the surgical procedure. Some rare abnormalities of the skull base could increase the risk of such complications. A meticulous surgical technique with fluoroscopic and neurophysiological control is mandatory in any percutaneous procedure on the trigeminal ganglion.
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Comparative Study
[Extradural hematoma: comparative radiological study between comatose and non-comatose patients].
A series of 129 patients harbouring extradural hematomas was analysed considering the neurological state immediately before operation as the most consistent variable. Seventy eight patients were considered to be comatose (Group I) and 51 were noncomatose. ⋯ Associated intracranial lesions increased the mortality and lowered the good results in both groups. Frontal hematomas (10 cases) in the comatose group were associated with high mortality (52.6%) due to bad neurological state (Glasgow 3-5) and to isolated or multiple intracranial associated lesions (6 patients).
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A high degree of variability in energy expenditure has characterized the metabolic response to traumatic brain injury. A goal of parenteral or enteral repletion in this population is the precise estimation of caloric requirement to avoid complications associated with overfeeding and underfeeding. The first aim of this study was to evaluate three predictive formulas for comparison to measured energy expenditure (MEE) derived from indirect calorimetry in patients with traumatic brain injury. ⋯ The second aim of this study was to evaluate the ability of additional nutritional markers to improve predictive ability. Regression analyses were performed on nutritional markers including indices of severity of injury, concurrent drug therapy, vital signs, neurological status, gluconeogenesis, protein synthesis/excretion, and immune response. The statistical results of the analysis on these multiple nutritional markers showed only heart rate, temperature, and number of days elapsed after injury to be significant predictors of MEE by indirect calorimetry in multiple regression analyses (R = 0.32; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatric neurosurgery · Jul 1992
Case ReportsPreliminary experience with controlled external lumbar drainage in diffuse pediatric head injury.
Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. ⋯ Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.
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Severe head injury often causes an increase in intracranial pressure (ICP) and decreases in cerebral blood flow (CBF) and cerebral oxygen delivery (CO2del). To determine if this reduction in CBF and CO2del would produce cerebral ischemia and if this reduction would be abrogated by maintaining global cerebral perfusion pressure (CPP), we studied CPP, ICP, CBF, CO2del, cerebral oxygen extraction ratio (CO2ER), and cortical water content (CWC) in a porcine model of focal cryogenic brain injury. Fifteen mature swine were randomized to two groups. ⋯ Cryogenic injury significantly increased the CWC in the lesioned hemisphere. These data indicate that focal brain injury results in persistent ischemia despite the normalization of CPP, suggesting that a significant increase in cerebral vascular resistance (CVR) occurs after brain injury. We conclude that in addition to maintenance of CPP, intervention to reduce CVR may be important in the management of brain injury.