Articles: brain-injuries.
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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)
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Minerva anestesiologica · Nov 1993
Review[Continuous monitoring of brain electrical activity as a guide to treatment of acute brain lesion].
Cortical activity of the brain can be monitored continuously by simple, cheap and non-invasive methods. Nevertheless routine monitoring in Neuro ICUs seldom includes traditional or processed EEG. Our clinical experience with the Cerebral Function Monitor (CFM) indicates that a reliable guide to treatment of acute cerebral lesion can be obtained in different clinical situations and steps of management.
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The officially appointed external expert needs a precise documentation of the initial clinical findings and the findings at follow-up of the patient with craniocerebral trauma. The next step in preparation of the expert report consists in a pathophysiological and a neurological examination, including CT scan and EEG repeated at intervals; a stable condition can be expected after 1-2 years. In the case of reversible closed head syndrome (brain concussion) the expert should certify a disability for about 6 months; a degree of 20% for over 3 months should not be certified unless there are massive vegetative signs and symptoms. ⋯ Adults who are unconscious for up to 5 days can be expected to make a complete recovery, while a longer duration of coma and more advanced age are associated with a worse outcome. The degree of functional impairment is thus important in the expert's decision on the level of disability. A flow chart is presented for guidance in the preparation of expert reports.(ABSTRACT TRUNCATED AT 250 WORDS)
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Brain injury : [BI] · Nov 1993
Comparative StudyA comparison of the Glasgow Coma Scale and the Swedish Reaction Level Scale.
The Glasgow Coma Scale (GCS) and the Swedish Reaction Level Scale (RLS85), two level-of-consciousness scales used in the assessment of patients with head injury, were compared in a prospective study of 239 patients admitted to a regional head injury unit over a 4-month period. Assessments were made by nine staff members ranging from house officer to registrar, after briefing about the two scales. Data were also collected on age, nature of injuries, surgical treatment, and condition at discharge or transfer using the Glasgow Outcome Scale. ⋯ The RLS85 was reported by all users to be simpler to use than the GCS, but the latter is much more widespread in use. Both scales function well in cases of severe and minor head injury, but have weaknesses when defining moderate head injury. Level-of-consciousness scales are only an aid to assessment and the final choice between the two scales must remain a matter of personal or departmental preference.