Articles: brain-injuries.
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Creatine kinase (CK) and its brain-specific isoenzyme (CK-BB), neuron-specific enolase (NSE), neural cell adhesion molecule (NCAM) and the ions sodium, potassium, chloride and calcium were measured both in CSF and serum and inorganic phosphate in CSF in order to assess their prognostic value in total brain ischemia due to cardiac arrest. The samples were collected at 4, 28 and 76 h after resuscitation. Twenty consecutive patients resuscitated from ventricular fibrillation or asystole were included in the study. ⋯ Statistically significant differences between the groups were seen in both CSF and blood pCO2, pO2, base excess (BE) and actual bicarbonate (HCO3-). CSF or serum NCAM has no prognostic value in anoxic-ischemic coma. The results suggest that in CSF CK-BB and NSE are useful prognostic indicators of hypoxic brain injury when measured 28-76 h after cardiac arrest whereas blood samples have no prognostic value.
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Journal of neurosurgery · May 1993
Historical ArticleTreatment of head injuries in the American Civil War.
At the time of the American Civil War (1861-1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. ⋯ Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.
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Swiss medical weekly · Apr 1993
Case Reports[Unstable spinal injuries in cranio-cerebral injuries].
Estimates of the incidence of injury to the cervical spine among patients suffering blunt trauma to the head vary widely. In an attempt to quantify the risk, the records of 593 consecutive patients with blunt craniocerebral injuries admitted to our trauma center in 1991 were reviewed. ⋯ In the management of head trauma with associated cervical spine injuries realignment and immobilization of the spine and surgery of the head were carried out as first step, followed by decompression and stabilization of the affected segment in the same session. In patients with altered consciousness there is always loss of cooperation and early spinal stabilization for optimal treatment in the intensive care unit and in the wake-up-phase is important.
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Certain clinical factors are considered to have an effect on patient outcome after penetrating missile injury. These include bilateral hemispheric injury, ventricular hemorrhage, intracerebral hemorrhage, mass effect, and missile or bony fragmentation. The relationship of subarachnoid hemorrhage (SAH) after penetrating craniocerebral injury and outcome is unknown. ⋯ One intracranial aneurysm (3.2%) was documented and treated surgically. In those patients who died within 48 hours of admission, 68% had SAH as compared with only 17% of those surviving. Outcome was based upon neurological evaluation at the time of discharge and at the time of clinical follow-up at 3 and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors monitored in children with craniocerebral injuries hospitalized in their department in the course of the more than one-year existence of the child ARO ward in addition to other vital parameters also changes of the haemocoagulation system. They describe the majority of commonly observed abnormalities as "latent consumption coagulopathy", where laboratory findings are not associated with clinical signs of coagulopathy. On the other end of the spectrum of coagulopathies after head injuries is the unit of disseminated consumption coagulopathy which is generally evaluated as a secondary phenomenon or as an intermediary mechanism of the disease which complicates various pathological conditions incl. craniocerebral injuries. The authors discuss the pathophysiology, diagnostic possibilities and their experience with the treatment of the mentioned disorders.