Articles: brain-injuries.
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Brain injury : [BI] · Oct 1991
ReviewCritical analysis of the concept of sensory stimulation for patients in vegetative states.
The practice of coma arousal and sensory stimulation is becoming the focus of heated debate. There is no theory on which patients may benefit, at what time in their recovery, or how the 'arousal' or 'stimulation' procedures should be applied. This paper considers some of the information processing mechanisms that are important mediators of arousal and awareness, pointing to some of the weaknesses in current practices and suggesting alternative approaches. Recommendations for a conceptual model of sensory stimulation are given that might provide a more scientific perspective to those who use such methods.
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To determine whether elevations in blood glucose levels were related to neurologic outcomes following severe brain injuries in children, 54 patients 16 years of age or younger admitted to a regional trauma center with a Glasgow Coma Scale score of 8 or less over a 2-year period were retrospectively reviewed. The mean initial blood glucose level on hospital admission was significantly higher in the 16 patients with outcomes of death or vegetative state in comparison with that of the 38 patients with outcomes of good recovery, moderate disability,or severe disability (288 mg/100 mL vs. 194 mg/100 mL, t = -2.74, p = 0.01). Blood glucose levels correlated significantly with indicators of the severity of the brain injury, which were also related to outcome. ⋯ Logistic regression analysis resulted in a model for prediction of outcome which included the Glasgow Coma Scale score on admission and the initial blood glucose level. The odds ratio of a poor outcome in this model in patients with blood glucose levels greater than or equal to 250 mg/100 mL relative to those with lower levels was 8.3 (95% confidence interval 1.3-53.6). A simple prognostic score was derived from the logistic regression which improved upon the prediction of outcome using the Glasgow Coma Scale score alone in those patients with initial blood glucose levels greater than or equal to 250 mg/100 mL.(ABSTRACT TRUNCATED AT 250 WORDS)
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In vivo levels of interleukin-1 (IL-1) and IL-6, present in the interstitial spaces of brain, have been repeatedly monitored up to 7 days after insertion of a microdialysis probe, designed to induce mechanical trauma to the brain. IL-1 is barely detectable immediately after implantation but over a 24-48 h period a 15-fold increase is seen. In contrast IL-6 levels at day 0 are high, increasing slightly (10%) by day 1 but decreasing to 40% by day 2. ⋯ The astrocytic response to injury, evidenced by increased glial fibrillary acidic protein staining occurs much later, by day 7, and is unlikely to be responsible for IL-1 and IL-6 production found at 24-48 h. Since upon isolation and stimulation of microglia in vitro with lipopolysaccharide IL-1 and IL-6 can be measured in the supernatant, it would appear that they have the capacity to produce cytokines in vivo. Localised synthesis of cytokines at sites of brain injury by microglia would further stimulate microglia in an autocrine manner and also propagate the astrocytic reaction.
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Fortschr Neurol Psychiatr · Sep 1991
Review[Prognostic factors in rehabilitation after severe craniocerebral injuries].
Even with modern standards of intensive care management and rehabilitation services, severe head injury often results in permanent disability. A review of the literature concerning predictors of outcome after severe head injury is presented. The early identification of those factors which are of greatest significance in determining outcome is of essential value in the appropriate management of rehabilitation therapy. ⋯ The presence of previous brain damage also seems extremely important. In contrast, the prognostic value of pretraumatic personality factors and of the psychosocial status of the head injured patient requires additional research. Comparison among studies is hindered by differences in patient samples, timing of assessments, and various outcome measures with respect to rehabilitation management.