Articles: brain-injuries.
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Transtentorial herniation is an ominous finding in the patient with head injuries. We report our experience with 10 patients suffering from acute transtentorial herniation secondary to posttraumatic unilateral hemispheric swelling who were treated aggressively with temporal lobectomy. Eight patients were men and 2 were women. ⋯ In this series, the mortality rate was 30%, including a single patient who was neurologically stable but died from nonneurological injuries. Of the 7 survivors, 4 were functionally independent and 3 required minimal assistance with the activities of daily living. Aggressive, early decompression via complete temporal lobectomy may thus significantly improve the outcome in patients with transtentorial herniation accompanying posttraumatic hemispheric swelling and midline shift.
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Experience with 120 patients who incurred a gunshot wound to the head with dural penetration is presented. All of the patients were managed by a standard resuscitation protocol and assigned a clinical grade based on their level of consciousness both at the time of presentation and at 2 to 4 months after injury. Fifty patients (42%) underwent surgery. ⋯ Nine patients, however, who were not comatose at the time of admission died from potentially preventable causes. In 3 of these patients, a more aggressive diagnostic approach (including cerebral angiography) may have altered their ultimate outcome. An expeditious approach to the trauma victim with a comprehensive management scheme after injury may have altered the course in the remainder of these patients.
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Zh Vopr Neirokhir Im N N Burdenko · Jul 1991
Comparative Study[The characteristics of closed craniocerebral trauma in older persons].
It is shown that in the recent 2 decades the incidence of craniocerebral trauma increased from 4.8 to 7.2% among old-aged individuals and from 53 to 72% in the group of patients over 60. The dynamics of changes in the clinical course of mild craniocerebral trauma in 21% of old-aged patients were marked by secondary acute cerebral circulatory disorders which often led to a fatal outcome. Mortality rate in craniocerebral trauma at old age was 52.3%.
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Analysis of 314 cases of penetrating craniocerebral missile injuries in civilians revealed a high rate of early mortality, with 228 victims having died at the scene and a further 38 dead within 3 hours. Surgery was performed in 44 patients who had a preoperative Glasgow Coma Score of at least 4. ⋯ Vigorous resuscitation and early surgery often resulted in useful survivals and occasionally in spectacular recoveries. However, the high mortality rate on the scene or soon after the injury restricted the possibility of effective management to a minority of cases.
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Fiziol Zh SSSR Im I M Sechenova · May 1991
[The effect of local electrostimulation of nerve tissue on its blood supply indices in extreme brain states].
The specifics of local blood flow (LBF) was studied in the areas of electrical stimulation. The occurring changes are determined primarily by the functional state of neural tissue in the stimulation area as well as in the whole brain. The cortex develops an insrement of the LBF after stimulation by the 4th-5th day whereas no such tendency was found in the white matter.