Articles: brain-injuries.
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Although head injury is a common occurrence in childhood, most of the brain injury that occurs is mild and uncomplicated. There are some differences between adults with head injuries and children with head injuries, and some of these differences are reviewed. Specific circumstances unique to childhood head injury are presented, including the importance of recognizing child abuse.
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Recent data have suggested that patients with both a normal cranial CT scan and normal neurologic examination following minimal head injury (MHI) have no risk of neurologic deterioration. This study prospectively examined the safety of discharging patients from the emergency department (ED) after MHI whether or not there was a responsible observer at home. MHI was defined as a history of loss of consciousness (LOC), a Glasgow Coma Scale (GCS) score of 14 or 15, and no focal neurologic findings. ⋯ Thirty-one patients who could not be followed up gave fictitious phone numbers. These data suggest that CT can reliably triage patients who can be discharged from the ED following MHI, even in the absence of a responsible observer. Hospital admission can be avoided in more than 80% of patients sustaining MHI, better utilizing scarce hospital resources.
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Comparative Study
A comparison of hypertonic to isotonic fluid in the resuscitation of brain injury and hemorrhagic shock.
We studied the early and late effects of hypertonic resuscitation (HR) on the injured brain using a porcine model of hemorrhagic shock and focal cryogenic brain injury. After shock, swine were randomly assigned to receive a bolus (4 cc/kg) of either Ringers lactate (RL) or 7.5% hypertonic saline in 6% Dextran 70, followed by either RL or hypertonic sodium lactate to restore mean arterial pressure to baseline. All animals were studied for 24 hr after the start of resuscitation. ⋯ At 24 hr CBF had deteriorated in the region of injury in all study groups and in the uninjured hemisphere in swine receiving RL. These data suggest that rapid resuscitation without increasing ICP for up to 6 hr as seen with hypertonic fluid could conceivably allow adequate time for surgical evacuation of mass lesions and effectively prevent secondary brain injury. This work underscores the importance of prolonged periods of study when evaluating brain resuscitation from traumatic shock.
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Journal of neurosurgery · Mar 1991
Acute regional cerebral blood flow changes caused by severe head injuries.
To evaluate the changes in cerebral blood flow (CBF) that occur immediately after head injury and the effects of different posttraumatic lesions on CBF, 61 CBF studies were obtained using the xenon-computerized tomography method in 32 severely head-injured adults (Glasgow Coma Scale score (GCS) less than or equal to 7). The measurements were made within 7 days after injury, 43% in the first 24 hours. During the 1st day, patients with an initial GCS score of 3 or 4 and no surgical mass had significantly lower flows than did those with a higher GCS score or mass lesions (p less than 0.05): in the first 1 to 4 hours, those without surgical mass lesions had a mean CBF of 27 cc/100 gm/min, which rose to 44 cc/100 gm/min by 24 hours. ⋯ In patients without surgical mass lesions, the findings suggest that CBF in the first few hours after injury is often low, followed by a hyperemic phase that peaks at 24 hours. Global CBF values vary widely depending on the type of traumatic brain injury, and brain-stem flow is often not accurately reflected by global CBF values. These findings underscore the need to define regional CBF abnormalities in victims of severe head injury if treatment is intended to prevent regional ischemia.
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Comparative Study
Combined hemorrhagic shock and head injury: effects of hypertonic saline (7.5%) resuscitation.
Hypertonic saline resuscitation was compared to isotonic fluid resuscitation in a large animal model combining hemorrhagic shock with head injury. Sheep were subjected to a freeze injury of one cerebral hemisphere as well as 2 hours of hypotension at a mean arterial pressure (MAP) of 40 mm Hg. Resuscitation was then carried out (MAP = 80 mm Hg) for 1 hour with either lactated Ringer's (LR, n = 6) or 7.5% hypertonic saline (HS, n = 6). ⋯ No differences were detected in the injured hemispheres. We conclude that hypertonic saline abolishes increases in ICP seen during resuscitation in a model combining hemorrhagic shock with brain injury by dehydrating areas where the blood-brain barrier is still intact. Hypertonic saline may prove useful in the early management of multiple trauma patients.