Articles: brain-injuries.
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Curr Opin Neurol Neurosurg · Dec 1992
ReviewIntracranial pressure measurement/cranial vault mechanics: clinical and experimental observations.
The absolute value of intracranial pressure (ICP) should be considered in conjunction with evaluation of a patient's clinical condition. In addition, other aspects of cranial vault mechanics may be important in multiple disease states. Among the important physiological measures of cranial vault sufficiency are hydrodynamic interaction between brain tissue, blood and cerebrospinal fluid (CSF)--volume-pressure relation, CSF dynamics--CSF outflow resistance, CSF production rate, sagittal sinus pressure, and appearance of ICP waves. Clinical and experimental studies brought together in this review provide an insight into the dynamics of ICP and the cranial vault.
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In the management of patients with acute cerebral disturbances, it is essential to determine precisely the degree of impaired consciousness. In order to secure the accuracy of observations, one must use a reliable coma scale. We have evaluated the Edinburgh 2 coma scale (E2CS) and explored the relationship between levels of the E2CS and the final outcome. ⋯ It was shown at the same time that each level has different prognostic significance and that the distance between each level is not identical. The recommendation is made to separate the levels on a chart not by an ordinal number but by the distance calculated on the basis of either mortality or morbidity rates. This will make it possible to get a rough estimate of the patients' prognoses by simply looking at a daily clinical chart.
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The Authors present a case of a young man who drowned in sea water after the shock caused by a lightening that fell close to him as the swam. The Authors discuss and analyze the effects of the two events (drowning and lightening) which developed similar cerebral injuries but with a different origin.
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The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject's status from field intervention through hospitalization. ⋯ Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% confidence interval [CI] = 1.1-1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1-1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0-3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9-2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients.