Articles: brain-injuries.
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A facio-cranio-cerebral injury due to a large piece of shrapnel causing direct and heat damage to the temporal lobe is described. It was managed by initial dural repair which was followed by sloughing and repeated wound débridement, leaving an open cerebral wound communicating with a facial wound. Auto-rotation of the temporal lobe occurred, allowing split-skin grafting onto arachnoid mater to obtain dural closure. Further treatment of the facial wound by skin-grafting the cavity and prosthetic reconstruction allowed early return to society and a full rehabilitation programme.
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Cahiers d'anesthésiologie · Jan 1990
[Indomethacin in severe cerebral contusions with intracranial hypertension].
In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control ICP by hyperventilation and barbiturate sedation, indomethacin Confortid was used as a cerebral vasoconstrictor drug. In all patients indomethacin reduced ICP below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in cerebral blood flow (CBF) at 2 hours. ⋯ In all patients indomethacin treatment was followed by a fall in rectal temperature. Outcome scaling has not yet been performed, but all patients left hospital without neurological deficits. These results suggest that indomethacin is an alternative in the treatment of intracranial hypertension in head-injured patients.
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Ann Oto Rhinol Laryn · Jan 1990
Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.
Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. ⋯ Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.