Articles: brain-injuries.
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The outcome in 159 cases of head injury was evaluated in terms of the Glasgow Coma Scale (GCS) score, age, and computed tomographic (CT) findings. Children below the age of 10 accounted for 30% of the head-injured patients, and 69% were Saudis. 81% of the patients had a GCS score of 8 or higher, and in this group the outcomes were favorable. In contrast, 19% had an initial GCS score of 7 or less, tended to be older, and had worse outcomes, with a mortality rate of 68%. The initial GCS score, age, presence or absence of associated injuries, and the degree of midline shift according to CT were useful prognostic indices in patients with head injury.
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Comparative Study
Mortality of patients with head injury and extracranial injury treated in trauma centers.
The types and severity of injuries of 49,143 patients from 95 trauma centers were coded according to the 1985 version of the Abbreviated Injury Scale (AIS). This paper analyzes the causes, incidence, and mortality in 16,524 patients (33.6% of the trauma center patients) with injury to the brain or skull and compares them to patients without head injury. Relative to its incidence, patients with head injury composed a disproportionately high percentage (60%) of all the deaths. ⋯ The cause of death in head-injured patients was approximated and it was found that 67.8% were due to head injury, 6.6% to extracranial injury, and 25.6% to both. Head injury is thus associated with more deaths (3,010 vs. 1,972) than all other injuries and causes almost as many deaths (2,040 vs. 2,170) as extracranial injuries. Because of its high mortality, head injury is the single largest contributor to trauma center deaths.
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We retrospectively evaluated the records of 459 children who had normal findings on a neurologic examination after moderate head injury characterized by brief loss of consciousness. Skull x-ray examination had been performed in 358 children, and 52 (14%) had fractures. ⋯ Three children required surgical evacuation of hematomas between approximately 24 and 72 hours after injury. On the basis of these results, we conclude that in the absence of a skull fracture, most alert children without symptoms who have sustained moderate head injury may be safely discharged from the emergency department in the care of a competent observer.
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While in animal experiments neurogenically initiated pulmonary edema is a well known event and is supposed to be due to centrally initiated hemodynamic disturbances ("neurohemodynamics") in patients with severe cerebral lesions fulminant alveolar edema is reported to occur very rarely. The questions addressed by this study are: 1. whether and to what extent changes in extravascular lung water (EVTVL) can be demonstrated in patients with a severe isolated cerebral lesion; 2. whether a relationship between the severity of the cerebral lesion and accompanying EVTVL changes can be proven; and 3. whether or not EVTVL changes are associated with corresponding changes in intravascular hydrostatic and oncotic Starling parameters; i.e. cardiogenic or noncardiogenic pulmonary edema accompanying the cerebral lesion. This study included 44 patients presenting with a severe isolated cerebral lesion and decerebrate posturing on admission. ⋯ While survivors (n = 13) remained within the normal range of EVTVL (less than 9 ml/kg), non-survivors (n = 31) started at an already elevated level (10.05 +/- 1.04 ml/kg) and reached their maximum values (15.4 +/- 2.3 ml/kg) on day 3 to 4. In 3 non-survivors these increased initial EVTVL values were accompanied by pathologically increased intravascular pressures, indicating that hydrostatic mechanisms were involved in the EVTVL rises. While the hydrostatic pressures normalized spontaneously, EVTVL values stayed within the pathological range throughout the remaining observation period.(ABSTRACT TRUNCATED AT 400 WORDS)
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Forty-one children with severe head injuries and diffuse brain lesions were selected from a consecutive series of 62 children in traumatic coma (21 focal mass lesions) and studied. According to the CT pattern, two main types of intracranial lesions were considered: diffuse axonal injury (DAI) and diffuse brain swelling (DBS). ⋯ However, children with normal CTs, and/or obvious shearing injuries indicative of DAI, had favorable outcomes; there was no mortality if increased ICP was not present. We conclude that although there does not seem to be any routine indications for ICP monitoring in children with pure DAI, early ICP monitoring and aggressive management of increasing ICP should be considered in comatose children with DBS, especially when associated with subarachnoid hemorrhage and respiratory or circulatory failure.