Articles: brain-injuries.
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Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burr-hole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. ⋯ These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can usually be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intracranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.
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Anasth Intensivther Notfallmed · Feb 1989
Review[Current possibilities and limits of transcranial Doppler sonography as a cerebral monitoring procedure].
Transcranial Doppler Sonography (TCD) can meet some requirements for an ideal measuring device of the cerebral circulation. TCD can measure non-invasively and repeatably blood flow velocities of basal cerebral arteries. Under the assumption of constant vessel diameters can altered flow velocities reflect alterations of cerebral blood flow. ⋯ Furthermore TCD has been applied in cerebrovascular diseases, during operations with extracorporal circulation and in patients with increased intracranial pressure. Unchanged diameters of basal cerebral arteries have been proven only for carbon dioxide variations and some drugs; this cannot be presupposed during alterations of mean arterial or intracranial pressure. If conditions as ventilation, hemodynamics and drug therapy are kept constant, TCD may be valuable for short-term-trend-detection of cerebral blood flow and intracranial pressure.
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We conducted a review of 98 cases of pediatric traumatic parietal skull fracture in which computed tomographic (CT) scans of the head were obtained during a seven-year period. There were 69 instances of an associated intracranial lesion identified in 47 children, including parenchymal injury (23), epidural hematoma (17), subdural hematoma (11), cerebral edema (ten), and subarachnoid hemorrhage (eight). ⋯ Children who sustain traumatic parietal skull fracture commonly experience associated intracranial injury. Those with evidence of neurologic deficit or complicated skull fracture are at particularly high risk, and should receive cranial CT scan evaluation.