Articles: brain-injuries.
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Arch Phys Med Rehabil · Sep 1988
Pediatric closed head injury: outcome following prolonged unconsciousness.
This report describes outcomes for a group of 26 children who remained unconscious longer than 90 days after traumatic brain injury. Twenty children regained consciousness; 11 are able to communicate. ⋯ In this series, children with the best recovery (IQ greater than or equal to 70) were predicted by minimal cerebral atrophy, demonstrated by computerized brain scan (CT scan) performed two months after injury (p = 0.001). In subjects over 12 years old, minimal CT atrophy predicted a good outcome with 89% accuracy.
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Four children with brain injury were later found to have coexisting spinal cord injury (SCI). Findings that warrant investigation for coexisting SCI include a dermatome pattern sensory loss; absence of movement and reflexes in either both arms or both legs with preservation in the remaining extremities; flaccidity; absence of sacral reflexes; diaphragmatic breathing without use of accessory respiratory muscles; bradycardia with hypotension; autonomic hyperreflexia; poikilothermia; unexplained urinary retention; history of neck pain; unexplained ileus; priapism; and the presence of clonus in an unconscious patient without decerebrate rigidity. If any of the above are present, the spine should be stabilized until either further diagnostic studies confirm SCI with treatment instituted or serial neurologic examinations confirm the absence of SCI.
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Biography Historical Article
Neurological surgery during the Great War: the influence of Colonel Cushing.
Despite von Bergmann's work in the Franco-Prussian War and Makins' experiences in the Boer conflict, military surgeons in World War I were unprepared for the nature and extent of intracranial injuries. Poor triage, disorganized transportation, incomplete surgery, and sepsis resulted in a mortality of over 50%. In 1915, as a volunteer to the Ambulance Américaine near Paris, Harvey Cushing spent 5 weeks observing the Allied medical system. ⋯ In September 1918, as senior consultant to the American Expeditionary Force, Cushing was in charge of organizing the neurosurgical care for the St. Mihiel and Meuse-Argonne offensives. His instruction of individual surgeons in operative techniques and the creation of identified hospital centers with suitable equipment and trained personnel helped to establish neurological surgery as a military specialty.
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Comparative Study
Acute cerebral effects of isotonic crystalloid and colloid solutions following cryogenic brain injury in the rabbit.
Despite the numerous studies examining the relative merits of crystalloids versus colloids for expansion of intravascular volume, little attention has been directed to the cerebral effects of these solutions. In particular, the effect of changes in plasma oncotic pressure on brain water content are poorly understood. The authors recently examined the acute effects of changes in plasma osmolality and colloid oncotic pressure in normal animals, and found that a 65% reduction in oncotic pressure had no detectable effect on brain water content or intracranial pressure. ⋯ The saline group required approximately twice as much fluid (207 +/- 17 ml) to maintain a stable mean arterial pressure and central venous pressure as did the hetastarch (105 +/- 14 ml) or albumin (103 +/- 29 ml) groups. As intended, the oncotic pressure decreased by a mean of 9.6 +/- 2.4 mmHg in the saline group, while remaining stable in the hetastarch and albumin groups. There were no significant changes in osmolality in any group during the hemodilution period.(ABSTRACT TRUNCATED AT 250 WORDS)
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The clinical and computed tomographic (CT) findings in a series of 161 consecutive patients operated upon for postraumatic extradural hematoma are analyzed. Thirteen (8%) patients had delayed epidural hematoma formation. The overall mortality for the series was 12%, significantly lower than that observed during the prior "angiographic" period at the same unit (30%). ⋯ There were no significant differences between these groups in age, sex, mechanism of injury, preoperative course of consciousness (lucid interval or not), or epidural hematoma location and shape. In contrast, significant differences were seen between the two subgroups in trauma-to-operation interval, hematoma volume, CT hematoma density (mixed low-high CT density vs. homogeneous hyperdensity), midline displacement, severity of associated intracranial lesions, and postoperative intracranial pressure (ICP). Patients comatose at operation usually evidenced a more rapid clinical deterioration (a shorter trauma-to-operation interval) and tended to have a large hematoma volume, a higher incidence of mixed CT density clot (hyperacute bleeding), more marked shift of midline structures, more severe associated lesions, and higher postoperative ICP levels.