Articles: brain-injuries.
-
Journal of neurosurgery · Jul 1985
Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury.
Patients with severe head injury frequently have evidence of elevated intracranial pressure (ICP) and ischemic neuronal damage at autopsy. Mannitol has been used clinically to reduce ICP with varying success, and it is possible that it is more effective in some types of head injury than in others. The aim of the present study was to determine the effect of mannitol on ICP, cerebral perfusion pressure (CPP), and cerebral blood flow (CBF) in patients with severe head injury, and to discover if these effects differed in different types of injury. ⋯ The baseline levels of flow did not correlate with ICP, CPP, Glasgow Coma Scale score, or outcome. Only four of the 55 patients had a CBF of less than 20 ml/100 gm/min in either or both hemispheres. The few low CBF's in this and other studies may reflect the steady-state conditions under which measurements are made in intensive care units, and that these patients have entered a phase of reperfusion.
-
66 patients with gunshot wounds were treated at the Department of Neurosurgery of Hanover University up to May 1982. These included wounds inflicted by bolt guns of the type used in slaughter houses, and by bolt-setting or nail-setting tools used in building construction work. The total mortality was 50%. ⋯ Postoperatively, there were several complications, mainly pneumonia and cerebrospinal fluid fistulas; in fact, pneumonia was responsible for the death of some patients. The mortality is compared with the findings by other authors. No patients remained in need of care after rehabilitation.
-
The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The average age was 23 years. ⋯ We showed that the predictive capabilities of brain stem reflexes were greater than those of motor responses. Although closely related (r = 0.68), the use of these two parameters in a single scale, the Glasgow-Liege scale, improves the precision of prognosis, especially for those head trauma patients with initial and complete loss of consciousness. Age was also revealed to be an important factor for outcome prediction.
-
The management of impaled foreign objects is always a challenge. Stabilization of the object, control of hemorrhage, and adherence to the basic principles of airway and breathing control are hallmarks of prehospital management. ⋯ A penetrating injury to the left hemisphere of the brain with a crowbar is presented. This case demonstrates the characteristics of these injuries in terms of extrication, assessment, management of complications, and neurologic sequelae.