Articles: brain-injuries.
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Case Reports
Auditory evoked responses in the management of acutely brain-injured children and adults.
In recent years, the role of auditory evoked responses (AERs) in the intensive care unit (ICU) setting has expanded dramatically for both pediatric and adult brain-injured patient populations. AERs have unique value in early identification and evaluation of peripheral auditory dysfunction that can result directly from head trauma or as a consequence of intensive medical therapy (such as prolonged intubation and ototoxic drugs). ⋯ The rationale for monitoring neurologic status with AERs in this setting is presented and supported with original group data. Important points are illustrated with selected case reports.
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Diving accidents related to barotrauma constitute a unique subset of ischemic insults to the CNS. Victims may demonstrate components of arterial gas embolism, which has a propensity for cerebral involvement, and/or decompression sickness, with primarily spinal cord involvement. Fourteen patients with diving-related barotrauma were studied with MR imaging of the brain and spinal cord and with CT of the brain. ⋯ However, scans obtained early in our study were frequently limited by technical constraints. MR of the brain is more sensitive than conventional CT scanning techniques in detecting and characterizing foci of cerebral ischemia caused by embolic barotrauma to the CNS. Although spinal MR may be less successful in the localization of spinal cord lesions related to decompression sickness, these lesions were previously undetectable by other neuroimaging methods.
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Wien. Klin. Wochenschr. · Oct 1988
[Prognosis and documentation of the disease course in severe craniocerebral injuries].
35 survivors of severe head injury were consecutively admitted to the Neurological Department, University of Vienna for early rehabilitation. The outcome after a mean observation periods of 19 months was compared with clinical signs (best motor response, pupillary light reaction, pupil size) in the acute stage. The clinical signs were graded semiquantitatively. ⋯ Solely with respect to the items "orientation and memory function" and "emotions" of the neuropsychological rating scale was no significant correlation obtained with the clinical sign "best motor response" in the acute stage. Our results indicate that it seems possible to assess the outcome after severe head injury not only be means of the widely-adopted Glasgow Outcome Scale, but also using the Karnofsky Performance Status and our neuropsychological rating scale without any marked loss of reliability. The clinical signs - "best motor response" and pupillary light reaction - are excellent prognostic indicators of the long-term outcome after severe head injury.
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The Authors report an analysis on 40 cases of craniocerebral gunshot wounds treated in a civil hospital over a 8-year period. The important role of CT for a correct diagnosis and treatment planning is stressed even though patients with a G. C. S. lower than 4 die regardless of their CT findings; subdural and intracerebral hematomas are not a serious complication unless patient's neurological status is poor; timing of surgical treatment plays a major role in order to avoid infection of the wound.
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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.