Articles: brain-injuries.
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We present a case in which the skull and brain were pierced by a piece of wood, the low attenuation value of which, in a CT scan, simulated an intracerebral pneumatocoele. The risk of misinterpreting the CT appearance of intracranial wood is discussed, and the importance of thorough exploration of a penetrating cranial injury is stressed.
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In accident diagnosis, the computed tomogram (CT) is nowadays decisive for the determination of craniocerebral traumas. This is true for children as well as for adult patients. ⋯ Furthermore the injuries to the osseous skull which can be represented by CT and the late consequences of the accident are mentioned. The special aspects of craniocerebral traumas in children are taken into consideration.
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Journal of neurosurgery · Feb 1984
Origin and evolution of plateau waves. Experimental observations and a theoretical model.
Laboratory observations made in cats with fluid-percussion head injuries have suggested that plateau waves or Lundberg "A-waves" are not independent of systemic circulatory events. Four distinct phases in the evolution of the plateau wave have been identified, and each related to a circulatory change in a causal manner. The first phase is the premonitory drift phase where intracranial pressure (ICP) gradually increases prior to the plateau proper. ⋯ The fourth phase is the resolution, characterized by a rapid decline in the ICP to baseline levels with stabilization of the SABP and CPP, and is best explained by autoregulatory vasoconstriction. Plateau waves appear to occur as the result of intact or mostly intact autoregulation responding to changes in CPP. The series of events that follow are best explained by what is known of normal autoregulation; the various properties of plateau waves are viewed and explained as the expected and logical consequences of an unstable CPP acting upon a generally intact cerebrovascular bed in the face of elevated ICP and decreased compliance.
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13 cases of severe cerebral trauma were subjected to varying degrees of elevation of the upper trunk (0 degrees, 15 degrees, 30 degrees, 45 degrees) and to head-raising only (0 degrees, 15 degrees, 30 degrees). The intracranial pressure and mean arterial pressure were measured in these positions. On raising the upper half of the body by 15 degrees, intracranial pressure fell from a mean of 35.3 mm Hg to 28.7 mm Hg, and to 25.2 mm Hg on raising to 30 degrees. ⋯ In contrast, the mean arterial pressure fell constantly as elevation increased, resulting in a decrease in cerebral perfusion pressure at levels above 30 degrees. In no cases did raising of the head alone result in a lowering of pressure. Instead, potentially dangerous increases were observed.