Articles: brain-injuries.
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Journal of neurosurgery · Nov 1983
Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study.
The influence of the type of intracranial lesion on the final outcome in a consecutive series of 277 severely head-injured patients was analyzed. Patients were studied with computerized tomography (CT) and underwent continuous measurement of intracranial pressure. ⋯ Patients with pure extracerebral hematoma (19 cases), single brain contusion (45 cases), general brain swelling (41 cases), and normal CT scans (28 cases) had a significantly better outcome than patients developing acute hemispheric swelling after operation for a large extracerebral hematoma (27 cases), patients with multiple brain contusion, either unilateral or bilateral (74 cases), and patients with diffuse axonal injury (43 cases). These anatomical patterns are interesting because, in addition to having clinical and physiopathological significance, they provide useful prognostic information and facilitate improved therapeutic decision-making in severely head-injured patients.
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The article describes the pathophysiological mechanisms of injuries caused by shots in the head. In particular, the effect exercised on the cerebral tissue by the impact of rapid projectiles is explained. ⋯ These cases are discussed and critically assessed, using the results communicated in other papers as basis. The requisite surgical measures are considered; the need for effecting complete cleansing of the path of the bullet is viewed with some reserve.
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31 patients with craniocerebral gunshot wounds were examined in the acute phase and 14 out of 22 survivors followed up for a period of up to 3 years. The clinical and CT findings as well as treatment measures are explained. The value of CT is convincingly demonstrated with this type of injury, as with others, but its prognostic value including prediction of follow-up results remains limited.