Articles: brain-injuries.
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Intensive care of the patient who has acute brain injury has undergone major changes. Neurologic monitoring, particularly continuous recording of the intracranial pressure, appears to have contributed to an improved outcome in head-injured patients. ⋯ Other techniques such as cerebral blood flow measurements, reflectance spectrophotometry, and sophisticated electrophysiologic recording are being utilized in the laboratory and in man as monitoring techniques. There utility and potential applications are discussed, and the present role of monitoring reviewed.
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Assessment of brain dysfunction in head injured patients is important as an index of severity of brain damage and forms the basis of monitoring.. The Glasgow Coma scale (G. C. ⋯ S. and provides informations concerning the brain stem reflexes. In a series of 60 head-injured patients, recovery rates were calculated on the basis of either Glasgow scores or Liege scores. The Liege Coma scale provides a more sensitive index of clinical course and a better prognosis.
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Acta Anaesthesiol Scand · Aug 1981
Cerebral blood flow in the acute phase after head injury. Part 2: Correlation to intraventricular pressure (IVP), cerebral perfusion pressure (CPP), PaCO2, ventricular fluid lactate, lactate/pyruvate ratio and pH.
In 40 comatose patients with severe head injury, cerebral blood flow (CBF) studies were performed with the 133Xenon washout technique over the most severely injured hemisphere. All patients were mildly sedated with diazepam, chlorpromazine and meperidine and subjected to respiratory support. Simultaneously with the CBF study, intraventricular pressure (IVP), systemic arterial pressure (SAP) and ventricular fluid (VF) lactate, pyruvate and pH were measured. ⋯ In patients with mainly supratentorial lesions without signs of brain-stem lesions, CBF and CPP were positively correlated, while CBF and ICP were negatively correlated (lost autoregulation). In contradistinction, CBF was positively correlated to ICP and PaCO2 in patients with diffuse brain injury. In some cases of repeated dynamic studies, the clinical course seemed to be related to changes in the measured parameters.