Articles: brain-injuries.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging.
The early post-traumatic vegetative state (VS) is compatible with recovery. Various clinical and laboratory tests have failed to predict recovery so we assessed the value of cerebral magnetic-resonance imaging (MRI) in prediction of recovery. ⋯ Cerebral MRI findings in the subacute stage after head injury can predict the outcome of the post-traumatic VS. Corpus callosum and dorsolateral brainstem lesions are highly significant in predicting non-recovery.
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J. Cereb. Blood Flow Metab. · Jun 1998
Randomized Controlled Trial Clinical TrialQuinolinic acid is increased in CSF and associated with mortality after traumatic brain injury in humans.
We tested the hypothesis that quinolinic acid, a tryptophan-derived N-methyl-D-aspartate agonist produced by macrophages and microglia, would be increased in CSF after severe traumatic brain injury (TBI) in humans, and that this increase would be associated with outcome. We also sought to determine whether therapeutic hypothermia reduced CSF quinolinic acid after injury. Samples of CSF (n = 230) were collected from ventricular catheters in 39 patients (16 to 73 years old) during the first week after TBI, (Glasgow Coma Scale [GCS] < 8). ⋯ There was a powerful association between time after TBI and increased quinolinic acid (P < 0.00001), and quinolinic acid was higher in patients who died than in survivors (P = 0.003). Age, gender, GCS, and treatment (32 degrees C versus 37 degrees C) did not correlate with CSF quinolinic acid. These data reveal a large increase in quinolinic acid concentration in CSF after TBI in humans and raise the possibility that this macrophage-derived excitotoxin may contribute to secondary damage.
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Critical care medicine · Apr 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffect of prophylactic administration of recombinant human granulocyte colony-stimulating factor (filgrastim) on the frequency of nosocomial infections in patients with acute traumatic brain injury or cerebral hemorrhage. The Filgrastim Study Group.
To determine whether the use of prophylactic recombinant human granulocyte colony-stimulating factor (filgrastim) reduces the frequency of nosocomial infections in patients with either acute traumatic brain injury or cerebral hemorrhage. ⋯ In this patient population, use of filgrastim was safe and the agent appeared to reduce the risk of primary bacteremias but had no beneficial effects on mortality, length of stay, or other nosocomial infections.
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Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Clinical TrialTreatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients.
The management of intracranial pressure (ICP) is a factor in outcome of patients with head trauma. However, recent studies have revealed that the current strategies, which have been applied to control ICP for adequate cerebral perfusion, are unsatisfactory. Against this background, the efficacy of short-term infusions of hypertonic saline on ICP was investigated. ⋯ In the individual cases the temporal course of the parameters amplitude and decline interval depict a tendency toward lower and higher values, respectively, under conditions of a generally increasing ICP. As expected, the infusion of hypertonic saline reduces ICP in patients suffering from SHI. The pressure drop, duration and dynamic behaviour are suspected to depend both on the pressure level to reduce and concomitant medications.
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Acta Anaesthesiol Scand · Nov 1997
Randomized Controlled Trial Clinical TrialEffects of cisatracurium on cerebral and cardiovascular hemodynamics in patients with severe brain injury.
For neuroanesthesia and neurocritical care the use of drugs that do not increase or preferentially decrease intracranial pressure (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) are preferred. The current study investigates the effects of a single rapid bolus dose of cisatracurium on cerebral blood flow velocity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension after severe brain trauma (Glasgow coma scale <6) under continuous sedation with sufentanil and midazolam. ⋯ The results from this study suggest that cisatracurium is a safe neuromuscular blocking agent for use in adult severe brain-injured patients with increased ICP under mild hyperventilation and continuous sedation.