Acta neurochirurgica
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Acta neurochirurgica · Jan 1988
Angiographic investigation of cerebral vasospasm in subarachnoid haemorrhage due to arteriovenous malformation.
Fifty (50) selected patients with arteriovenous malformation (AVM) with and without subarachnoid haemorrhage (SAH) were investigated, in respect of occurrence and course of the vasospasm. The diameters of the carotid siphon and its main branches were measured and plotted against the time elapsing between the haemorrhage and the angiographic study. ⋯ Patients with intracerebral haematoma may show vasospasm from the first day onwards. It seems that the radiologically demonstrated spasm in AVM had no impact on the clinical outcome in this series.
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A consecutive series of 178 civilians with gunshot wounds of the brain was retrospectively analyzed. The overall mortality was 93%, with 88% of the victims having succumbed within 3 hours. ⋯ Good outcome occasionally resulted in patients with lesions crossing the midline, or affecting two lobes of a single hemisphere. Although spectacular recoveries in individual patients with apparently devastating injuries can be regarded as a sufficient basis for an aggressive approach, including vigorous resuscitation and early surgery, bleak possibilities still exist as to the management of civilian gunshot wounds, owing to the high mortality rate on the scene, or soon after the injury.
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Extradural haematoma (EDH) is generally a condition of young adult males. It represents only a small percentage of the total number of head injuries admitted to a neurosurgical service, but it must be differentiated from simple concussion, and this means that it is considered in a large number of patients. EDH has the potential for a low mortality rate because of its extraaxial location, but in practice it is approximately 10%. ⋯ There is a place for conservative treatment of EDH but only if the shift of the midline is minimal (less than 5 mm). A score has been developed to predict accurately a patient's outcome after suffering an EDH. This score includes the Glasgow Coma Scale, pupillary reaction and initial CT scan appearance, and has an accuracy of 88%.