Journal of neurosurgery
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Journal of neurosurgery · Feb 1988
Biphasic ventricular dilatation following posterior fossa subdural hematoma in the full-term neonate.
Five full-term neonates with a posterior fossa subdural hematoma caused by birth injury are reported. All of the patients were successfully treated with surgery. They all presented with biphasic ventricular dilatation as demonstrated by serial computerized tomography (CT) scanning. ⋯ The other four patients showed transient dilatation of the ventricles without symptoms of increased intracranial pressure. Subarachnoid hemorrhage associated with posterior fossa subdural hematoma is considered to be the most likely causative factor for the delayed ventricular dilatation. The degree of dilatation roughly depended on the volume of the subarachnoid clot that was demonstrated on the initial CT scan.
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Journal of neurosurgery · Feb 1988
Traumatic dissections of the extracranial internal carotid artery.
Traumatic dissections of the extracranial internal carotid artery (ICA) in 18 patients aged 19 to 55 years were studied. All had suffered blunt head or neck injury of marked or moderate severity; motor-vehicle accidents were the leading cause of the injury. Delayed focal cerebral ischemic symptoms were the most common presenting symptoms. ⋯ Common angiographic findings, in decreasing order of frequency, are: aneurysm, stenosis of the lumen, occlusion, intimal flap, distal branch occlusion (embolization), and slow ICA-to-middle cerebral artery flow. Although two patients died as the result of massive cerebral infarction and edema and some were left with severe neurological deficits, most made a good recovery. Residual dissecting aneurysms and occlusion seem to occur more frequently with traumatic dissections than with spontaneous dissections of the extracranial ICA.
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Journal of neurosurgery · Feb 1988
Case ReportsStress-induced malignant hyperthermia in a head-injured patient. Case report.
Susceptibility to malignant hyperthermia is a rare inherited myopathy. Hypermetabolic crises accompanied by a rise in body temperature to as high as 44 degrees C are the hallmark of malignant hyperthermia episodes. ⋯ It has been proposed that stress-induced malignant hyperthermia occurs in man. The present paper presents a case of stress-induced malignant hyperthermia in a 21-year-old man in whom the inciting stress was a head injury.
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Journal of neurosurgery · Jan 1988
Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma.
Mortality due to epidural hematoma is virtually restricted to patients who undergo surgery for that condition while in coma. The authors have analyzed the factors influencing the outcome of 64 patients who underwent epidural hematoma evacuation while in coma. These patients represented 41% of the 156 patients operated on for epidural hematoma at their centers after the introduction of computerized tomography (CT). ⋯ Forty-eight patients (75%) had one or more associated intracranial lesions, and 70% of these required treatment for elevation of ICP after hematoma evacuation. An ICP of over 35 mm Hg strongly correlated with poor outcome; administration of high-dose barbiturates was the only effective means for lowering ICP in nine of 15 patients who developed severe intracranial hypertension after surgery. This study attempts to identify patients at greater risk for presenting postoperative complications and to define a strategy for control CT scanning and ICP monitoring.
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Calorie and protein supplementation improves nutritional status. This support may improve outcome and decrease morbidity and mortality in acutely brain-injured patients. Investigators have observed a poor tolerance to enteral feedings after brain injury and have noted that this persists for approximately 14 days postinjury. ⋯ The authors conclude that patients with acute severe brain injury do not adequately tolerate feedings via the enteral route in the early postinjury period. Tolerance of enteral feeding is inversely related to increased ICP and severity of brain injury. It is suggested that parenteral nutritional support is required following brain injury until enteral nutrition can be tolerated.