Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewManagement of head injury. Treatment of abnormal intracranial pressure.
Intracranial hypertension is recognized as a fundamental pathophysiologic process in brain injury. Although the exact pressure level defining intracranial hypertension remains to be firmly established, the majority of evidence available currently suggests that ICP should generally be treated when it exceeds 20 mm Hg. We suggest that lesions in the temporal lobe be treated at 15 mm Hg owing to the special relationship of this region to the brain stem. ⋯ The basic mechanisms of raised ICP are slowly becoming elucidated. Clinical clues with which to subdivide patients with intracranial hypertension are being defined. New agents with efficacy in lowering raised ICP are appearing, and determination of their mechanisms of action may provide insight into the underlying disorder.
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Gunshot wounds to the head are a common problem in the United States. A review of the literature and a survey of neurosurgeons suggests some differences of opinion regarding treatment. But the series upon which these opinions are based may be quite different. ⋯ Angiography should be used in cases in which bullets have passed near major vessels. We suggest an aggressive approach, with evacuation of clots and monitoring of intracranial pressure and treatment of elevations, as well as the routine use of anticonvulsants and antibiotics. Vocational rehabilitation is also important.
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Neurosurg. Clin. N. Am. · Jan 1991
ReviewAspects on pathophysiology of nerve entrapments and nerve compression injuries.
The microanatomy of the neuron and the peripheral nerve, which is a composite tissue, should be considered when discussing the pathophysiology of nerve compression injuries. Acute and chronic compression of peripheral nerve can induce changes in intraneural microcirculation and nerve fiber structure, increase vascular permeability with subsequent edema formation, and impair anterograde and retrograde axonal transport, which all contribute to the clinical symptoms and deterioration of nerve function. ⋯ Diabetes mellitus may confer on the peripheral nerve an increased susceptibility to compression injuries. Clinical stages of compression syndromes, such as carpal tunnel syndrome, may be related to specific pathophysiologic events occurring in the nerve.
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Neurosurg. Clin. N. Am. · Jan 1991
ReviewNeurosurgical management of birth injuries of the brachial plexus.
While most newborns with birth injury of the brachial plexus make a full spontaneous recovery, the minority who do not can expect lifelong disability from weakness, disturbed patterns of muscle activity, contracture, and deformity. Those children who are destined to a poor recovery can be identified in early infancy. Early reconstruction of the brachial plexus carries low morbidity and has been shown by many to support useful shoulder and elbow function. Patients who are referred later in childhood may still benefit from plexus exploration, but how to best use clinical and electrophysiologic data to plan a surgical intervention that will improve on the natural history remains to be elucidated for this group.
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Neuroimaging entails knowing both which modality to use and when in the sequence of clinical evaluation to use a particular modality. This article review the role, both diagnostic and prognostic, of neuroimaging in the various categories of intradural spinal disease and presents the spectrum of neuroimaging modalities.