Articles: traumatic-brain-injuries.
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Traumatic Brain Injury (TBI) triggers a cascade of secondary biological and physiological effects that are variable, depending on the severity, location, and complexity of the injury. Improved diagnosis and prognosis of brain injury may be possible by examining changes in protein biomarker concentrations and, determining their role in long-term outcomes may improve treatment. One promising direction for biomarker research surrounds pro- and anti-inflammatory cytokines which may have utility for predicting short and long-term prognosis after TBI, and may also be therapeutic targets in shaping neuronal recovery following a TBI. ⋯ Increased levels of interleukin (IL)-6, IL-1, IL-8, IL-10 and tumor necrosis factor alpha (TNFα) were associated with worse outcomes, with most studies focusing on morbidity and mortality. It is important to identify the biochemical changes that may influence or initiate the presentation of health outcomes after a TBI. Earlier identification of symptoms associated with these biochemical changes can be used to support better treatment planning, targeted interventions and ultimately, improvement in patient outcomes.
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Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. ⋯ Prehospital and neuro ICU management of TBI patients can significantly improve patient outcome. However, it is important to also consider whether these patients would actually want to be treated particularly in the elderly population.
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Normal hemostasis provides for balanced interactions between the blood vessel wall, coagulation proteins, and platelets. After vascular injury, primary hemostasis and secondary hemostasis function in a coordinated fashion to stop bleeding. ⋯ Emerging coagulation tests are useful point-of-care assays that guide transfusion therapy and diagnose patients with hyperfibrinolysis. This article provides an overview of hemostasis, a summary of standard coagulation testing and point-of-care tests, and a brief review of coagulation test usefulness in neurosurgery, focusing on studies in patients with traumatic brain injury.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2018
Review[Multimodal Neuromonitoring and its Impact on Therapeutic and Diagnostic Decisions in Critical Ill Patients].
Patients with acute cerebral injuries for various reasons (traumatic, ischemic, hemorrhagic) are at risc for developing secondary brain damage and further neurological deterioration. The aim of neuromonitoring is to recognize subtile changes in intracranial physiology as early as possible to initiate adequate diagnostic and therapeutic measures to prevent secondary brain damage. ⋯ Electrophysiological monitoring by electrocorticography or evoked potentials and measurement of cerebral blood flow provide additional information. The indications and clinical impact of these various monitoring techniques are discussed to ensure optimal medical care in patients with acute brain injury.
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Review Case Reports
Full Recovery After a Bihemispheric Gunshot Wound to the Head: Case Report, Clinical Management, and Literature Review.
Nearly 33,600 people die each year in the United States as a result of gunshot wounds (GSWs). Penetrating craniocerebral GSWs are often fatal with a nearly 70% death rate at the scene of the trauma. Overall combined mortality rate for patients who die at the scene or at the hospital is almost 91%. Poor outcome is associated with initial low Glasgow Coma Scale score and bihemispheric and transventricular gunshot trajectory. We summarize current understanding in management, prognostic factors, and survival outcomes in patients with a penetrating GSWs to the head. We report a patient with return to full function despite bihemispheric, multilobar involvement. Full function is defined here as ability to return to previous work and perform activities of daily living. ⋯ Craniocerebral GSWs have a high mortality rate and usually require aggressive management. Evaluation of most GSWs requires appropriate imaging studies followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is often necessary and ranges from local wound débridement to craniectomy, decompression, and wound exploration.