Articles: brain-injuries.
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Brain injury : [BI] · Feb 2001
ReviewDiagnostic criteria and differential diagnosis of mild traumatic brain injury.
Brain injury is classified clinically as severe, moderate or mild brain injury characteristics, including admission Glasgow coma score, duration of unconsciousness and post-traumatic amnesia and any focal neurological findings. Most traumatic brain injuries are classified as mild traumatic brain injury (MTBI). Headache, nausea and dizziness are frequent symptoms after MTBI and may continue for weeks to months after the trauma. ⋯ Computed tomography of the brain seems to be the best way to exclude the development of relevant intracranial lesions. MTBI has a good clinical outcome, although a substantial group of patients develop post-concussional complaints (PCC). There is little information on the effectiveness of various methods suggested for reducing the frequency of PCC.
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Ann Fr Anesth Reanim · Feb 2001
Review[Hyponatremia in neurologic intensive care: cerebral salt wasting syndrome and inappropriate antidiuretic hormone secretion].
Hyponatraemia is a frequent complication in neurologically injured patients; it is a secondary cerebral injury. Hyponatraemia leads to consciousness problems, convulsions, worsening of the neurological status and thus the neurological evaluation. Hyponatraemia is secondary to free water retention (inappropriate ADH secretion) or to renal salt loss. ⋯ The diagnostic approach and monitoring are based on the assessment of sodium and water losses. Therapy is based on correction of the circulating volume and natraemia. Speed of correction is a matter of debate: slow correction presents the risk of further neurological injury whereas rapid correction presents the risk of central pontine myelinosis.
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Journal of neurotrauma · Feb 2001
Injury severity and sensitivity to treatment after controlled cortical impact in rats.
We sought to determine sensitivity of the cortical impact injury model of traumatic brain injury (TBI) to severity of injury and to treatment. We examined the pattern of motor and cognitive deficits and recovery following TBI over a range of injury severities, and examined the efficacy of surface-induced moderate hypothermia at three disparate injury levels. In experiment I, Sprague-Dawley rats were injured at one of eight injury severity levels from 0 mm (sham) to 2.5 mm depth of penetration. ⋯ The 1.0-mm group exhibited small deficits that recovered completely by day 3; the 1.6-mm group recovered to the level of shams by day 5, and the 2.5-mm group did not show significant recovery during the testing period. Hypothermia effectively attenuated behavioral deficits for the 1.6-mm group, but had no effect on the other two groups. These three observations--that increasing injury severity is associated with increasing motor and cognitive deficits, that injury severity is related to recovery time, and that hypothermia treatment is selectively effective--have each been reported in the human TBI population; thus, moderate cortical impact injury in rats may be a model with clinical predictability for evaluating neuroprotective therapies.
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Case Reports Historical Article
The history of the Glasgow Coma Scale: implications for practice.
The Glasgow Coma Scale (GCS) has been the gold standard of neurologic assessment for trauma patients since its development by Jennett and Teasdale in the early 1970s. The GCS was found to be a simple tool to use. ⋯ Although the scale has been shown to be effective, many authors have cited weaknesses in the scale including the inability to predict outcome, variation in inter-rater reliability, and the inconsistent use by caregivers in the prehospital and hospital settings. This article outlines the components of the GCS and how practitioners can best use the scale, particularly in patients whose injuries and treatments make them difficult to assess.
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Semin. Pediatr. Surg. · Feb 2001
Glasgow Coma Scale predicts coagulopathy in pediatric trauma patients.
The aim of this study was to determine if neurologic findings at the time of initial resuscitation can predict coagulation abnormalities resulting from head injury. Fifty-three children with head injury were reviewed for Glasgow Coma Scale (GCS), prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), use of fresh frozen plasma (FFP) and outcome. Twenty-six of the 53 children (49%) presented with a GCS of 15 and 27 (51%) had a GCS less than 14. ⋯ Children with GCS less than 14 are at risk for intracranial injury and coagulopathy, this risk increases inversely with the GCS. Children who present with a GCS less than 8 should have FFP prepared at the time of admission. These data may guide the use of laboratory tests and blood bank resources during trauma resuscitation.