Articles: brain-injuries.
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Intentional injury is associated with significant morbidity and mortality and has been associated with certain demographic and socioeconomic groups. Less is known about the relationship of intentional traumatic brain injury (TBI) to injury severity, mortality, and demographic and socioeconomic profile. The objective of this study was to delineate demographic and event-related factors associated with intentional TBI and to evaluate the predictive value of intentional TBI on injury severity and mortality. ⋯ Many demographic variables are risk factors for intentional TBI, and such injury is a risk factor for both injury severity and mortality. Future studies are needed to definitively link intentional TBI to disability and functional outcome.
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Clin Neurol Neurosurg · Sep 2000
Case ReportsDiffusion-weighted imaging demonstrates transient cytotoxic edema involving the corpus callosum in a patient with diffuse brain injury.
Reversible T2 hyperintense signal abnormality in the corpus callosum, although frequently seen after diffuse brain injury, has not been well clarified. With some accumulated evidence, we report a case of diffuse brain injury in a 24-year-old man. Magnetic resonance imaging (MRI) demonstrated T2 hyperintense signals in the trunk and the splenium of the corpus callosum 12 days postinjury. ⋯ Follow-up MRI at 6 months showed complete resolution of the T2 signal abnormalities and of the corresponding decreased diffusion. Considering that diffusion-weighted imaging showed transient decreased diffusion, the lesion in the corpus callosum indicated the existence of cytotoxic edema. Also, transient DWI hyperintensity, namely cytotoxic edema, in the trunk and the splenium of the corpus callosum does not necessarily reveal callosal deficits.
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Clin Neurol Neurosurg · Sep 2000
Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage.
We retrospectively evaluated the MRI from 17 patients with primary brain stem injury obtained in the acute stage. Clinical and radiological findings were analyzed in these 17 patients. T2-weighted imaging proved to be most sensitive and specific for the diagnosis of primary brain stem injury. ⋯ These acute stage findings are seen only temporally in many cases so that it is most important to examine MRI findings in the acute stage to evaluate the prognosis of the patient. MRI was valuable in predicting the outcome. The possible mechanism of brain stem injury in patients with head injury is briefly discussed.
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J Clin Neurophysiol · Sep 2000
ReviewThe role of evoked potentials in anoxic-ischemic coma and severe brain trauma.
The early recognition of comatose patients with a hopeless prognosis-regardless of how aggressively they are managed-is of utmost importance. Median somatosensory evoked potentials supplement and enhance neurologic examination findings in anoxic-ischemic coma and severe brain trauma, and are useful as an early guide to outcome. The key finding is that bilateral absence of cortical evoked potentials, generated by thalamocortical tracts, reliably predicts unfavorable outcome in comatose patients after cardiac arrest, and correlates strongly with death or persistent vegetative state in severe brain trauma. ⋯ The majority of patients with normal central conduction times had a good outcome, whereas a delay in central conduction times increased the likelihood of neurologic deficit or death. This report includes a systematic review of the literature concerning adults in anoxic-ischemic coma and severe brain trauma, in which somatosensory evoked potentials were used as an early guide to predict clinical outcome. Greater use of somatosensory evoked potentials in anoxic-ischemic coma and severe brain trauma would identify those patients unlikely to recover and would avoid costly medical care that is to no avail.
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A critical evaluation was done about the guidelines and effects of the hyperventilation maneuver on prevention and treatment of increased intracranial pressure (ICP) that follows severe traumatic brain injury (TBI). The prophylactic use of hyperventilation should be avoided after severe TBI acute phase, unless high venous O2 values are recorded at jugular bulb blood (SjO2), or to allow time when there are evidences of neurologic deterioration with posturing. ⋯ Then, hyperventilation may be used as a screening therapeutic test in acute severe TBI, since BBB impairment is the pointer that other available clinical procedures for high ICP control (sedation, paralysis and osmotic diuretics) are not workable. A new pathogenetic hypothesis about traumatic brain edema and its therapeutic approach is presented.