Articles: brain-injuries.
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Comparative Study Clinical Trial
Serum neuron-specific enolase as a predictor of intracranial lesions in children with head trauma: a pilot study.
To determine the reliability of serum neuron-specific enolase (NSE) levels in predicting intracranial lesions (ICL) in children with blunt head trauma (HT). ⋯ These results suggest that serum NSE may be a useful screening tool for predicting ICL in children with blunt head trauma. However, the NSE alone was neither sensitive nor specific in predicting all patients with ICL.
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Critical care medicine · Jul 2000
Early hyperthermia after traumatic brain injury in children: risk factors, influence on length of stay, and effect on short-term neurologic status.
a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. ⋯ Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.
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The cerebral cortex is selectively vulnerable to cell death after traumatic brain injury (TBI). We hypothesized that the ratio of mRNAs encoding proteins important for cell survival and/or cell death is altered in individual damaged neurons after injury that may contribute to the cell's fate. To investigate this possibility, we used amplified antisense mRNA (aRNA) amplification to examine the relative abundance of 31 selected candidate mRNAs in individual cortical neurons with fragmented DNA at 12 or 24 hr after lateral fluid percussion brain injury in anesthetized rats. ⋯ By 24 hr after injury, many of the mRNAs altered at 12 hr after injury had returned to baseline (sham-injured) levels except for increases in caspase-2 and bax mRNAs. These data suggest that TBI induces a temporal and selective alteration in the gene expression profiles or "molecular fingerprints" of TUNEL-positive neurons in the cerebral cortex. These patterns of gene expression may provide information about the molecular basis of cell death in this region after TBI and may suggest multiple avenues for therapeutic intervention.
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The aim of this study was to determine the functional outcome and mortality in relation to the Glasgow coma score (GCS) on presentation in patients aged over 65 years with acute head injury. 2331 patients with head injury were identified by searching the neurosurgery database (1984-1996); 191 met the inclusion criteria and systematic review of medical records was undertaken. Functional outcome on discharge from hospital and mortality were tested statistically against GCS on presentation. Mortality overall was 33. 5%. ⋯ Comparison with outcome for the 132 patients with GCS >/=11, of whom 91 had satisfactory outcomes, was highly statistically significant (P<0.001). Elderly patients with presenting GCS <11 due to acute head injury have poor functional outcomes and high mortality rates. Conservative treatment of these patients should be considered.