Articles: brain-injuries.
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The objectives of this study were as follows: (1) to determine whether clinical symptoms and signs of brain injury are sensitive indicators of intracranial injury (ICI) in infants admitted with head trauma, (2) to describe the clinical characteristics of infants who have ICI in the absence of symptoms and signs of brain injury, and (3) to determine the clinical significance of those ICIs diagnosed in asymptomatic infants. ⋯ We found that 19 of 101 ICIs in infants admitted with head trauma were clinically occult. All 19 occult ICIs occurred in infants younger than 12 months of age, and 18 of 19 had skull fractures. None experienced serious neurologic deterioration or required surgical intervention. Physicians cannot depend on the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.
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Secondary brain injury is associated with a reduction in cerebral blood flow, oxygenation and perfusion related to hypotension, hypoxemia and raised intracranial pressure. This has been confirmed on autopsy and is associated with a higher mortality rate, as supported by many studies. The primary goal of nursing management in severe head trauma is to maintain adequate cerebral perfusion and improve cerebral blood flow in order to prevent cerebral ischaemia and secondary injury to the brain. ⋯ The majority of the evidence was derived from class II and class III classifications, which provide guidelines and options for practice. Nursing and medical management were found to overlap, with the focus for the nurse being an integrated balance of scientific, technical and humanistic management. The nurse's role is extremely important because the expert nurse cognitively manipulates many variables over a continuum of care and, if such tasks are skillfully and successfully performed, the incidence of secondary brain injury is reduced.
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Journal of neurosurgery · Dec 1998
Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study.
To determine the extent and duration of change in extracellular glutamate levels after human traumatic brain injury (TBI), 17 severely brain injured adults underwent implantation of a cerebral microdialysis probe and systematic sampling was conducted for 1 to 9 days postinjury. ⋯ Extracellular neurochemical measurements of excitatory amino acids may provide a marker for secondary insults that can compound human TBI.
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We investigated the time course of inducible nitric oxide synthase (iNOS) enzymatic activity and immunocytochemical localization of iNOS expression after traumatic brain injury (TBI), as well as the possible role of iNOS in the pathogenesis of TBI. ⋯ These data indicate that iNOS is expressed after moderate parasagittal fluid-percussion brain injury, in a time-dependent manner, and that inhibition of iNOS synthesis improves histopathological outcomes. Thus, inhibition of iNOS activation may represent a potential therapeutic strategy for the treatment of TBI.
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This review focuses on neuro-ophthalmic disorders caused by trauma. Most articles discussed were published after 1995. ⋯ The topics are the oculomotor nerves and the facial nerve, the cavernous sinus, the orbit, the optic nerve, and the brain. Treatment options are discussed, including strabismus surgery, orbital reconstruction, and medical as well as surgical treatment of traumatic optic neuropathy.