Articles: brain-injuries.
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Acta Neurochir. Suppl. · Jan 1998
Decompressive craniectomy in patients with uncontrollable intracranial hypertension.
There has been controversial discussion about the benefits of decompressive craniectomy in patients with critically raised intracranial pressure (ICP) after severe head injury. The aim of this retrospective study was to analyze the results of secondary decompressive craniectomy in patients with uncontrollable raised ICP after maximum aggressive medical treatment. The data of 28 patients (mean age 22 years, range 8-44 years) with severe head injury and posttraumatic cerebral edema were analyzed retrospectively. ⋯ The outcome was classified according to the Glascow Outcome Scale (GOS) after one year. The decompressive crainectomy was performed an average of 68 hours after trauma, and ICP (< 25 mm Hg) decreased always while cerebral perfusion pressure (CPP > 75 mm Hg) improved as well as cerebral blood flow and microcirculation to normal values. 15 patients (56%) had a good outcome after one year (GOS 4 + 5). 5 patients (18%) were severely disabled, 4 patients (14%) remained in vegetative state and 3 patients (11%) died. Decompressive craniectomy should be kept in mind as the last therapeutic step, especially in young patients with head injury and raised ICP, which is not controllable with conservative methods.
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Comparative Study Clinical Trial
Thiopental in CSF and serum correlates with prolonged loss of cortical activity.
Barbiturate coma is initiated in brain-injured patients whenever elevated intracranial pressure remains unresponsive to other therapeutical strategies. However, barbiturates alter cortical activity resulting in difficulties in clinical evaluation. ⋯ Prolonged unresponsiveness to exteroceptive stimuli correlates with persisting thiopental in CSF and serum. Thus, quantitative analysis of thiopental in serum becomes indispensable in predicting the length of drug-induced neurological impairment and in avoiding misinterpretation of the neurological status.
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Acta Neurochir. Suppl. · Jan 1998
Relationship of neuron specific enolase and protein S-100 concentrations in systemic and jugular venous serum to injury severity and outcome after traumatic brain injury.
Neuron specific enolase (NSE) and protein S-100 have previously been described as markers of brain injury. We aimed to discover whether concentrations of either were raised in arterial and jugular venous serum after traumatic brain injury, and whether serum profiles were related to injury severity and neurological outcome. We recruited 22 patients with a traumatic brain injury who were admitted to the intensive care unit. ⋯ There was a small, but significant difference between jugular venous and arterial concentrations of S-100 (p = 0.022). High NSE and S-100 concentrations were significantly related to poor neurological outcome (p = 0.004 and p < 0.001 respectively). Both serum NSE and S-100 may be of some value in helping to predict outcome after a traumatic brain injury.
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Acta Neurochir. Suppl. · Jan 1998
Interhemispheric pressure gradients in severe head trauma in humans.
Interhemispheric pressure gradients may occur following severe head trauma in patients even in the absence of intracranial space occupying lesions. A higher ICP of the contralateral hemisphere may escape routine unilateral ICP monitoring. ⋯ According to our data with a limited number of patients, interhemispheric pressure gradients seem to occur in the initial posttraumatic phase in some patients, and they seem to resolve following adequate ICP treatment after several hours. Therefore, simultaneous bilateral ICP measurement may be warranted in the initial posttraumatic phase.
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Trauma in the United States is the leading cause of death and disability in the pediatric population. Differences of age and development affect recovery and outcome following head injury. ⋯ Treatment and management should be tailored to each case in order to effect a positive outcome with respect to brain functioning. Aggressive intervention for prevention of primary and secondary injury must be continued and understanding of the impact of these injuries should provide for a brighter future for these patients.