Articles: brain-injuries.
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Ann Fr Anesth Reanim · Jan 1998
Case Reports-Coagulopathy suggestive of a primary fibrinolysis after head injuries with brain death-.
Coagulopathies associated with severe head trauma are usually of disseminated intravascular coagulation type with secondary fibrinolysis. We report a case whose semeiology was in part suggestive of a primary fibrinolysis.
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Monitoring of comatose patients in the neurosurgical intensive care unit (NICU) is constantly extended by the development of new methods for monitoring of cerebral function, metabolism and oxygenation. To simplify the interpretation of the rising number of parameters, and to avoid data overflow, a multimodal cerebral monitoring (MCM) system has been developed for the acquisition, display, on-line analysis and recording of physiological parameters from multiple bedside data sources. This article describes the technical details and the design of this computerized data acquisition system for variable applications in clinical patient monitoring and research. ⋯ The MCM system has become a valuable tool for monitoring of comatose patients. The simultaneous display of trend graphs of various monitoring parameters and the online processing of histograms improved the survey of the patient's condition in the ICU. Recorded data were analysed offline and contribute to a consecutively increasing data bank.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Comparative Study[Minimal invasive, percutaneous ventriculostomy in therapy of severe craniocerebral trauma].
From May 1996 until April 1997 percutaneous CT-controlled ventriculostomy (PCV) was performed in 19 patients with severe traumatic brain injury and no indication for decompressive craniotomy. There was a significant reduction in the duration of the procedure compared to burr-hole ventriculostomy with no complications. Because of further advantage of PCV CT-controlling is the possibility of puncturing even very narrow ventricles.
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Acta Neurochir. Suppl. · Jan 1998
Multimodal hemodynamic neuromonitoring--quality and consequences for therapy of severely head injured patients.
Fifty-five head injured patients (GCS < 8) were studied at an average of 7.5 +/- 3.4 days on the ICU to check quality of hemodynamic monitoring and the consequences for therapy. Multimodal neuromonitoring included intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), endtidal CO2 (EtCO2) as well as brain tissue--pO2 (p(ti)O2), regional oxygen (rSO2) and jugular venous oxygen saturation (SjO2). Regional p(ti)O2 as well as global SjO2 were sensitive technologies to detect hemodynamic changes. ⋯ Longterm-measurements of rSO2 using near infrared spectroscopy reached, if possible, a restricted reliability (good data quality up to 70%) and sensitivity in comparison to p(ti)O2. Especially p(ti)O2 enabled detection of critical p(ti)O2 (< 15 mm Hg) in up to 50% frequency during the first days after trauma and a second peak after day 6 to 8 according to evidence of CPP insults. Knowledge of baseline p(ti)O2 and CO2-reactivity allowed minimizing risk of ischemia by induced hyperventilation and improvement on cerebral microcirculation after mannitol administration could be individually recognized.
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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.