Articles: brain-injuries.
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Pediatric neurosurgery · May 1997
Intracranial neurological injuries associated with orbital fracture.
We attempted to define the central nervous system (CNS) concomitants of various types of orbital fractures in children by reviewing the records of 95 inpatients with admission diagnoses including orbital fracture who presented to the Children's National Medical Center from 1987 through 1994. Patients were divided into three age groups: group I: 0-5 years; group II: 6-12 years; group III: older than 12 years. Orbital fractures were classified by location: roof alone (A); orbital roof plus another orbital wall (B), and orbital fractures sparing the roof (C). ⋯ Seven of the patients with intracranial injury required emergent neurosurgical procedures. Younger children with maxillofacial injury sparing the orbital roof appear more likely to have coexisting intracranial injury, as reflected by CT findings and GCS on admission, than their older cohorts with similar injuries. Fracture of more than one orbital wall greatly increases risk of concurrent intracranial injury in all age groups.
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Traumatic brain injury (TBI) induces an acute inflammatory response characterized by early recruitment of inflammatory cells (white blood cells). Rapid resuscitation of TBI with hypertonic saline/dextran (HS/DEX) yields promising results in clinical and experimental studies. The purpose of this paper was to test the hypothesis that HS/DEX exerts its effects in part through a modulation of the acute inflammatory response to TBI. ⋯ Whether the anti-inflammatory effect of HS/DEX plays a role in reducing delayed brain damage (> 6 hours after TBI) or other systemic complications of TBI arises as an important question and should be investigated further.
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Arch Phys Med Rehabil · May 1997
Case ReportsCerebral salt wasting syndrome in brain injury patients: a potential cause of hyponatremia.
Hyponatremia is a common neuromedical problem seen in survivors of central nervous system injury. The etiology of this hyponatremia is often diagnosed as syndrome of inappropriate diuretic hormone (SIADH). Fluid restriction is usually the first line of treatment. ⋯ Cerebral salt wasting is a syndrome of renal sodium loss that may occur commonly after central nervous system injury, yet remains unrecognized. Treatment of cerebral salt wasting consists of hydration and salt replacement. This article uses a case report to discuss the importance of recognition of this syndrome, and treatment concerns are reviewed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Review[Mild and moderate hypothermia as a new therapy concept in treatment of cerebral ischemia and craniocerebral trauma. Pathophysiologic principles].
Hypothermia protects the brain and other vital organs during periods of ischaemia. We differentiate between mild (36-34 degrees C), moderate (33-29 degrees C), deep (28-17 degrees C) and profund (16-4 degrees C) hypothermia. During hypothermia, cerebral metabolic rate and cerebral blood flow decrease dependent on temperature. ⋯ In most instances, deep hypothermia renders neurologic outcome worse, which is most likely related to the generation of toxic metabolites and inadequate myocardial function during rewarming. The neuroprotective effects of hypothermia are related to several mechanisms along the ischaemic cascade: prevention of postischaemic hypoperfusion, reduction of functional and basal metabolism, decreased accumulation of lactic acid and oedema formation, inhibition of excitatory neurotransmitter release, prevention of Ca(++)- and Na(+)-influx, inhibition of lipid peroxidase activity, and free radical formation, stimulation of regenerative immediate early genes. The side effects of hypothermia include myocardial ischaemia, cardiac arrhythmias, decreased left ventricular contractility, coagulation abnormalities, and suppression of metabolic and immunological processes.
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Annals of epidemiology · Apr 1997
Case ReportsUrban and rural traumatic brain injuries in Colorado.
The purpose of this study was to compare and contrast the epidemiology of traumatic brain injury among urban and rural residents of Colorado. ⋯ These results provide justification for expanding efforts to prevent traumatic brain injury to include the small, but high-risk group of residents in rural areas.