Articles: brain-injuries.
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Tidsskr. Nor. Laegeforen. · Jan 1997
[Penetrating head and neck gunshot injuries. A 10-year neurological material].
37 patients with penetrating injuries of the head or upper neck caused by gunshot wounds were admitted to the neurosurgical department during the ten-year period 1986 to 1995. There was a marked preponderance of males. 29 of the cases were attempted or successful suicides, four were homicides, and four were presumed to be accidents. The most common weapons used were pistol and rifle. ⋯ Four of the patients suffered reduced vision, two of whom became blind. Two had hemiparesis, one had moderate mental dysfunction, and one recovered completely. None of the patients who were unconscious upon admission to hospital and had bilateral brain injury survived.
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Case Reports
Orbito-cranial injury caused by penetrating metallic foreign bodies: report of two cases.
Two cases of orbito-cranial injury caused by foreign bodies (FBs) penetrating the lateral wall and roof of the orbit are described. In the first patient, a long rusted nail acted as a missile and was only detected by X-rays and CT scan. The nail penetrated the orbit, the eyeball, the lateral orbital wall, and the temporal lobe of the brain. ⋯ In the second patient, large metallic FB, having penetrated the orbital roof was lodged intracranially above the chiasma. This was removed via frontal craniotomy. Mechanism of such injuries and appropriate surgical approaches are described as well.
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The purpose of this study was to evaluate the effect of altering the use of the protocol for brain death determination in traumatically injured patients, on time to brain death determination, medical complication rates, organ procurement rates and charges for care rendered during brain death determination. A retrospective chart review of trauma patients with lethal brain injuries at an urban tertiary care trauma center was performed. Two groups of trauma patients with lethal head injuries were compared. Group I consisted of patients pronounced brain dead using a protocol requiring two brain examinations, and group II contained patients evaluated using a protocol requiring one brain examination in conjunction with a nuclear medicine brain flow scan. ⋯ Medical complications are universal in the traumatized patient awaiting the determination of brain death. These complications necessitate aggressive and costly care in the intensive care unit in order to optimize organ function in preparation for possible transplantation. In our institution, the determination of brain death using a single clinical examination and a nuclear medicine flow study significantly shortened the brain death stay and reduced associated charges accrued during this period. The complication and organ procurement rates were not affected in this small, preliminary report sample.