Articles: brain-injuries.
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Ann Fr Anesth Reanim · Jan 1997
[Use of Glasgow coma scale by anesthesia and intensive care internists in brain injured patients].
To evaluate the quality and reliability of the Glasgow coma scale (GCS) score when determined, in head trauma patients, by trainees in anaesthesiology. ⋯ In order to provide optimal care and allow an accurate assessment of therapeutic efficiency, special attention should be given to the teaching of the GCS scoring method in head trauma patients.
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During the war period 1991-1992 in Croatia, ten wounded children (16 years of age or younger) with war injuries to the brain were admitted to the Division of Neurosurgery, Osijek Clinical Hospital. Six of them had been wounded by shrapnel and four by pistol or rifle bullets. All but one were managed surgically (i.e. by craniotomy). ⋯ Five of the wounded (four injured by shrapnel and one by bullets) had associated injuries (fractures of the leg bones, eye lesion, amputation of the right leg) which influenced morbidity, and in one case mortality. Children wounded with shrapnel had brain edema on admission to hospital. Our experience indicates that the thermal effect from heated shrapnel, as well as velocity, mass, size and shape of the shrapnel, could be an additional factor for the development of severe brain edema.
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Journal of neurotrauma · Dec 1996
Riluzole, a novel neuroprotective agent, attenuates both neurologic motor and cognitive dysfunction following experimental brain injury in the rat.
Several potential mechanisms are involved in mediating the pathophysiology of traumatic brain injury (TBI), including inflammatory processes and excitotoxicity. In the present study, we evaluated the ability of the use-dependent sodium channel inhibitor Riluzole to attenuate cognitive and neurologic motor deficits and reduce regional cerebral edema and histologic cell damage following lateral fluid-percussion (FP) brain injury in rats (n = 109). In study 1, 58 anesthetized male Sprague-Dawley rats (350-400 g) were subjected to FP brain injury of moderate severity (2.3-2.5 atm). ⋯ In study 3, brain-injured animals were treated with Riluzole (8 mg/kg x 3 doses, n = 10) or vehicle (n = 10), and posttraumatic lesion volume was assessed at 48 h postinjury using 2,3,5-triphenyltetrazolium chloride (TTC) staining. Treatment with Riluzole had no significant effect on posttraumatic lesion volume. The present study demonstrates that use-dependent sodium channel inhibitors, such as Riluzole, can attenuate both cognitive and neuromotor dysfunction associated with brain trauma.
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Moderate or severe traumatic brain injury (TBI) resulting from cranial trauma is usually easily recognizable. Mild TBI (MTBI), however, may escape detection at presentation because of delayed symptoms and the absence of radiographic abnormalities. Despite its subtle or delayed presentation, the spectrum of symptoms often experienced after MTBI, collectively referred to as "postconcussive syndrome," may cause serious psychosocial dysfunction. ⋯ These data, obtained from a population of patients considered to be at extremely low risk for TBI, indicate that MTBI occurs more often among blunt trauma patients than is commonly appreciated, even in busy trauma centers. Because early recognition of MTBI may expedite referral of these patients for appropriate outpatient follow-up care, thereby avoiding potentially serious social and financial repercussions, emergency department personnel should have a high index of suspicion for MTBI in any patient sustaining blunt systemic trauma. Current measures that screen for MTBI appear to be inadequate; follow-up protocols may prove to be more sensitive screening tools.