Articles: brain-injuries.
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We report the CT appearances of a low-velocity missile that lodged within the brain and which subsequently migrated spontaneously back along the entry path. We review the literature of similar instances of migration and draw conclusions about the presurgical radiological management.
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Neurosurg. Clin. N. Am. · Oct 1995
ReviewThe prehospital and emergency department management of penetrating head injuries.
The prehospital and emergency department management of the patient with a penetrating cranial injury can be summarized by the following tenets: 1. Assume any alteration in level of consciousness to be a result of the brain injury and not from alcohol or illicit drug intoxication. 2. Have a low threshold to protect the patient's airway with endotracheal intubation and chemical paralysis if a surgical lesion is suspected, there is seizure activity, or the patient is too combative to obtain the necessary studies. 3. ⋯ Remember, first do no harm. The primary brain injury has already been done. The clinician maximizes preservation of viable brain tissue by preventing secondary injury.
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Journal of neurosurgery · Oct 1995
Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report.
The effect of indomethacin, a cyclooxygenase inhibitor, was studied in the treatment of 10 patients with head injury and one patient with spontaneous subarachnoid hemorrhage, each of whom presented with high intracranial pressure (ICP) (34.4 +/- 13.1 mm Hg) and cerebral perfusion pressure (CPP) impairment (67.0 +/- 15.4 mm Hg), which did not improve with standard therapy using mannitol, hyperventilation, and barbiturates. The patient had Glasgow Coma Scale scores of 8 or less. Recordings were made of the patients' ICP and mean arterial blood pressure from the nurse's end-hour recording at the bedside, as well as of their CPP, rectal temperature, and standard therapy regimens. ⋯ The effects of standard therapy regimens before and during indomethacin infusion showed no significant changes, except in three patients in whom mannitol reestablished its action on ICP and CPP. Sudden discontinuation of indomethacin treatment was followed by significant ICP rebound. The authors suggest that indomethacin may be considered one of the frontline agents for raised ICP and CPP impairment.
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Comparative Study
Psychiatric disorders and functional disability in outpatients with traumatic brain injuries.
This study examined psychiatric sequelae of traumatic brain injuries in outpatients and their relation to functional disability. ⋯ Depression and anxiety are common in outpatients with traumatic brain injuries. Patients with depression or anxiety are more functionally disabled and perceive their injury and cognitive impairment as more severe. Depressed patients report more increasingly severe postconcussion symptoms.