Articles: brain-injuries.
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Brain injury : [BI] · Feb 1995
Developmental models of social cognition in assessing the role of family stress in relatives' predictions following traumatic brain injury.
The present study extended the utilization of developmental models of social cognition to the investigation of stress and relatives' perception of traumatic brain injury (TBI) survivors. Structured interviews were conducted with 21 TBI survivors utilizing interpersonal negotiation strategies (INS) and self understanding (self) in the framework of Selman's model of social perspective-taking and Damon and Hart's multidimensional model of self understanding. A relative group composed of 21 participants was interviewed and their predictions of the responses of the TBI survivors to the action domain of the INS stories were obtained. ⋯ Person correlation coefficients indicated significant negative correlations between Beck scores and predictive INS scores. ANOVA indicated significantly higher Beck depression scores in relatives of TBI survivors living in residential facilities than relatives of TBI survivors in an outpatient treatment programme. The study supports the view that developmental social cognition methods appear to advance our understanding of psychosocial adjustments and relatives' perceptions of social cognition in TBI survivors.
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Gunshot wounds to the head have a high morbidity and mortality [1, 2, 3, 4, 5]. In our areas this kind of injury is rarely seen, being mostly due to attempted suicide [6]. To help determine the optimal management of patients with penetrating GSW to the head, retrospective experience with 47 patients from 1986 to 1993 is presented. ⋯ With these informations we decide about the further treatment: We operate patients with stable vital signs, with GCS higher than 3, as long the ventricular system is not involved. 18 patients survived the injury. The currently living 16 patients were examined and checked concerning outcome after GSW to the head. 11 of 16 patients had a GOS 4 or 5. The remaining 5 patients are dependent on permanent help.
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Neurosurgical review · Jan 1995
Review Case ReportsDelayed post-traumatic epidural hematoma. A review.
Post-traumatic acute epidural hematoma (EDH) is generally visible on the CT scan done immediately after admission: occasionally, it only comes to light at a later scan and is then termed delayed (DEDH). Since the introduction of CT, the frequency of this occurrence has gone up from 6-13% to 30%. The mechanisms responsible for the delayed appearance of the epidural hematoma a "tamponade" effect are usually increased endocranial pressure and post-traumatic arterial hypotension as well as, in a limited number of cases, coagulopathy, CSF drainage, and arterio-venous shunt. The authors report 5 of their own cases and 45 published cases and discuss the characteristics of this particular form of hematoma and its outcome.
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Brain injury : [BI] · Jan 1995
ReviewPsychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations.
The psychosocial problems of decreased social contact, depression, and loneliness that occur for many with traumatic brain injury (TBI) create a major challenge for enhancing efforts at community re-entry. Despite dramatic physical progress within the first six months after injury, these psychosocial problems remain a persistent long-term problem for the majority of individuals with severe TBI. Researchers have consistently suggested that the psychosocial problems associated with TBI may actually be the major challenge facing rehabilitation. ⋯ The treating physiatrist cannot be expected to provide the insight and frequency of psychological services that may be necessary for many of these patients. (2) Since the literature seems to suggest that the presence of one psychosocial deficit, e.g., anxiety, will often be followed by other similar types of problems, e.g. depression, the treatment team needs to be sensitive to how rapidly these problems can cascade into a very dangerous situation. (3) Perhaps the most compelling recommendation we can make is for community rehabilitation specialists to focus significantly more energies and resources upon the psychological health of clients with TBI. Staff need to be trained to detect these signals that clients with TBI are often sending. It is apparent that psychosocial factors contribute to a rising obstacle level to community adjustment.
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Acta neurochirurgica · Jan 1995
CT and clinical criteria for conservative treatment of supratentorial traumatic intracerebral haematomas.
In search of guidelines for the management of traumatic intracerebral haematomas (TICHs) with slight mass effects on computed tomography (CT) scans, the author reviewed the records of 29 patients who did not undergo surgery and 11 patients who did. It is found that patients with a TICH volume of less than 15 ml, a midline shift of less than 5 mm, an open perimesencephalic cistern on CT scans, a Glasgow Coma Scale (GCS) score of 12 or more, and an absence of lateralizing signs may be treated conservatively and expected to make a good recovery. On the other hand, with zero mortality and satisfactory outcomes, the patients under-going early surgery tended to have a TICH volume of more than 15 ml, a midline shift of more than 5 mm, an obliterated perimesencephalic cistern on CT scans, a GCS score of less than 12, and the presence of lateralizing signs. However, the position of such features as the criteria of early operation for a TICH is weakened by the retrospective nature of this study because some surgical patients, free of lateralizing signs in particular, might have managed to do well without craniotomy.