Articles: brain-injuries.
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Posttraumatic agitation is perhaps the most dramatic behavioral consequence of severe traumatic brain injury. The mechanism for this behavior remains to be determined. ⋯ Concurrent neurologic or medical decline during the recovery from an acute traumatic brain injury may precipitate delirium, which has many clinical features that overlap with posttraumatic agitation. Hence, the differential diagnosis of posttraumatic agitation includes all medical and neurologic etiologies for transient declines in consciousness and cognition.
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Acta neurochirurgica · Jan 1995
Criteria for conservative treatment of supratentorial acute subdural haematomas.
Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores. It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. ⋯ In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.
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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.
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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.