Articles: brain-injuries.
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Cerebral lesions of variable severity lead to systemic and intracranial reactions. These create secondary brain damage due to hypoxia and ischemia. The causes as well as the sequelae of secondary brain damage necessitate long-term intensive care treatment with high technical and personal expenditure. ⋯ The decision to limit treatment should be based on the numerous national and international statistical models and discussed on an individual basis, excluding even a 5% chance of survival. Early information of the family on the probable prognosis is useful. Their participation in the process of decision can be assessed only on an individual basis.
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Zentralbl. Neurochir. · Jan 1994
Randomized Controlled Trial Multicenter Study Clinical Trial"Ultrahigh" dexamethasone in acute brain injury. Results from a prospective randomized double-blind multicenter trial (GUDHIS). German Ultrahigh Dexamethasone Head Injury Study Group.
In a prospective randomized double-blind multicenter trial, the efficacy and safety of a 51-hour ultra-high intravenous dexamethasone dosing regimen was investigated in patients with moderate and severe head injury. 300 patients between 15 and 55 years of age were randomized to receive either placebo or dexamethasone: 500 mg intravenous infusion within 3 h after trauma initially, followed by 200 mg after 3 h, thereafter 8 times 200 mg at 6 hourly intervals, resulting in a total administered dose of 2,3 g in 51 hours. Primary end points for assessment of efficacy were: Modified Glasgow Coma Scale (grading 3-16) on Day 5, modified Glasgow Outcome Scale (grading 1-6) 10-14 months after injury, and the time interval until consciousness improved above a level of modified GCS > or = 8. ⋯ Results were surprisingly favourable in both groups: Lethality in the dexamethasone and placebo group was 14.3 and 15.4%, respectively, and 61.7 and 57.4%, respectively, achieved social and professional rehabilitation after 10-14 months (outcome scale 6). No statistical difference was seen between the dexamethasone and the placebo group in any of the primary end points of efficacy and safety (incidence of upper gastrointestinal bleeding, infection, and thrombosis).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Neuropsychiatry Clin Neurosci · Jan 1994
The prevalence of traumatic brain injury and co-occurring disabilities in a national household survey of adults.
This original point prevalence study provides sociodemographic characteristics and Canadian household prevalence rates of adults (15 years and older) with disability who have survived a traumatic brain injury (TBI) and the type, number, and prevalence rates of co-occurring disabilities. This report is based on the Health and Activity Limitation Survey, a national survey conducted by Statistics Canada in 1986-87. ⋯ Rates are highest in the 45-64 age range, 3 times those in the 15-24 age group. Eighty-four percent of adults with TBI have co-occurring disabilities (median = 2), the most prevalent being limited mobility and agility.
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Acta neurochirurgica · Jan 1994
Penetrating craniocerebral shrapnel injuries during "Operation Desert Storm": early results of a conservative surgical treatment.
A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. ⋯ No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only.