Articles: brain-injuries.
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The mortality rate after traumatic brain injury in children ranges between 2.5% and 21%. Standardized diagnostic procedures and therapeutic strategies for the management of traumatic brain damage are presented in this article. Children with traumatic cerebral lesions have a better clinical outcome than head-injured adults. Optimized medical management and intensive rehabilitation may help to reduce the frequency of mental retardation and physical disability following such injuries in children.
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Surgical therapy for intracranial extracerebral haemorrhages is one of the oldest surgical techniques. The low mortality and morbidity in recent years have come about through of the emergency service, modern neurosurgical techniques, widespread use of the CT scanner, and adequate intensive care. The treatment target in the case of head injuries is to provide the optimal milieu for recovery from the primary injury and to prevent secondary damage to the brain. ⋯ Twist drill evacuation of the fluid (= chronic haematoma) in local anaesthesia is now accepted as the treatment of choice. An extradural haematoma is a potentially lethal lesion with a mortality rate of 5%. Emergency surgical intervention is appropriate before neurological signs appear.
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Anesthesia and analgesia · Nov 1993
Effects of isoflurane, fentanyl, or thiopental anesthesia on regional cerebral blood flow and brain surface PO2 in the presence of a focal lesion in rabbits.
These studies were conducted to determine the effect of anesthetic drugs on tissue perfusion and O2 supply in the brain with focal cerebral edema. Using an open cranium preparation, we studied the effects of isoflurane (I; 1 minimum alveolar anesthetic concentration), of fentanyl (F; 0.5-1 microgram.kg-1 x min-1), or of thiopental (T; 32.5 mg.kg-1 x h-1) on regional cerebral blood flow (rCBF) and regional brain tissue PO2 in albino rabbits (n = 6 per group) with a focal brain lesion (cold injury). The doses of anesthetics were sufficient to suppress nociception. rCBF (H2 clearance) and tissue PO2 (multiwire surface electrode) were studied adjacent to and distant from the lesion. ⋯ The heterogeneity of the tissue PO2 in fentanyl anesthesia, as well as the increased frequency of hypoxic PO2 values with thiopental, might have resulted from microcirculatory disturbances. Thus, although isoflurane seemed to facilitate hyperemia with an increased O2 supply to the brain, fentanyl tended to induce the opposite response. Although these properties suggest the potential to manipulate perfusion and O2 supply in cerebral ischemia or hyperemia after head injury, the effects of such measures on intracranial pressure, neurologic status, and outcome have yet to be proven.
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Transcranial Doppler sonography (TCD) is a simple, noninvasive bedside procedure that can be repeated any time for the measurement of cerebral blood flow velocity in the great basal cerebral arteries. It is practicable in most severely head-injured patients in critical care. Flow patterns and pulsatility index (PI) resulting from maximal systolic and diastolic flow velocities and representing cerebrovascular resistance give quite an accurate impression of potential intracranial hypertension and the dependent cerebral perfusion pressure (CPP). ⋯ Under continuous TCD monitoring of the middle cerebral artery, increases in maximal flow velocity (from 4% up to 102%, on average 27%) and mean flow velocity (from 18% up to 153%, on averaged 73%) were always observed after osmotherapy. In addition, a variable increase in negative frequencies was noted, probably due to increased turbulences. After barbiturate administration (thiopentone bolus of 0.3 g) a flow reduction was always seen [from -2% up to -25% (on average -13%) for maximal flow velocity and from -9% up to -30% (on average -19%) for mean flow velocity].(ABSTRACT TRUNCATED AT 250 WORDS)
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The officially appointed external expert needs a precise documentation of the initial clinical findings and the findings at follow-up of the patient with craniocerebral trauma. The next step in preparation of the expert report consists in a pathophysiological and a neurological examination, including CT scan and EEG repeated at intervals; a stable condition can be expected after 1-2 years. In the case of reversible closed head syndrome (brain concussion) the expert should certify a disability for about 6 months; a degree of 20% for over 3 months should not be certified unless there are massive vegetative signs and symptoms. ⋯ Adults who are unconscious for up to 5 days can be expected to make a complete recovery, while a longer duration of coma and more advanced age are associated with a worse outcome. The degree of functional impairment is thus important in the expert's decision on the level of disability. A flow chart is presented for guidance in the preparation of expert reports.(ABSTRACT TRUNCATED AT 250 WORDS)