Articles: brain-injuries.
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Nihon Hoigaku Zasshi · Oct 1993
Review[Recent advances in the study on the mechanism of brain injury].
A cerebral contusion and DAI (diffuse axonal injury) are practically very important in a medico-legal case of the closed head injury. In this paper, we will report the epitome of the recent advances in the study on the mechanism of them. Coup contusion can be mainly attributed to the skull inbending and/or the skull fracture which develop in the impact region. ⋯ As to the brain injuries which include a cerebral contusion and DAI, two theories are reported. Centripetal progression of strains to the core of a brain injuries the brain (Ommaya). Natural frequency of impact determines the nature of resulting injury to the brain (Willinger).
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The neuropathological changes produced by a captive bolt pistol are described. The primary wound track in the brain was similar to that inflicted by a weapon such as a .22 calibre rifle. However neural and vascular damage at a distance from the primary wound canal was much less severe and widespread after penetration of the low velocity captive bolt projectile due to the formation of a smaller temporary wound cavity by radial forces imparted to the parenchyma. These findings suggest that the use of a captive bolt pistol for euthanasia should be immediately followed by further actions to ensure that an animal is rendered permanently unconscious.
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Transcranial Doppler sonography (TCD) has gained increasing relevance since its introduction by Aaslid in 1982. Basal cerebral arteries are insonated with a 2-MHz ultrasound beam. The backscattered ultrasound is analyzed by Fast-Fourier transformation and permits continuous and noninvasive determination of flow velocities (v) and pulsatility index (PI). ⋯ TCD is a fascinating monitoring device with many advantages. It can be useful for many patients and physicians, if its limitations and the clinical situation are kept in mind. Further studies have to define the role of TCD in neuroanaesthesia.
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Assessment of the level of cerebral function or of functional deficits, respectively, as in patients with acute cerebral lesions in coma, is the main purpose of cerebral monitoring. Although the clinical-neurological exploration of the patient with employment of scoring systems, such as the Glasgow Coma Scale, is the most comprehensive approach, it is of limited quantitative nature. ⋯ Recording of the intracranial pressure in comatose patients with severe head injury continues to play a central role in early recognition of fatal complications threatening the brain, such as an intracranial mass. Besides, assessment of the intracranial pressure is indispensable for selection of appropriate methods of treatment and adjustment of its necessary dose.