Articles: brain-injuries.
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Administration of hypertonic solutions is the method of choice for acute treatment of intracranial hypertension. Recording of the intracranial pressure during treatment facilitates adjustment of the dosis to the actual ICP-response, avoiding thereby administration of an excessive osmotic load as a basis to prolong therapeutical efficacy. The mechanisms underlying reduction of the intracranial pressure by hypertonic solutions are still controversially discussed. ⋯ No evidence has been obtained in a variety of experimental studies that hypertonic/hyperoncotic solutions have adverse effects on the brain in the presence of a cerebral lesion. To the contrary, the fluid mixture has been found to lower the increased intracranial pressure. Administration of hypertonic/hyperoncotic solutions appears therefore appropriate in acute cerebral insults from head injury and impending circulatory failure from shock in order to inhibit development of secondary brain damage.
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A retrospective study was carried out of 202 patients with traumatic intracerebral haematomas (TICH) noted on CT, to determine which factors most affected outcome. There were 151 (75%) males and 51 (25%) females, whose ages ranged from 1 to 84 years. One-hundred-and-two (51%) had a good outcome (Glasgow Outcome Score 1 and 2). ⋯ No patient with three or more haematomas had a good outcome. Single factor logistic regression analysis identified Glasgow Coma Score (GCS), haematoma volume and difficulty with airway maintenance or poor arterial oxygenation as important factors in determining outcome. A four-factor logistic regression analysis model was developed which revealed that, when all other factors had been taken into consideration, craniotomy significantly improved the probability of a good outcome.