Articles: brain-injuries.
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We report two patients in whom bullets in the brain migrated into the adjacent lateral ventricle and moved freely as a consequence of gravity. A review of the literature suggests that the spontaneous migration of intracerebral bullets is influenced by cerebral softening, the specific gravity of the bullet compared with brain tissue, and the sink function of the cerebral ventricles. In patients undergoing the surgical removal of intracerebral or intraventricular bullets, it is recommended that an x-ray be obtained after the final positioning of the head.
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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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During the war in Croatia so far, more than 250 casualties having missile wounds of the brain, spinal chord and peripheral nervous system were admitted to the Neurosurgical Clinic, University Hospital-Rebro. These injuries were mainly caused by low-velocity missiles. However, the high-velocity ones, used nowadays, in direct injury to the head, cause destruction of the brain that is incompatible with survival in most of the cases. ⋯ The mechanism of the brain destruction is not completely clear since the missile was found at the very entrance of the missile wound, while the brain was destroyed up to the opposite side of the endocranium. Four mechanisms of the missile's effect aimed at explaining the cause of death of the patient, as well as the bizarre position of the missile, were taken into consideration. The review shows how perilous a wound from a direct missile injury to the head could be, regardless of its speed.
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Aktuelle Traumatologie · Dec 1992
[Epidural "sulmycin implant" coverage for local prevention of infection in surgical management of open craniocerebral injuries].
In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. ⋯ Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".