Articles: brain-injuries.
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Acta Anaesthesiol Scand · May 1992
Complications and side effects during thiopentone therapy in patients with severe head injuries.
This study reports all complications and side effects occurring in 38 patients with severe traumatic brain lesions treated with barbiturate coma because of a dangerous increase in intracranial pressure. The treatment was induced by intravenous infusion of thiopentone (5-11 mg.kg-1) followed by a continuous infusion of 4-8 mg.kg-1.h-1. The subsequent rate of thiopentone infusion was governed by the level of the intracranial pressure with the intention of keeping ICP below 20 mmHg (2.7 kPa). ⋯ Mortality in 17 patients was caused by an untreatable increase in intracranial pressure. In one patient complications due to barbiturate treatment may have contributed to the fatal outcome. In none of the other cases were the noted complications and side effects associated with any permanent symptoms or dysfunctions.
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Neurol Neurochir Pol · May 1992
Review[Use of transcranial Doppler ultrasonography for evaluation of intracranial pressure].
Transcranial Doppler (TCD) studies are very useful for the evaluation of intracranial pressure changes. The most informative for the TCD increase diagnosis are the diastolic pressure decrease and increase of two computed indices: pulsatility index (PI) and resistance index (RI). ⋯ Additional information is provided by TCD studies in cerebral blood flow autoregulation tests. The usefulness of TCD in brain death diagnosis is discussed also.
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Fishhook injuries rarely pose a true emergency, and only a few cases of posterior ocular injury from fishhooks have been described. We present a case of penetrating ocular, orbital, and cranial trauma produced by a broken fishhook. The morbidity and mortality as well as the initial emergency evaluation of penetrating foreign objects in the orbital-cranial region are discussed.
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Using transcranial doppler ultrasonography, cerebral blood flow velocity was measured daily from both middle cerebral arteries in 121 patients who had suffered minor (n = 55), moderate (n = 16), or severe (n = 50) brain injury. Serial computed tomographic scans were performed to identify noncontusion-related infarction (NCI). Cerebral perfusion pressure was monitored continuously in 41 patients who had severe head injury; of these, 22 had continuous measurement of arterial and jugular bulb venous oxygen (SJO2) saturation. ⋯ Four of the 23 patients with increased MFV developed NCI, as compared with none of the patients without elevated MFV (P = 0.015). All patients with NCI had suffered severe brain injury, had unilateral elevation of MFV in the terriory of the relevant cerebral vessel, and had received therapy to correct reduced cerebral perfusion pressure (P = 0.008). NCI did not occur in any patient with increased MFV that was associated with global hyperemia.
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A new concept of cerebral hemodynamic and metabolic physiology, cerebral hemodynamic reserve (CHR), was evaluated in 20 comatose adults with acute traumatic brain swelling who were undergoing continuous monitoring of the arteriojugular difference in oxyhemoglobin saturation, along with cerebral perfusion pressure and expired PCO2. The CHR was measured as the ratio of relative (percent) changes in cerebral oxygen extraction to relative changes in cerebral perfusion pressure during spontaneous increases in intracranial pressure. ⋯ It is concluded that cerebral hemodynamic reserve abnormalities very closely associate with signs of increased intracranial "tightness" on computed tomographic scans of the head. Cerebral hemodynamic reserve could therefore become an important guide in the functional evaluation and management of acute brain swelling (focusing on cerebral oxygenation and perfusion pressure) in a variety of predominantly diffuse acute intracranial disorders.