Articles: brain-injuries.
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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.
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Transorbital penetrating brain injury is rare during this time of peace. In our paper, we reported seven cases of these injuries and discussed the mechanism and treatment of intracranial complications. Transorbital penetrating brain injuries were caused by thin, long and relative hard objects such as chop-stick (case 3), pencil (case 6), bamboo stick (case 1, 2, 7) and a piece of metal (case 4, 5). ⋯ The one exception was a case in which a large intracerebral hematoma was over-looked in an ophthalmological clinic. This patient died. Nowadays, CT scan and MRI give clear information about the anatomical location of injuring objects and intracranial complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Surg Gynecol Obstet · Apr 1992
Traumatic brain injury attenuates the effectiveness of lactated Ringer's solution resuscitation of hemorrhagic shock in rats.
Traumatic brain injury suppresses spontaneous cardiovascular compensation for hemorrhage, prompting us to examine the possibility that trauma to the brain modifies hemodynamic response to therapy in hemorrhage. Thirty rats that were anesthetized were randomly assigned to four groups--hemorrhagic shock (H), hemorrhagic shock after brain trauma (TH), hemorrhagic shock treated with lactated Ringer's (LR) solution (HR), and hemorrhagic shock after brain trauma treated with LR (THR). After hemorrhage, group TH had significantly lower mean arterial pressure (MAP), cardiac index (CI) and stroke volume index (SVI) than group H. ⋯ Furthermore, neither brain trauma nor fluid replacement altered the content of water in the brain in hemorrhaged rats. These data indicate that brain trauma not only suppresses spontaneous hemodynamic recovery from hemorrhage, but also impedes the efficacy of LR resuscitation. The results of the current study suggested that a more aggressive fluid replacement may be needed to treat hemorrhagic shock in individuals with brain injury.
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Fever or pyrexia is a common clinical phenomenon. Among survivors of traumatic brain injury, it may appear immediately after injury, signal the presence of infection or reflect dysfunction of the thermoregulatory system. ⋯ Guidelines for decision making regarding the nursing management of patients with fever are presented. Given the potential benefit of fever, the ability of most patients to tolerate temperature elevations and the adverse effects, costs and discomforts associated with therapy, our habit of automatically reducing temperature should be examined.
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Journal of neurotrauma · Mar 1992
ReviewCerebral blood flow, cerebral blood volume, and cerebrovascular reactivity after severe head injury.
Traumatic brain injury (TBI) often causes disturbances of the cerebrovascular circulation, which contribute to the infliction of secondary injury, although the complex nature of the mechanisms involved is not fully understood. First, the role of ischemia in TBI is still controversial. Despite experimental and pathologic data suggesting important interactions between ischemia and trauma, evidence for posttraumatic ischemia with CBF measurements in patients so far had eluded most investigators. ⋯ Impairment of cerebrovascular CO2 reactivity and autoregulation often occurs after TBI. Although no correlation with the severity of injury or outcome has been established, it is obvious that diminished adaptive responses of the cerebral vasculature render the brain more vulnerable to additional systemic insults, such as derangements of blood pressure, altered rheology, or hypoxia. The posttraumatic status of vascular reactivity and autoregulation also has important implications with regard to the treatment of high ICP, in particular for the use of hyperventilation and pharmacologic management of blood pressure, which are discussed in detail.