Articles: brain-injuries.
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Acta neurochirurgica · Jan 1991
Comparative StudyA comparative study of the Reaction Level Scale (RLS85) with Glasgow Coma Scale (GCS) and Edinburgh-2 Coma Scale (modified) (E2CS(M)).
In this work a new coma scale for the assessment of responsiveness in acute brain disorders, constructed near the year 1985 by Scandinavian investigators, the Reaction Level Scale (RLS85), is compared with two other coma scales namely: (i) the Glasgow Coma Scale: (GCS); (ii) the Edinburgh-2 Coma Scale, after modification: (E2CS(M)). The study proceeded in the form of a statistical analysis of assessments made on 46 patients according to RLS85 and GCS (i.e., when comparison was with GCS) and on 28 patients according to RLS85 and E2CS(M). In all 74 cases two physicians participating as "observers" carried out the assessments. ⋯ Those corresponding to RLS85 are considerably higher. In particular the overall value based on 74 pairwise assessments amounted to kappa = 0.733 associated with a standard error sigma(kappa) = 0.061. This was a satisfactory result regarding the features of RLS85. (4) As far as coverage is concerned, again--by the "sign" test--the predominance of RLS85 versus GCS (EMY profile) was accepted.
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According to reports in the literature traumatic interhemispheric subdural haematomas (I. S. H.) are supposed to present acutely or subacutely with contralateral monoparesis of a lower extremity or hemiparesis or in bilateral haematomas even with paraparesis, and to need early operative evacuation. ⋯ We conclude that the indication for operative evacuation depends on the clinical course and that in patients with spontaneously improving symptomatology non-surgical management under close supervision may be the better solution. Also the C. T. finding of open convexity cisterns may be possible indication for conservative management.
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Acta neurochirurgica · Jan 1991
Increases of neuron-specific enolase, S-100 protein, creatine kinase and creatine kinase BB isoenzyme in CSF following intraventricular catheter implantation.
In 15 patients without acute brain injury the concentrations of Neuron-specific Enolase (NSE), S-100 Protein (S-100), Creatine Kinase (CK), and Creatine Kinase BB isoenzyme (CK-BB) in ventricular cerebrospinal fluid (CSF) were measured immediately after lateral ventricle cannulation for diagnostic or treatment purposes. From patients who were treated with a shunt another CSF sample was obtained one week after shunt implantation by puncture of the antechamber of the valve. ⋯ One week after shunt implantation the concentrations of S-100, CK and CK-BB had returned to normal levels in almost all patients, while the NSE concentrations remained elevated. These findings indicate that the sampling procedure may result in contamination of CSF with NSE, S-100, CK and CK-BB and they should be taken into account in the prognostic evaluation of enzyme concentrations after brain injury.
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Severe head injury (Glasgow Coma Score less than or equal to 7) is associated with high mortality and morbidity which can be improved by early energetic therapy. Such patients must be picked up by prehospital/EMS service with three aims: controlling ventilation, controlling haemodynamics, avoiding any increased intracranial pressure. ⋯ At admission to emergency unit, intensive care must be continued while X-rays and CT-scan are achieved. Imperative indications of transport to neuro-intensive care unit are discussed for hospitals without a neuro-surgeon.
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We investigated retrospectively 761 acute head trauma patients, who were admitted to our intensive care unit from 1983 to 1989. The objective of our study was to investigate the influence of pre-hospital acute care and intensive care protocols on mortality and outcome. We showed that the introduction of organized pre-hospital emergency care and well organized interdisciplinary patient management in the hospital and in the intensive care unit had a significant effect on outcome.