Articles: brain-injuries.
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Zh Nevropatol Psikhiatr Im S S Korsakova · Jan 1985
[Neuropathologic syndromes in the late period of closed cranio-cerebral injuries].
Using a comprehensive psychoneurological examination including a number of paraclinical methods (EEG, REG, echoventriculometry, thromboelastography, audiography, etc.) the authors studied 160 war veterans who had sustained a closed craniocerebral injury of a mild or moderate degree during the Great Patriotic War. The following neuropathological syndromes most characteristic for its long-term period were identified: cochleo-vestibular disorders, oculomotor and optico-vestibular disorders, as well as vegetovascular, hypothalamic, Parkinsonism, dyssomnic, epileptic and hydrocephalohypertensive syndromes. The authors also describe a number of the features of these syndromes related to the type of the course of the long-term period of the injury and to the predominance in the clinical picture of the disease of posttraumatic or cerebrovascular disturbances.
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Acta neurochirurgica · Jan 1985
Epidural monitoring of the intracranial pressure in severe head injury characterized by non-localizing motor response.
Recent studies on prognostic variables and the intensive care of head injuries enabled us to select 64 patients and administer a standard treatment protocol to prevent secondary brain injury. All the patients were in coma with a flexor motor pattern as the best response between 6 and 24 hours after the accident and/or decompressive surgery. Continuous epidural intracranial pressure (ICP) monitoring was used in all patients to control the effect of positioning, analgetics, hyperventilation and osmotherapy. ⋯ A subsequent further rise to 40 mm Hg signified a very high risk of progression towards brain tamponade. The majority of the patients (71%) with a maximum ICP increase of less than 40 mm Hg had an acceptable recovery. After 6-12 months, the outcome in this series of patients was 48% with a good/moderate recovery, 14% with severe deficits and 38% dead/vegetative.
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The "Krönlein" shot (evisceration of the brain) is a very rare injury of the skull caused by a high-velocity bullet. The requirement for this type of low-range shot wound is a broad opening of the skull with laceration of the dura mater. In the past, several cases of this particular injury have been reported and all led to immediate death.
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Anesthesia and analgesia · Dec 1984
Cerebral and cardiopulmonary responses to high-frequency jet ventilation and conventional mechanical ventilation in a model of brain and lung injury.
The cardiopulmonary and intracranial effects of high-frequency jet ventilation (HFJV) were evaluated in four groups of 10 mongrel dogs and compared to conventional mechanical ventilation with and without positive and expiratory pressure (PEEP). Each group of animals was studied with various combinations of normal and abnormal brain and lung function. Experimental brain injury (abnormal cerebral elastance) was produced by infusion of saline into the subarachnoid space to increase intracranial pressure (ICP), while lung injury resulted from intratracheal instillation of 0.1N HCl. ⋯ ICP responses did not vary significantly with the different modes of ventilation and were not influenced by the status of lung or brain function. However, significant reductions in cerebral perfusion pressure were noted with 20 cm H2O PEEP compared to HFJV. We conclude that unless high levels of PEEP (15-20 cm H2O) are required for adequate oxygenation, the cardiovascular and cerebral effects of HFJV do not differ significantly from those of conventional mechanical ventilation.
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Head injury is a significant economic, social and medical problem in the United States. For this reason, prognostic factors in head injury are of major importance to all surgeons who treat severely injured patients. Outcome of severe head injury is frequently determined at the time of impact, and surgical and medical treatment is often ineffective. ⋯ Multimodality evoked responses are a noninvasive prognostic technique which predicts outcome with a high degree of certainty. For optimal accuracy, prognosis should be based upon a combination of factors, including age, Glasgow coma score, pupillary response, eye movements, presence of surgical lesion, motor posturing and multimodality evoked responses. Decisions regarding surgical and medical treatment of patients with head injury should be based upon these prognostic factors.