Articles: brain-injuries.
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While primary neurologic damage in the patient with head trauma may be irreversible, damage from secondary injuries can often be avoided with rapid identification and correction of factors potentially leading to such injury. In patients with severe injuries, systematic evaluation is needed, including assessment of respiratory and circulatory systems, history taking, inspection of the head, and neurologic, general, and roentgenographic examination, as well as monitoring of vital functions, continuing patient care, and administration of intravenous fluids and medications.
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Journal of neurosurgery · Feb 1983
Randomized Controlled Trial Clinical TrialFailure of prophylactically administered phenytoin to prevent early posttraumatic seizures.
A randomized double-blind placebo-controlled study was carried out to determine whether phenytoin administered soon after injury lessens the incidence of epilepsy in the 1st week after severe head trauma. In this study, 244 patients were randomized into either a phenytoin or placebo group. The patients in the phenytoin group were administered phenytoin intravenously or intramuscularly within 24 hours of hospital admission. ⋯ There was no significant difference in the interval from injury to first seizure between the treated and placebo groups (p = 0.41). The early administration of phenytoin did not lessen the occurrence of seizures in the 1st week after head injury. Since the effectiveness of seizure prophylaxis has not been established, the authors suggest that anticonvulsant drugs be administered only after an early seizure has occurred.
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In summary, although the prognosis for the severely head-injured patient may be poor, there are a multitude of techniques available to the anesthetist for minimizing the occurrence of secondary head injury. Aggressive resuscitative efforts toward maintaining homeostasis must be directed at cardiovascular and neurological systems. Sound knowledge of physiologic principles and the clinical application of these principles are essential to the safe management of a patient who has sustained traumatic head injury.
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Case Reports
Real-time ultrasonography: a useful tool in the evaluation of the craniectomized, brain-injured patient.
Real-time ultrasonography is being used increasingly to establish the diagnosis of and serially assess intraventricular hemorrhage and hydrocephalus in neonates. The procedure requires an open fontanel because scatter from the bone occurs from direct application of the transducer to the skull and bone density precludes satisfactory imaging. With an adult, under circumstances where a bone flap is left out after intracranial procedures and the patient's clinical status is such that the patient cannot be transferred for computed tomographic scanning, real-time ultrasonography allows a safe, noninvasive, bedside demonstration of ventricular size, degree of shift of midline structures, and intraparenchymal and intraventricular lesions.