Articles: brain-injuries.
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Findings of computerized tomography (CT) in 183 cases of head injury in children were investigated with special reference to CT findings of mild head injury. As was expected, CT findings of mild head injury fell within the normal range, in almost all cases. However, abnormal findings were noticed in 4 out of 34 cases (12%) in acute stage and 7 out of 76 cases (9%) in chronic stage. ⋯ These findings were invariably converted to cerebral atrophy from 10 days to 2 months after the impacts. In the cases with intracranial hematoma revealed by CT, only 32% of them showed clinical signs of Araki's type IV in their acute stage and 63% of them showed no neurological defects, that is Araki's type I & II. A case of extreme diffuse cerebral atrophy which followed acute subdural hematoma caused by tear of bridging veins without cortical contusion was presented.
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J. Neurol. Neurosurg. Psychiatr. · Apr 1981
Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.
The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality of life in disabled survivors.
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A 12 year boy with an isolated head injury and subdural hematoma developed neurogenic pulmonary edema and intraoperatively a low cardiac output syndrome. The postoperatively depressed cardiac function and hemorrhagic pulmonary edema were treated with Dobutamine and Nitroglycerin given intravenously. ⋯ Nitroglycerin applied in a low dosage with exclusive venodilator effect was added for treatment of pulmonary edema and left ventricular failure. About 2 1/2 h after the start of the treatment pulmonary edema had subsided and circulation was stabilized.
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In 16 patients with severe head injury and 2 patients with subarachnoid hemorrhage, positive end-expiratory pressure (PEEP) ventilation was required to maintain adequate oxygenation. The effects of PEEP on intracranial pressure (ICP) were evaluated with respect to the volume-pressure response (VPR), an indicator of intracranial compliance, and the static lung compliance (CL). ⋯ In addition, however, decreased lung compliance may buffer these effects in patients who have decreased intracranial compliance. We propose that ICP monitoring and intracranial compliance determination are necessary in the management of brain-injured patients requiring PEEP ventilation.
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In the search to reduce the prevalence and severity of handicap in childhood, a high priority should be accorded to identifying and eradicating possible causes of brain damage; to achieving a uniformly high standard of perinatal care; and to eliminating other causes of disability. At he same time attempts must be made to improve attitudes to handicapped children and to support parents in their efforts to minimise the effects of disability. It should be accepted that expectations of perfection in the newborn infant set an impossibly high standard and are likely to create that rejecting environment which itself increases handicap.