Articles: brain-injuries.
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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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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 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.
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Case Reports
[Traumatic posterior fossa epidural hematoma--especially the value of CT scan (author's transl)].
Epidural hematoma in the posterior fossa is a rare clinical entity which requires the early diagnosis and treatment, and the difficulty of the diagnosis has been pointed out. However, more recently CT scan began to use to make the valuable diagnostic method for traumatic posterior fossa hematomas. Epidural hematoma may be classified as acute, subacute and chronic, according to the time of free interval or lucid interval after injury. ⋯ Liquor cavity in the posterior fossa which is thought to serve as a buffer action of hematoma is about 20 ml, so we discuss about the volume of hematoma, especially of 20 ml, associated with clinical course and prognosis. Volume of epidural hematoma is one of the most important factors affecting clinical course and prognosis. In summary of these our experiences, we again emphasize the value of CT scan as the rapid, noninvasive, accurate radiological examination in the diagnosis of traumatic posterior fossa epidural hematoma.