摘要:

&NA;The authors studied 538 patients who had sustained minor head trauma, which was defined as a history of unconsciousness of 20 minutes or less, a Glasgow Coma Scale score of 13 to 15, and hospitalization not exceeding 48 hours. Of these patients, 424 were evaluated 3 months after injury. The follow‐up evaluation included a history of events since the accident, assessment of subjective complaints and objective measures such as employment status, a neurological examination, a psychosocial assessment designed for estimating life stress, and a neuropsychological test battery to measure higher cortical function. Of these 424 patients, 79% complained of persistent headaches, and 59% described problems with memory. Of the patients who had been gainfully employed before the accident, 34% were unemployed 3 months later. Comparisons were then made between the employed and the unemployed groups. Three explanations for the high rate of unemployment were examined.(a) Evidence of organic brain damage:Although the neurological examination was completely normal in nearly all patients, neuropsychological testing demonstrated some problems with attention, concentration, memory, or judgment in most of the 69 patients evaluated.(b) Psychological responses to the injury:Emotional stress caused by persistent symptoms seems to be a significant factor in the long term disability of these patients.(c) Litigation and compensation:These factors have a minimal role in determining outcome after minor head injury. In conclusion, the most striking observations of these studies are the high rates of morbidity and unemployment in patients 3 months after a seemingly insignificant head injury and the evidence that many of these patients may have, in fact, suffered organic brain damage. (Neurosurgery9:221‐228, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Measurements of the serum levels of pituitary hormones were made in six patients with uncomplicated head injury. Samples were obtained at 4‐hour intervals for 72 hours to evaluate diurnal rhythms. Three of the six patients revealed elevations of serum growth hormone (GH) and prolactin, but no trends could be established. Likewise, three patients had marked elevations of luteinizing hormone and lesser elevations of follicle‐stimulating hormone, but no pattern was discernible. The level of thyroid‐stimulating hormone was stable and remained in the normal range throughout. GH was measured after intravenous glucose loading. A paradoxical rise reverted to normal at the late follow‐up evaluation. It is suggested that the abnormal levels were related to abnormal hypothalamic function rather than to pituitary damage. (Neurosurgery9:229‐235, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The characteristics of 1311 head‐injured patients admitted to 10 selected San Diego hospitals are detailed. Fifty patients who subsequently died are included. Glasgow coma scale scores were strongly related to survival. After adjustment for the Glasgow coma scale score, there was an independent association between age and survival, but not between sex and survival. The four characteristics associated with head injury that bore the highest case fatality ratios (all greater than 30%) in descending order were spinal cord injury, obstructed airway, difficulty breathing, and shock. Previous unconsciousness and transport by private vehicle were predictive of survival. None of the four adverse predictors or multiple injury showed an independent association with mortality when the Glasgow coma scale score was taken into account. (Neurosurgery9: 236‐241, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Upon admission, 17 of 223 (8%) consecutive patients with severe head injury exhibited a flaccid, wholly unresponsive motor examination. In this study alcoholic intoxication neither caused depressed motor responsiveness in head‐injured patients with high serum ethanol levels nor accounted for the motor examination in those exhibiting the flaccid state. Flaccidity was attributed principally to impaired ventilation in 4 patients, a major intracranial mass in 12. and a spinal cord injury in 1. Compared to the larger group of head‐injured patients, the flaccid patients had a significantly greater incidence of hypercapnia (P< 0.001), acidosis (P< 0.01), and both elevated and uncontrollable intracranial pressure (ICP) (P< 0.001). These findings and the high mortality rate (76%) in this study suggest that the magnitude of respiratory complications and the severity of mechanical brain injury are greater in flaccid patients. The flaccid patients undergoing surgical decompression for major intracranial mass lesions (11 cases) have all died and. although still small in number, this group may represent an important subset with a poor prognosis. Nonetheless, a protocol that encourages rapid radiological and electrophysiological assessment and vigorous surgical and ICP management until the probable cause of flaccidity is identified and treated has benefit. The flaccid state was reversed and a good recovery was attained after the restoration of blood pressure and/or ventilation in 2 patients who appeared to have sustained a very grave head injury. In another patient, absent somatosensory evoked potentials greatly facilitated the diagnosis of a spinal subdural hematoma. This program of prompt diagnosis and intense therapy did not result in a protracted course or undue numbers of severely braindamaged survivors. (Neurosurgery9:242‐248. 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor. (Neurosurgery9:249‐252, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Etight cases of chordoma limited to the cervical spine are presented. The radiological features are analyzed. Although there is no single diagnostic feature, the combination of osteosclerosis and lysis, multiple vertebral involvement, and the presence of a pre‐ or paracervical mass is strongly suggestive of a chordoma. Although none of our patients can be considered cured, we recommend an anterior cervical approach with radical removal of the tumor and interbody fusion followed by immobilization in a halo vest and postoperative radiation therapy. The biological behavior of the tumor is extremely variable, and multiple operations for symptomatic recurrences may be helpful. (Neurosurgery9:253‐256, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;This is a report of three children with spinal epidural abscess. The literature is reviewed and the features of this condition in children are noted. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. resulting in a worse outcome, especially in children under I year of age. The extensive laminectomy advised for the treatment of spinal epidural abscesses in adults is undesirable in children because of the risk of spinal deformity and in most cases is probably not necessary. (Neurosurgery9:257‐260, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Giant aneurysms of the vertebrobasilar system can easily mimic other mass lesions in the posterior fossa and 3rd ventricle. Recently, we treated eight cases of giant aneurysm in the vertebrobasilar circulation that were demonstrated by computed tomography with angiographic correlation. We describe the salient radiological features that help to distinguish giant aneurysms from neoplasms and discuss their clinical manifestations and surgical management. (Neurosurgery9:261‐267, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;A 3‐mm‐diameter synthetic polytetrafluoroethylene (PTFF.) cervical carotid bypass graft 20 cm in length was implanted in 30 dogs for the evaluation of blood flow, tissue response, and patency at intervals of 1 to 120 days. Although 4 of 5 grafts removed after 5 to 8 days were patent (80%). long term patency was observed in only 1 graft (10%). Aspirin treatment did not influence patency. Scanning electron microscopy demonstrated the lack of a neoendothelial layer upon the luminal surfaces of patent grafts, which were covered with a fibrin‐blood cell lining. Subintimal fibrosis resulted in stenosis at sites of anastomosis in thrombosed grafts. The graft length, its small caliber, and a 40% decrease in blood flow after implantation may have contributed to thrombosis of the bypass graft in this model. Synthetic PTFE microvascular grafts may not be suitable for clinical use in extracranial‐intracranial arterial bypass surgery. (Neurosurgery9:268‐274, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Using rabbit cerebral arteries in an in vitro chamber, we examined the cerebral arterial contraction initiated by clotting whole blood. By using methysergide maleate and a novel thromboxane synthetase inhibitor, l‐carboxyheptylimidazole (1‐CHI), we studied the contributions of both serotonin and the prostaglandin metabolite thromboxane A2. Nontreated platelet‐rich plasma (PRP) in the presence of methysergide produced a reliable contraction, whereas platelet‐poor plasma did not. PRP from a rabbit pretrealed with 1‐CHI (50 mg/kg) compared to nontreated PRP caused a significantly smaller contraction. Blockade of this cerebral arterial contraction occurred without the disruption of platelet aggregation. Whole blood (1 ml) plus thrombin produced a consistent contraction over the I hour that was monitored. Whole blood drawn from a rabbit pretreated with 1‐CHI (50 mg/kg) produced a smaller contraction, which began to dissipate in 5 minutes. When nontreated whole blood was added to the chamber in the presence of methysergide maleate (1,3 × 10−5g/ml), a contraction less than control was produced, and it persisted at 30 minutes. When whole blood pretreated with 1‐CHI (50 mg/kg) was added to the chamber containing methysergide. there was a transient contraction that dissipated to nearly zero at 30 minutes. From our results, it is apparent that the thromboxane synthetase inhibitor has a profound effect on the later phase of blood‐induced vasoconstriction. In contrast, the serotonin antagonist affected primarily the initial vasoconstriction and left the later phase largely unaltered. The role of thrombin, used to initiate coagulation, was also examined, and it was found to have a minimal direct constrictive effect when in a plasma solution. (Neurosurgery9:275 282. 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID