ISSN:0269-9052    

DOI:10.3109/02699058809150934

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

From January to June 1986, 158 patients with extradural haematoma were admitted to our neurosurgical unit. They were divided into four groups, reflecting their clinical features.:A 46 cases (GCS≤12) in whom a condition of coma/stupor had occurred at the time of injury and persisted to the time of surgical decompression;B 41 cases showing deterioration of consciousness (GCS≤12) after a lucid interval;C 46 cases of 'asymptomatic' patients (GCS consistently≥13, no neurological deficits, no signs of increased intracranial pressure);D 25 cases arriving at our unit in a conscious state, but restless and/or with neurological deficits.The location of the haematoma (temporal in only 35%), the incidence of associated lesions such as cerebral lacerations and/or subdural effusion (303%), and the age of the patients (28.4±18.4 years were similar in the four groups. The size of the haematoma and the displacement of the midline structures were significantly greater in comatose/stuporose patients (groups A and B). The overall mortality was 12% (19 patients), with a morbidity of 14% (22 patients). Factors statistically significant in determining mortality and morbidity were.: degree of coma as assessed by GCS; displacement of midline structures.: age of the patient; size of the haematoma. There was no mortality or morbidity in those patients who remained conscious (groups C and D).A pronounced increase in the number of CT examinations performed in patients with head injury in our area of referral has caused profound changes in the population of patients admitted to our centre, resulting in a greater proportion of extradural haematomas detected in patients who are still conscious, and in whom operative mortality and morbidity are negligible.One further therapeutic implication of the increase in the number of patients with EDH admitted while asymptomatic may be the option of conservative management in those patients who remain in a good clinical condition, with haematomas of less than 1 cm in thickness and no displacement of midline structures.

ISSN:0269-9052    

DOI:10.3109/02699058809150935

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Recent advances in clinical neuropharmacology are likely to improve the treatment and rehabilitation of traumatic brain injury (TBI) patients. Treatment may be directed to alleviate specific symptoms, to improve function in certain areas, or even to enhance the cortical recovery process. The author reviews pertinent issues in clinical neuropharmacology for the following drug classes.: stimulants, other dopamine agonists, antidepressants, lithium, cholinergics, neuroleptics, anticonvulsants, beta-blockers, calcium channel blockers, nootropes, opiates and neuropeptides. Since the relevant research literature in TBI is so sparse, information and recommendations are extrapolated from some other patient groups, especially developmentally handicapped children and adults, and patients with dementia.

ISSN:0269-9052    

DOI:10.3109/02699058809150936

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

In a simulated functional task involving comprehension of a spoken passage, the performance of 20 traumatically brain-injured and 14 non-brain-injured control patients was compared under conditions which included the presence and absence of competing vocal stimuli. The subjects heard 10 target paragraphs which were approximately 1 minute in length. Five of these paragraphs were transmitted without any interference, while the other five were presented with distraction caused by a second voice reading a different paragraph with equal volume and intensity. Based on the answers to subsequent multiple-choice questions, the traumatically brain-injured subjects had significantly more difficulty comprehending the target passages in the presence of the interfering or competing passages compared to control subjects. The results of this study suggest the need for specific rehabilitation programmes to aid brain-injured persons in improving their auditory comprehension in everyday situations where distracting or competing auditory stimuli are present.

ISSN:0269-9052    

DOI:10.3109/02699058809150937

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Although the need for an integrated approach to the management of the head-injured patient has been recognized, and the concept of incorporating the family in the rehabilitation treatment programme suggested, there is minimal documentation of how the services of family members can be utilized to optimal effect. At a large university teaching hospital in Sydney, Australia, an early intensive rehabilitation programme was pretested on 37 patients during 1984–85. The pretest was to identify the extent to which relatives could contribute input as lay-therapists to such a programme. The findings indicate that relatives can make a major time commitment to providing therapy, but that to avoid harm to both patients and relatives certain safeguards need to be enforced. These experiences and resultant recommendations may have a bearing on the organization of rehabilitation programmes for other categories of patient.

ISSN:0269-9052    

DOI:10.3109/02699058809150938

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Cognitive remediation programmes were delivered by microcomputer to three patients showing visual neglect using single-case experimental methodology with multiple-baseline across-function designs. The patients included one head injury case and two cases of cerebrovascular accident. Clear differences were produced in target functions. The most likely mechanism for this change was the learning of new verbal regulation strategies, although other, non-verbal, mechanisms may have been involved.

ISSN:0269-9052    

DOI:10.3109/02699058809150939

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Recovery from head injury is long process. Agitation is a well-known stage in the recovery. Unfortunately, patients in agitation are often unable to participate in rehabilitation programmes and disrupt the rehabilitation ward activities. Several medications [1-6] have been used in the treatment of agitation. The following is a report of the patient treated with a new medication, buspirone, in the treatment of agitation. Two other patients responded to buspirone. Their agitation did not recur after the medication was stopped. A causal effect could not clearly be documented except in this case.

ISSN:0269-9052    

DOI:10.3109/02699058809150940

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Heterotopic calcification can delay the rehabilitation process of the patient with severe head injury. This ectopic bone can cause limitation in range of motion and even ankylosis. The incidence of heterotopic calcification following severe head injury varies from 11 to 76%, and in 20-35% of patients with neurological impairment it may become a disability. The existence of this problem has long been recognized; its prevention has not been emphasized enough.

ISSN:0269-9052    

DOI:10.3109/02699058809150941

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

It is a pleasure to share some of our experiences at the University of Pennsylvania regarding head-injured patients and heterotopic ossification (HO).I am not an expert of HO, but through the efforts of people with whom I work closely, particularly Dr Rogers and Gem Spielman, RN, our head-injury clinical co-ordinator, I've learned a lot about HO in recent years.I believe that we neurosurgeons have underappreciated both the frequency and the severity of heterotopic ossification in patients with head injuries. In such patients we're often mainly concerned with intracranial pressure, cerebral blood flow and the CT scan, and with trying to pull the patient through a catastrophic illness.But some of the treatment regimens for head injury have been significantly improved, and we're now better able to control intracranial pressure and cerebral blood flow and other factors. More patients are surviving-but often they're surviving with complications that are potentially preventable, such as HO.So there are two messages I'd like to share with you: One is about which patients in the head-injury population are at high risk for HO, and the other is about the regimen that we've used for HO prophylaxis.We have to keep in mind that nothing in clinical medicine is 100%. The method I'll describe will not prevent HO in every patient. But from preliminary results of some studies we've been engaged in, we think that it's important to begin prevention extremely early-if possible, on the very day of injury-with a prophylactic programme aimed at minimizing and mitigating the occurrence of ossification.

ISSN:0269-9052    

DOI:10.3109/02699058809150942

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor