1/95. Severe craniocerebral injury by an axe with good outcome: case report.We report a young patient who was operated on for a penetrating slow impact craniocerebral injury in the left frontal region caused by an axe. The patient was admitted comatose, with right hemiplegia. The blade of the axe was embedded deeply into his head. A craniectomy was carried out around the axe blade and it was removed easily. The cerebral wound was 6 cm long in horizontal plane and about 7 cm deep. Significant amount of contused and necrotic brain tissue was aspirated. The patient showed an uneventful recovery.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/95. Functional recovery despite prolonged bilateral loss of somatosensory evoked potentials: report on two patients.A bilateral loss of short latency somatosensory evoked potentials (SSEPs) after head trauma or non-traumatic brain damage is normally associated with a deleterious neurological outcome. An adequate recovery in reported in two deeply comatose patients with head trauma or severe hypertensive encephalopathy despite prolonged bilateral loss of SSEPs over days, found in repeated recordings. Hence, a bilateral loss of SSEPs should not be considered alone for prediction of outcome in cerebral injury.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/95. Heterotopic ossification in childhood and adolescence.Heterotopic ossification, or myositis ossificans, denotes true bone in an abnormal place. The pathogenic mechanism is still unclear. A total of 643 patients (mean age, 9.1 years) admitted for neuropediatric rehabilitation were analyzed retrospectively with respect to the existence of neurogenic heterotopic ossification. The purpose of this study was to obtain information about incidence, etiology, clinical aspect, and consequences for diagnosis and therapy of this condition in childhood and adolescence. Heterotopic ossification was diagnosed in 32 patients (mean age, 14.8 years) with average time of onset of 4 months after traumatic brain injury, near drowning, strangulation, cerebral hemorrhage, hydrocephalus, or spinal cord injury. The sex ratio was not significant. In contrast to what has been found in adult studies, serum alkaline phosphatase was not elevated during heterotopic ossification formation. A persistent vegetative state for longer than 30 days proved to be a significant risk factor for heterotopic ossification. The incidence of neurogenic heterotopic ossification in children seems to be lower than in adults. A genetic predisposition to heterotopic ossification is suspected but not proven. As a prophylactic regimen against heterotopic ossification we use salicylates for those patients in a coma or persistent vegetative state with warm and painful swelling of a joint and consider continuous intrathecal baclofen infusion and botulinum toxin injection for those patients with severe spasticity. We prefer to wait at least 1 year after trauma before excision of heterotopic ossification.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/95. 'Is this what life is going to be like?' The story of a 34 year old man (T) who suffered a severe head injury after a fall.Imagine this. You don't remember but you fell from a ladder, a distance of 20 ft onto concrete, on Christmas eve whilst cleaning windows. You suffered a severe head injury and emerged from a coma four weeks later yelling and fighting thinking that you are back in the Falklands. After 6 months in a specialist neurological unit, where you were for a majority of the time 'as unhelpful as possible', you are finally discharged home and your rehabilitation is 'complete'. You believed that your body would 'jump out of bed and go home' months ago but 'it did not respond to your orders'. This was the beginning of a 'long and painful journey back to a reasonable life'. Home was not the safe and loving environment that you thought it would be. Everyone was beginning to see that life was not going to be the same again. There was conflict and distress. wife: He was a vibrant, energetic physical man and now he is a shell of himself. All his anger and frustration he feels about his injury he is taking out on us and whilst we all feel compassion and sympathy for him, it's hard to take... The physical problems are easy to deal with but it is the psychological problems that are hardest. son: He has changed alot. He is more short tempered and we can't reason with him. Anything we say is classed as arguing. He won't let us give our views on matters. He's always right.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/95. Craniocerebral injury resulting from transorbital stick penetration in children.OBJECTS: Two children were admitted to hospital for treatment of craniocerebral injury with transorbital penetration. methods: One child aged 6 years and 6 months had poked a chopstick in his orbit. There was no report of either a palpebral or an ocular wound. He had subsequently developed a meningeal syndrome with a cerebral abscess managed by needle aspiration biopsy and intravenous antibiotics. The other child, aged 4, had fallen onto a metal rod. He presented with a palpebral wound, motor disorders and coma, all due to a frontal intracerebral hematoma. There was an improvement in outcome without complications of an infectious nature or motor sequelae. CONCLUSIONS: Such head injuries are rare. Clinical, radiological and ophthalmological investigations must be performed, including computed tomography (CT) scan or cerebral magnetic resonance imaging (MRI) with antibiotic treatment for suspected microorganisms.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/95. Isolated medulla oblongata function after severe traumatic brain injury.The objective was to report the first pathologically confirmed case of partly functionally preserved medulla oblongata in a patient with catastrophic traumatic brain injury.A patient is described with epidural haematoma with normal breathing and blood pressure and a retained coughing reflex brought on only by catheter suctioning of the carina. Multiple contusions in the thalami and pons were found but the medulla oblongata was spared at necropsy. In conclusion, medulla oblongata function may persist despite rostrocaudal deterioration. This comatose state ("medulla man") closely mimics brain death.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/95. To do or not to do? magnetic resonance imaging in mild traumatic brain injury.Clinical quantification of mild traumatic brain injury (MTBI) patients should be based on glasgow coma scale (GCS) score, duration of loss of consciousness (LOC) and post-traumatic amnesia (PTA). In addition, a short practicable neuropsychological test might be useful in detecting minor memory and attentional deficits. MRI appears to be the most sensitive imaging method for assessing MTBI so far, but information regarding a visualized lesion is not usually utilized in the classification of MTBI. magnetic resonance imaging (MRI) should, therefore, play a major role in any MTBI classification scheme. An appropriate MRI protocol has to be chosen using at least T1 weighted, T2 weighted, proton density and gradient-echo (GRE) sequence images, all in at least two planes, in order to detect and classify all lesions precisely. Owing to the fact that acute lesions may be missed, it is advisable to perform MRI in the first 2 weeks following trauma. Further research is necessary to clarify the relationship between chronic symptoms after MTBI and MRI abnormalities. It may, thus, be possible to provide optimal strategies for emergency department management, to define a group of patients with a need for acute and rehabilitative intervention after MTBI, and to predict their outcome.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/95. Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal baclofen therapy.In the initial phase of severe head injury, dysautonomic abnormalities are frequent. Within the framework of a prospective study, evaluating the efficacy of continuous intrathecal baclofen therapy (CIBT) on hypertonia during the initial recovery phase of severe head injury, the authors report on the preliminary results of this treatment on paroxysmal dysautonomia about four patients. Continuous intrathecal baclofen infusion was first delivered, for a test period, continuously for 6 days. If a relapse of dysautonomia occurred at the end of the test period, an implantation of a continuous intrathecal infusion pump delivering baclofen was performed. Results were assessed with four continuous variables; duration (days), dose of baclofen per day (microg/d), number of dysautonomic paroxysmal episodes per day, and initial recovery evaluated by a scale of the first initial stages of head injury coma recovery. For three patients: (1) the number of dysautonomic paroxysmal episodes per day and the doses of baclofen during the follow-up period were correlated (p = 0.02, p < 0.001, p = 0.008, respectively, distribution-free test of Spearman), (2) during the test period and the relapse after the test period, the number of paroxysmal episodes and the baclofen dose are correlated to p < 0.05, p = 0.03, p = 0.04, respectively (distribution-free test of Spearman). The second statistical test was used to prove that baclofen doses and number of paroxysmal dysautonomic episodes are correlated independently of the duration of follow-up. The fourth patient improved with CIBT without any recurrence at the end of the treatment test period. For the four patients, recovery score increased during the overall follow-up. In the authors' experience CIBT is very efficient to control paroxysmal dysautonomia during the initial recovery phase in severe head injury, and seems to facilitate recovery.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/95. Recovery of children after severe head injury. Psychoreactive superimpositions.After the regaining of consciousness and awareness in the strange environment of an intensive care unit, an injured child is exposed to a situation of extreme psychological impact. This situation, in addition to a probably organically changed reactivity, is liable to provoke a particular, abnormal psychic response. The abnormal reaction can follow the pattern of a feigned-death response and thus mimic an organic coma vigile (apallic state). The resulting psychoreactive stuporous state ("Sleeping beauty syndrome") may lead to a misjudgement of the recovery degree and may delay early rehabilitation. With the help of a representative case, the clinical manifestation, course, and treatment of this reactive juvenile syndrome are presented. The interaction of physiogenic and psychogenic factors responsible for some psychiatric sequelae during the early period after head injury is emphasized.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/95. The late neurological, psychological, and social aspects of severe traumatic coma.Thirty patients who had survived a heavy head trauma and a post-traumatic coma, lasting for more than one week, were investigated 8 to 14 years after the trauma. The patients have been followed up from a social, psychological, and neurological point of view. Fifty per cent of these patients are considered to be well rehabilitated. All the investigated patients showed slight to severe reduction in mental capacity. Eighty per cent of the patients had neurological defects which were not as important with respect to social rehabilitation as was the mental capacity reduction.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
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