1/18. head injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors.INTRODUCTION: Following head injury complex pathophysiological changes occur in brain metabolism. The objective of the study was to monitor brain metabolism using the Paratrend multiparameter sensor and microdialysis catheters. patients, MATERIAL AND methods: Following approval by the Local ethics Committee and consent from the relatives, patients with severe head injury were studied using a triple bolt inserted into the frontal region, transmitting an intracranial pressure monitor, microdialysis (10 mm or 30 mm membrane; glucose, lactate, pyruvate, glutamate) catheter and Paratrend multiparameter (oxygen, carbon dioxide, pH and temperature) sensor. A Paratrend sensor was also inserted into the femoral artery for continuous blood gas analysis. RESULTS: 21 patients were studied with cerebral microdialysis for a total of 91 monitoring days (range 19 hours to 12 days). Of these, 14 patients were also studied with cerebral and arterial Paratrend sensors. The mean ( /- 95% confidence intervals) arterial and cerebral oxygen levels were 123 /- 10.9 mmHg and 27.9 /- 5.71 mmHg respectively. The arterial and cerebral carbon dioxide levels were 34.3 /- 2.35 mmHg and 45.3 /- 3.07 mmHg respectively. Episodes of systemic hypoxia and hypotension resulting in falls in cerebral oxygen and rises in cerebral carbon dioxide were rapidly detected by the arterial and cerebral Paratrend sensors. Systemic pyrexia was reflected in the brain with the cerebral Paratrend sensor reading 0.17 degree C (mean) higher than the arterial sensor. Elevations of cerebral glucose were detected, but the overall cerebral glucose was low (mean 1.57 /- 0.53 mM 10 mm membrane; mean 1.95 /- 0.68 mM 30 mm membrane) with periods of undetectable glucose in 6 patients. Lactate concentrations (mean 5.08 /- 0.73 mM 10 mm membrane; mean 8.27 /- 1.31 mM 30 mm membrane) were higher than glucose concentrations in all patients. The lactate/pyruvate ratio was 32.1 /- 5.16 for the 10 mm membrane and 30.6 /- 2.17 for the 30 mm membrane. Glutamate concentrations varied between patients (mean 15.0 /- 10.5 microM 10 mm membrane; mean 28.8 /- 17.8 microM 30 mm membrane). CONCLUSION: The combination of microdialysis catheters and Paratrend sensors enabling the monitoring of substrate delivery and brain metabolism, and the detection of secondary metabolic insults has the potential to assist in the management of head-injured patients.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/18. rupture of the round window membrane.A perilymph leak into the middle ear through a ruptured round window membrane results in the symptoms of hearing loss, tinnitus and vertigo, either singly or in combination. The case histories of thirteen patients with such a fistula are described, these patients having in common a predisposing incident which had led to a rise of C.S.F. pressure. Symptomatology and the results of investigation are analysed and operative technique and results discussed. While it appears that vertigo uniformly responds very satisfactorily to operative treatment the improvement in hearing loss and tinnitus is more difficult to predict.- - - - - - - - - - ranking = 0.55555555555556keywords = membrane (Clic here for more details about this article) |
3/18. rupture of the round window membrane.Considerable interest has been displayed in sudden sensori-neural deafness in recent years, and especially since Blair Simmons postulated that this could be caused by mechanical disruption of the membranes in the inner ear. The literature concerning such reports is reviewed briefly and two cases of rupture of the round window membrane resulting from inner ear barotrauma are reported in detail. Both these cases were experienced divers who had had little difficulty in auto-inflation whilst diving. The first case had progressive sensori-neural deafness with mild vertigo, and tympanotomy revealed rupture of the round window membrane in both ears. These ruptures were repaired with plugs of fat, following which his hearing was restored. The second case developed marked vertigo following a dive and was thought to be suffering from decompression sickness. When the appropriate treatment did not help him, tympanotomy was performed and a rupture of the round membrane was found. This was plugged with fat with a most satisfactory result. Both of these cases had difficulty with autoinflation, and had been aware of such difficulties for some time. Nasal problems were responsible for this, and it is strongly recommended that all divers should have normal nasal function and that they should be educated in the technique of autoinflation, and, in particular, in the importance of avoiding forceful autoinflation at all times. A third case of rupture of the round membrane following an injury to the head is also reported.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/18. Consciousness disturbances in megalencephalic leukoencephalopathy with subcortical cysts.Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a genetic disorder featuring diffuse MRI white matter abnormalities and a discrepantly mild clinical picture. It is related to different mutations in MLC1 gene encoding a putative membrane protein of still unknown function. We report on a genetically proven MLC patient who presented with a peculiar clinical course characterized by a prolonged comatose state following a minor head trauma at 12 years of age. The disturbance of consciousness lasted for over four months and then gradually improved. Proton MR spectroscopic imaging studies showed a moderately severe depletion of N-acetylaspartate restricted to the white matter with sparing of the cortical grey matter. The full recovery from coma suggests a transitory functional impairment of the structures implicated in the maintenance of consciousness.- - - - - - - - - - ranking = 0.11111111111111keywords = membrane (Clic here for more details about this article) |
5/18. Vitreoretinal traction and perimacular retinal folds in the eyes of deliberately traumatized children.The pathophysiology of perimacular folds in eyes of deliberately traumatized children is disputed. The authors reviewed the clinical and forensic records and systemic and ocular findings at autopsy of three children with perimacular retinal folds who died after being violently shaken. Two of the children suffered direct head trauma in addition to being shaken; one patient was violently shaken without any physical or forensic evidence of direct head trauma. No direct ocular trauma was detected. In each case, the vitreous had partially separated from the retina but remained attached to the internal limiting membrane at the apices of the folds and the vitreous base, implicating traction in the pathogenesis of these folds. Although some intraocular findings in deliberately traumatized children may be explained by direct head injury, the possibility of both direct head trauma and shaking must be considered. Perimacular folds may develop without direct ocular or head trauma and may constitute evidence supporting violent shaking.- - - - - - - - - - ranking = 0.11111111111111keywords = membrane (Clic here for more details about this article) |
6/18. brain tissue pH in severely head-injured patients: a report of three cases.It is well established that low cerebrospinal fluid (CSF) pH and high CSF lactate concentration indicate the development of brain acidosis after severe human head injury. However, there is no direct evidence that tissue acidosis actually occurs. We measured brain extracellular pH (pHe) in three patients undergoing operation for the evacuation of acute subdural hematomas. A pH-sensitive polymer membrane electrode was inserted 500 micron into the cerebral cortex close to the damaged area. The pHe values obtained were correlated with ventricular CSF acid-based parameters and extension of the brain lesion. The CSF pH was higher than the pHe in all cases; the pHe was particularly low in areas of contusion or compression by mass lesion. The effect of focal brain tissue acidosis on clinical course after severe head injury is discussed.- - - - - - - - - - ranking = 0.11111111111111keywords = membrane (Clic here for more details about this article) |
7/18. Agenesis of internal carotid artery presenting with oculomotor nerve palsy after minor head injury.We report a patient with unilateral agenesis of the internal carotid artery in whom the oculomotor nerve was paralyzed on the same side as the agenesis after a minor head injury. It is conceivable that the palsy was caused by sudden tension of the nerve between the petroclinoid ligament and the enlarged posterior communicating artery.- - - - - - - - - - ranking = 2.0959631128627keywords = ligament (Clic here for more details about this article) |
8/18. Acute subdural hematoma with rapid resolution in infancy: case report.An infant who suffered acute subdural hematoma due to minor head trauma twice in a short period is presented. Each subdural hematoma, showing high density on computed tomographic scanning, resolved with unusual rapidity, resulting in full recovery after nonsurgical management. The mechanism of this rapid resolution of each hematoma was thought to be participation of cerebrospinal fluid secondary to a tearing of the arachnoid membrane.- - - - - - - - - - ranking = 0.11111111111111keywords = membrane (Clic here for more details about this article) |
9/18. Occipito-cervico-thoracic spine fusion in a patient with occipito-cervical dislocation and survival.A 16-year-old man with occipito-cervical dislocation and survival was treated at Rancho Los Amigos Medical Center. The patient had ligamentous instability between the occiput and the cervical spine. His neurologic level was complete at the C1 level, and he was dependent on a mechanical respirator. Sternocleidomastoid and other neck musculature were not functional. A fusion of the occiput to cervical spine and cervical spine to thoracic spine was performed to obviate the need for external neck support. The patient went on to fuse and is now independently mobile with a tongue-switch driven wheelchair with a respirator trailer 2 years after injury. The patient has no need for external support as a result of his fusion.- - - - - - - - - - ranking = 2.0959631128627keywords = ligament (Clic here for more details about this article) |
10/18. Jefferson fracture with disruption of the transverse ligament. A case report.A 20-year-old male incurred a vertex injury of the skull, disruption of the transverse ligament of the atlas, and a Jefferson fracture--lateral displacement of the lateral masses of the atlas in relation to the lateral margins of the second cervical vertebra. The combination of Jefferson fracture with transverse ligament disruption was not appreciated initially (or even late) because of the head injury. The hospital course was complicated by the patient's initial unconsciousness and restlessness caused by associated intracranial injury. Roentgenograms in all views of the cervical spine were essential to its recognition and had to be carefully examined. Laminograms of the cervical spine showed a small anterolateral fragment on the right at the location of the tubercle attachment of the transverse ligament. Surgical stabilization is essential in this complex injury to protect the spinal cord from damage by subluxation and/or dislocation at the C1-C2 interval. Posterior cervical fusion of C1-C2 was performed at 4 1/2 weeks postinjury to allow time for healing of the ring of the atlas.- - - - - - - - - - ranking = 14.671741790039keywords = ligament (Clic here for more details about this article) |
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