The treatment of penetrating wounds of the brain sustained in warfare

1974 ◽  
Vol 40 (2) ◽  
pp. 157-167 ◽  
Author(s):  
E. Stephen Gurdjian
Keyword(s):  
Head Injuries ◽  
Penetrating Wounds ◽  
Content Type ◽  
Modern Times ◽  
History Of ◽  
The Brain ◽  
Fine Print

✓ The author reviews the history of the management of head injuries with particular emphasis on penetrating wounds from antiquity to modern times. He traces the influence of gunpowder weaponry and early instrumentation on the development of treatments.

Production of experimental brain abscess in the rat

1979 ◽  
Vol 51 (5) ◽  
pp. 685-690 ◽  
Author(s):  
H. Richard Winn ◽  
Michael Mendes ◽  
Paul Moore ◽  
Clarabelle Wheeler ◽  
George Rodeheaver
Keyword(s):  
Brain Abscess ◽  
Clinical Situation ◽  
Small Animals ◽  
Content Type ◽  
History Of ◽  
Slow Infusion ◽  
The Brain ◽  
Number Of Bacteria ◽  
Experimental Brain Abscess ◽  
Fine Print

✓ Experimental evaluation of brain abscess has been inhibited by the lack of a simple and reproducible model in small animals. A stereotaxic headholder and slow infusion of 1 µl of saline, containing a known number of bacteria, were used to produce brain abscess consistently in the rat. The natural history of the brain abscess produced by this technique closely simulated that found in the human clinical situation.

Asymmetry of pressure autoregulation after traumatic brain injury

2003 ◽  
Vol 99 (6) ◽  
pp. 991-998 ◽  
Author(s):  
Eric A. Schmidt ◽  
Marek Czosnyka ◽  
Luzius A. Steiner ◽  
Marcella Balestreri ◽  
Piotr Smielewski ◽  
...  
Keyword(s):  
Head Injuries ◽  
Cerebral Arteries ◽  
Brain Lesion ◽  
Fatal Outcome ◽  
Midline Shift ◽  
Content Type ◽  
Arterial Blood ◽  
Left And Right ◽  
The Brain ◽  
Fine Print

Object. The aim of this study was to assess the asymmetry of autoregulation between the left and right sides of the brain by using bilateral transcranial Doppler ultrasonography in a cohort of patients with head injuries. Methods. Ninety-six patients with head injuries comprised the study population. All significant intracranial mass lesions were promptly removed. The patients were given medications to induce sedation and paralysis, and artificial ventilation. Arterial blood pressure (ABP) and intracranial pressure (ICP) were monitored in an invasive manner. A strategy based on the patient's cerebral perfusion pressure (CPP = ABP − ICP) was applied: CPP was maintained at a level higher than 70 mm Hg and ICP at a level lower than 25 mm Hg. The left and right middle cerebral arteries were insonated daily, and bilateral flow velocities (FVs) were recorded. The correlation coefficient between the CPP and FV, termed Mx, was calculated and time-averaged over each recording period on both sides. An Mx close to 1 signified that slow fluctuations in CPP produced synchronized slow changes in FV, indicating a defective autoregulation. An Mx close to 0 indicated preserved autoregulation. Computerized tomography scans in all patients were reviewed; the side on which the major brain lesion was located was noted and the extent of the midline shift was determined. Outcome was measured 6 months after discharge. The left—right difference in the Mx between the hemispheres was significantly higher in patients who died than in those who survived (0.16 ± 0.04 compared with 0.08 ± 0.01; p = 0.04). The left—right difference in the Mx was correlated with a midline shift (r = −0.42; p = 0.03). Autoregulation was worse on the side of the brain where the lesion was located (p < 0.035). Conclusions. The left—right difference in autoregulation is significantly associated with a fatal outcome. Autoregulation in the brain is worse on the side ipsilateral to the lesion and on the side of expansion in cases in which there is a midline shift.

William Macewen and the treatment of brain abscesses: revisited after one hundred years

1996 ◽  
Vol 84 (1) ◽  
pp. 133-142 ◽  
Author(s):  
Dee J. Canale
Keyword(s):  
Brain Abscess ◽  
Clinical Findings ◽  
Brain Diseases ◽  
Content Type ◽  
Harvey Cushing ◽  
Relevant Today ◽  
Clinical Observations ◽  
History Of ◽  
The Brain ◽  
Fine Print

✓ The year 1993 marked the centennial of the publication of Sir William Macewen's monograph, Pyogenic Infective Diseases of the Brain and Spinal Cord, and its accompanying volume, Atlas of Head Sections. As Harvey Cushing noted, the text on pyogenic diseases of the brain was a landmark in surgery of the nervous system. At the time of its publication, Macewen's work was the most comprehensive study of pyogenic brain diseases. In this paper the author reviews the state of knowledge of brain abscess existing in the 19th and 20th centuries, with particular emphasis on the late 19th century, and elucidates factors contributing to Macewen's remarkable success. His thorough knowledge of the natural history of pyogenic diseases of the temporal bone and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The x-ray had not yet been discovered; Macewen's diagnosis was based on clinical findings superbly illustrated by his three clinical stages of brain abscess development. His clinical observations are as relevant today as when he described them 100 years ago. Macewen recorded 25 cases of brain abscess. Nineteen of these patients came to his attention in time to undergo surgery, resulting in 18 recoveries. All five of his patients with extradural abscess recovered. These results were achieved in the era known as “the most glorious period in British surgery.” Neurosurgery was in its infancy; nevertheless, even as the 20th century closes, Macewen's results still have not been surpassed.

The intriguing encounters of Pavlov and Cushing

2004 ◽  
Vol 100 (3) ◽  
pp. 568-571 ◽  
Author(s):  
Kiarash Shahlaie ◽  
Joseph C. Watson ◽  
Daniel R. Benson
Keyword(s):  
20Th Century ◽  
Early 20Th Century ◽  
Content Type ◽  
New Era ◽  
History Of Neuroscience ◽  
The Us ◽  
History Of ◽  
Journal Entries ◽  
The Brain ◽  
Fine Print

✓ Ivan Petrovich Pavlov and Harvey William Cushing were two of the most prominent neuroscientists of the early 20th century. Their contributions helped advance the understanding of the brain and its disorders, and propelled neuroscience into a new era of research and treatment. Although separated geographically and culturally, Pavlov and Cushing exchanged letters and followed one another's careers from afar. They met only a few times, during international scientific gatherings in the US and abroad. These encounters were captured in journal entries, letters, and photographs, and provide a glimpse into the lives of these two great men and the history of neuroscience at the turn of the last century.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment

1990 ◽  
Vol 73 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Stephen L. Ondra ◽  
Henry Troupp ◽  
Eugene D. George ◽  
Karen Schwab
Keyword(s):  
Mortality Rate ◽  
Arteriovenous Malformations ◽  
Original Population ◽  
Major Morbidity ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

Catecholamine neurotransmitters, psychoactive drugs, and biological clocks

1981 ◽  
Vol 55 (5) ◽  
pp. 669-677 ◽  
Author(s):  
Julius Axelrod
Keyword(s):  
Nobel Laureate ◽  
Vital Role ◽  
Psychoactive Drugs ◽  
Biological Clocks ◽  
Content Type ◽  
Chemical Agents ◽  
History Of ◽  
The Brain ◽  
Experimental History ◽  
Fine Print

✓ In his Cushing oration, the 1970 Nobel Laureate reviews the experimental history of the vital role which chemical agents play in the transmission of nerve impulses and the important functions of the brain. He reveals the intriguing steps in his own early involvement in the field of neurotransmitters. A beacon for neuroscientists of the future is his unique talent for not only looking, but seeing potentially significant clues.

The shaken baby syndrome

1987 ◽  
Vol 66 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Ann-Christine Duhaime ◽  
Thomas A. Gennarelli ◽  
Lawrence E. Thibault ◽  
Derek A. Bruce ◽  
Susan S. Margulies ◽  
...  
Keyword(s):  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Shaken Baby Syndrome ◽  
Radiographic Findings ◽  
Content Type ◽  
Blunt Impact ◽  
History Of ◽  
Subarachnoid Hemorrhages ◽  
Infants And Young Children ◽  
Fine Print

✓ Because a history of shaking is often lacking in the so-called “shaken baby syndrome,” diagnosis is usually based on a constellation of clinical and radiographic findings. Forty-eight cases of infants and young children with this diagnosis seen between 1978 and 1985 at the Children's Hospital of Philadelphia were reviewed. All patients had a presenting history thought to be suspicious for child abuse, and either retinal hemorrhages with subdural or subarachnoid hemorrhages or a computerized tomography scan showing subdural or subarachnoid hemorrhages with interhemispheric blood. The physical examination and presence of associated trauma were analyzed; autopsy findings for the 13 fatalities were reviewed. All fatal cases had signs of blunt impact to the head, although in more than half of them these findings were noted only at autopsy. All deaths were associated with uncontrollably increased intracranial pressure. Models of 1-month-old infants with various neck and skull parameters were instrumented with accelerometers and shaken and impacted against padded or unpadded surfaces. Angular accelerations for shakes were smaller than those for impacts by a factor of 50. All shakes fell below injury thresholds established for subhuman primates scaled for the same brain mass, while impacts spanned concussion, subdural hematoma, and diffuse axonal injury ranges. It was concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome.

False aneurysm secondary to penetration of the brain through orbitofacial wounds

1972 ◽  
Vol 36 (4) ◽  
pp. 503-506 ◽  
Author(s):  
Darwin J. Ferry ◽  
Ludwig G. Kempe
Keyword(s):  
False Aneurysm ◽  
Arterial Injury ◽  
Penetrating Wounds ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Two cases of intracranial false aneurysm following penetrating orbitofacial wounds are reported. These were the only false aneurysms identified in a series of 2187 penetrating wounds of the brain from Vietnam. Three similar false aneurysms have been reported previously, and these also were associated with orbitofacial penetration. The unusual incidence of this type of arterial injury secondary to penetrating orbitofacial wounds suggests the value of early arteriographic evaluation.

Analysis of 2187 consecutive penetrating wounds of the brain from Vietnam

1971 ◽  
Vol 34 (2) ◽  
pp. 127-131 ◽  
Author(s):  
William M. Hammon
Keyword(s):  
Postoperative Complications ◽  
Operative Technique ◽  
Organ System ◽  
Dural Repair ◽  
Penetrating Wounds ◽  
Content Type ◽  
Army Hospital ◽  
Continued Use ◽  
The Brain ◽  
Fine Print

✓ A series of 2187 cases of penetrating wounds of the brain, treated in a U.S. Army Hospital in Vietnam, is analyzed according to operability, wounding agents, sites of cranial penetration, associated organ system injuries, operative and postoperative complications, and mortalities. A detailed description of the operative technique of thorough intracranial debridement and dural repair is presented and stressed. The previously established principles of combat neurosurgery are confirmed and their continued use recommended.

Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 247-254 ◽  
Author(s):  
Jason Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Content Type ◽  
The Brain ◽  
Fine Print

Object. Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival. Methods. A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival. The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging. Conclusions. Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.

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