Severe head injury managed without intracranial pressure monitoring

1983 ◽  
Vol 59 (4) ◽  
pp. 601-605 ◽  
Author(s):  
Gordon G. Stuart ◽  
Glen S. Merry ◽  
James A. Smith ◽  
John D. N. Yelland
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Head Injuries ◽  
Pressure Monitoring ◽  
Intracranial Hematoma ◽  
Content Type ◽  
Airway Control ◽  
Life Threatening ◽  
Fine Print

✓ A prospective series of 100 consecutive severe head injuries is presented. There were 34 deaths. Intracranial pressure (ICP) was not monitored in this series, and it is suggested that the outcome compares favorably with series in which ICP monitoring was performed. Early evacuation of life-threatening intracranial hematoma and airway control remain essentials of treatment of severe head injury.

A clinical comparison of subdural screw pressure measurements with ventricular pressure

1983 ◽  
Vol 58 (1) ◽  
pp. 45-50 ◽  
Author(s):  
A. David Mendelow ◽  
John O. Rowan ◽  
Lilian Murray ◽  
Audrey E. Kerr
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Fluid Pressure ◽  
Ventricular Catheter ◽  
Pressure Measurements ◽  
Content Type ◽  
Single Lumen ◽  
Ventricular Fluid Pressure ◽  
Fine Print

✓ Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon

2002 ◽  
Vol 97 (3) ◽  
pp. 542-548 ◽  
Author(s):  
Hiroshi Nakaguchi ◽  
Kazuo Tsutsumi
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Sports Injuries ◽  
Head Injuries ◽  
Acute Subdural Hematoma ◽  
Opposite Edge ◽  
Winter Sports ◽  
Content Type ◽  
Shear Injury ◽  
Fine Print

Object. To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms. Methods. The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries. The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441). Conclusions. The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding.

Initial CT findings in 753 patients with severe head injury

1990 ◽  
Vol 73 (5) ◽  
pp. 688-698 ◽  
Author(s):  
Howard M. Eisenberg ◽  
Howard E. Gary ◽  
E. Francois Aldrich ◽  
Christy Saydjari ◽  
Barbara Turner ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Ct Scans ◽  
Midline Shift ◽  
Prospective Multicenter Study ◽  
Content Type ◽  
Ct Findings ◽  
Subarachnoid Blood ◽  
Fine Print

✓ In this prospective multicenter study, the authors have examined data derived from the initial computerized tomography (CT) scans of 753 patients with severe head injury. When the CT findings were related to abnormal intracranial pressure and to death, the most important characteristics of the scans were: midline shift; compression or obliteration of the mesencephalic cisterns; and the presence of subarachnoid blood. Diffuse hemispheric swelling was also found to be associated with an early episode of either hypoxia or hypotension.

Experience with Althesin in the management of persistently raised ICP following severe head injury

1986 ◽  
Vol 64 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Ross Bullock ◽  
James R. van Dellen ◽  
Derek Campbell ◽  
Ian Osborn ◽  
S. Gustav Reinach
Keyword(s):  
Patient Outcome ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Severe Head Injury ◽  
Perfusion Pressure ◽  
Surgical Decompression ◽  
Icp Monitoring ◽  
Content Type ◽  
Fine Print

✓ Of 243 patients who underwent intracranial pressure (ICP) monitoring after severe head injury, 42 (17%) were found to have severe persistently raised ICP, in spite of hyperventilation, mannitol, and surgical decompression. Althesin was infused to reduce ICP in these patients. This agent was shown to be effective and safe in reducing ICP, and a significant improvement in cerebral perfusion pressure was demonstrated. In this respect, Althesin may be more effective than barbiturates. However, no improvement in patient outcome was demonstrated in this series.

Creatine kinase isoenzymes in severe head injury

1983 ◽  
Vol 58 (5) ◽  
pp. 689-692 ◽  
Author(s):  
Pol Hans ◽  
Jacques Daniel Born ◽  
Jean-Pierre Chapelle ◽  
Germain Milbouw
Keyword(s):  
Cerebrospinal Fluid ◽  
Creatine Kinase ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Brain Dysfunction ◽  
Quantitative Index ◽  
Reliable Criterion ◽  
Content Type ◽  
Fine Print

✓ Brain-type creatine kinase (CK) isoenzyme (CK-BB) was found in the ventricular cerebrospinal fluid (CSF) and the serum in a series of 35 patients within 13 hours following severe head injury. There was a good correlation between total CK and CK-BB activities in CSF only. The values found in the CSF appear to be a quantitative index of brain dysfunction at admission, and did not correlate with intracranial pressure activity. High levels of CK-BB in the CSF correlated with a poor outcome, and thus offer a reliable criterion for the assessment of the severity of head injury.

Assessment of Leeds device for monitoring intracranial pressure

1984 ◽  
Vol 60 (1) ◽  
pp. 123-129 ◽  
Author(s):  
N. Mark Dearden ◽  
D. Gordon McDowall ◽  
Robert M. Gibson
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Subarachnoid Space ◽  
Severe Head Injury ◽  
Infusion Test ◽  
Free Communication ◽  
Content Type ◽  
Fine Print

✓ In Leeds a screw device is used to monitor surface subarachnoid pressure following severe head injury. The possibility that such measurements may under-read true intracranial pressure (ICP) has led to the development of an infusion test to confirm free communication with the surface subarachnoid space. The results of 69 infusion tests using 18 devices reveal that the device was reading accurately on 33 of 69 occasions. In 31 of the remaining 36, correction of the problem was possible. Particularly at ICP values exceeding 20 mm Hg the Leeds device may under-read, and possible causes for this are discussed. Reliable readings can usually be obtained using the infusion sequence described.

Predicting the need for operation in the patient with an occult traumatic intracranial hematoma

1981 ◽  
Vol 55 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Sam Galbraith ◽  
Graham Teasdale
Keyword(s):  
Intracranial Pressure ◽  
Midline Shift ◽  
Pressure Monitoring ◽  
Intracranial Hematoma ◽  
Content Type ◽  
Intracranial Hematomas ◽  
Traumatic Intracranial Hematoma ◽  
Tomography Scanning ◽  
Diagnosis Age ◽  
Fine Print

✓ Computerized tomography scanning has shown that acute traumatic intracranial hematomas are more common than was previously realized, but whether all hematomas must be removed remains controversial. About half of this series of 26 patients who were not clinically deteriorating and who were initially managed without operation had to undergo hematoma removal because they subsequently deteriorated. Features present at the time of diagnosis (age, type and site of hematoma, presence of focal signs, level of responsiveness, and degree of midline shift) were not helpful in predicting that operation would be needed. The only discriminatory factor was the level of intracranial pressure (ICP). All the patients with ICP greater than 30 mm Hg deteriorated and required operation, but only one patient whose ICP was less than 20 mm Hg deteriorated. Half the patients with ICP between 20 and 30 mm Hg did not require an operation. Intracranial pressure monitoring can, therefore, be useful in managing patients with an occult intracranial hematoma.

Prophylactic phenytoin in severe head injuries

1979 ◽  
Vol 51 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Richard N. W. Wohns ◽  
Allen R. Wyler
Keyword(s):  
Retrospective Study ◽  
Head Injury ◽  
High Probability ◽  
Late Onset ◽  
Head Injuries ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
Fine Print

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

Impairment of helper T-cell function and lymphokineactivated killer cytotoxicity following severe head injury

1991 ◽  
Vol 75 (5) ◽  
pp. 766-773 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Edmund H. Frank ◽  
Claramae H. Miller ◽  
Asim Amin ◽  
Bernardo W. Issel ◽  
...  
Keyword(s):  
T Cell ◽  
Head Injury ◽  
Severe Head Injury ◽  
Cell Cytotoxicity ◽  
Content Type ◽  
Lak Cell ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Infection is a major complication of severe head injury, occurring in 50% to 75% of patients who survive to hospitalization. Previous investigations of immune activity following head injury have demonstrated suppression of helper T-cell activation. In this study, the in vitro production of interferon-gamma (INF-γ), interleukin-1 (IL-1), and interleukin-2 (IL-2) was determined in 25 head-injured patients following incubation of peripheral blood lymphocytes (PBL's) with the lymphocyte mitogen phytohemagglutinin (PHA). In order to elucidate the functional status of cellular cytotoxicity, lymphokine-activated killer (LAK) cell cytotoxicity assays were performed both prior to and following incubation of PBL's with IL-2 in five patients with severe head injury. The production of INF-γ and IL-2 by PHA-stimulated PBL's was maximally depressed within 24 hours of injury (p < 0.001 for INF-γ, p = 0.035 for IL-2) and partially normalized within 21 days of injury. There was no change in the production of IL-1. When comparing the in vitro LAK cell cytotoxicity of PBL's from head-injured patients and normal subjects, there was a significant depression in LAK cell cytotoxicity both prior to (p = 0.010) and following (p < 0.001) incubation of PBL's with IL-2. The results of this study indicate that IL-2 and INF-γ production, normally required for inducing cell-mediated immunity, is suppressed following severe head injury. The failure of IL-2 to enhance LAK cell cytotoxicity suggests that factors other than decreased IL-2 production, such as inhibitory soluble mediators or suppressor lymphocytes, may be responsible for the reduction in cellular immune activity following severe head injury. These findings may have significant implications in designing clinical studies aimed at reducing the incidence of infection following severe head injury.

The outcome of severe closed head injury

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S28-S36 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Theresa Gautille ◽  
Melville R. Klauber ◽  
Howard M. Eisenberg ◽  
John A. Jane ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Severe Head Injury ◽  
Closed Head Injury ◽  
Data Bank ◽  
Content Type ◽  
Severity Of Injury ◽  
Gcs Score ◽  
Fine Print ◽  
Overall Mortality

✓ The outcome of severe head injury was prospectively studied in patients enrolled in the Traumatic Coma Data Bank (TCDB) during the 45-month period from January 1, 1984, through September 30, 1987. Data were collected on 1030 consecutive patients admitted with severe head injury (defined as a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation). Of these, 284 either were brain-dead on admission or had a gunshot wound to the brain. Patients in these two groups were excluded, leaving 746 patients available for this analysis. The overall mortality rate for the 746 patients was 36%, determined at 6 months postinjury. As expected, the mortality rate progressively decreased from 76% in patients with a postresuscitation GCS score of 3 to approximately 18% for patients with a GCS score of 6, 7, or 8. Among the patients with nonsurgical lesions (overall mortality rate, 31%), the mortality rate was higher in those having an increased likelihood of elevated intracranial pressure as assessed by a new classification of head injury based on the computerized tomography findings. In the 276 patients undergoing craniotomy, the mortality rate was 39%. Half of the patients with acute subdural hematomas died — a substantial improvement over results in previous reports. Outcome differences between the four TCDB centers were small and were, in part, explicable by differences in patient age and the type and severity of injury. This study describes head injury outcome in four selected head-injury centers. It indicates that a mortality rate of approximately 35% is to be expected in such patients admitted to experienced neurosurgical units.

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