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  • 1
    ISSN: 0942-0940
    Keywords: Brain contusion ; contusion volume ; quantitative assessment, CT ; CSF-CKBB clearance ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)-as estimated from the CT scans-and the post-traumatic CSF-CKBB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CKBB from the CSF was constructed. The relation between contusion volume and CSF-CKBB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CKBB, as estimated at 6 hours after trauma from the clearance curve, and outcome, were.
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  • 2
    ISSN: 0942-0940
    Keywords: Severe head injury ; brainstem auditory evoked response ; cold caloric response ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Brainstem auditory evoked response (BAER) performed in 60 serious head injury patients, over the last two year period at All India Institute of Medical Sciences, New Delhi have been analysed, to correlate the findings with ultimate outcome. All patients included in this study were unconscious, not following any command at the time of initial evaluation, mostly within 48 hours of injury. Repeat studies were performed in surviving patients. Computerized cranial tomography was performed to establish the nature of the intracranial pathology. The clinical status and cold caloric responses were recorded in all. The patients were followed up for 1 to 24 months. Three patients had extradural haematoma, 2 patients had subdural haematoma and 30 patients had intracerebral contusion/haematoma. Brain oedema was recorded in 14 cases. BAER was normal in 32 patients and 26 of them had good recovery (81%). Three patients with normal BAER died. Abnormal BAER was recorded in 21 patients and only 50% of them had good recovery and 25% of them died. In 7 patients BAER was absent and only 2 (29%) had a good recovery. Thus 48 out of 60 patients (66%) had a good recovery and 11 (18%) died. When compared to cold caloric response, 87% patients with normal caloric response had a good recovery and 5 out of 6 patients with absent caloric response died and remaining 1 left in a vegetative state. Thus the caloric response is at least as good a prognostic factor as BAER.
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  • 3
    ISSN: 0942-0940
    Keywords: Small acoustic neuroma ; investigation ; outcome ; hearing preservation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors report their experience in the surgical management of small (less than 1.5 cm diameter) acoustic neuromas. Twenty-nine patients were treated. They had suffered symptoms of unilateral eighth nerve dysfunction on average for 37 months. High resolution CT with iv contrast was the primary investigation. In equivocal cases, air meatography was performed. All operations were performed by the senior author (LS). All tumours were totally removed, there were no deaths and all patients had an excellent result. There were 6 complications (CSF leak 3; meningitis 2; deep venous thrombosis 1). The facial nerve was preserved in 26 cases (and functioned adequately in all) and. the cochlear nerve in 62%. In 4 cases with hearing pre-operatively, the decibel loss was the same or less post operatively. In 8 cases speech discrimination remained above 35%.
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  • 4
    ISSN: 0942-0940
    Keywords: Brainstem haemorrhage ; CT scan ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Thirty-two patients with CT-documented primary brainstem haemorrhage were reviewed retrospectively to obtain a clearer overall clinical picture, especially of the severely disabled survivors. They were divided into 3 groups according to outcome: eleven cases (Group 1) died within 1 month following haemorrhage, 11 cases (Group 2) survived but became bedridden, necessitating full living support, and 10 cases (Group 3) showed minimal neurological deficits and resumed normal activities. Owing to CT and improved critical care, the survival rate was 66% for the whole series. Group 2 comprised 34% of all cases. These patients were mostly alert, quadruplegic, and communicated only with great difficulty. The most common initial symptoms and CT finding in each group were as follows;Group 1: unconsciousness, respiratory disturbance, negative light reflex, tachycardia, and haematoma 〉3.0 cm;Group 2: disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0〉 haematoma 〈3.5 cm; andGroup 3: alertness or only slight disturbance of consciousness, normal respiration, positive light reflex, normal heart rate, haematoma 〈2.5 cm. Although there is an overlap among them, these findings will be useful to distinguish the three groups from each other. Patients with disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0〉 haematoma 〈3.5 cm, have a chance to survive, but in severely disabled condition, if they were treated with vigorous intensive care in the acute stage.
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  • 5
    ISSN: 0942-0940
    Keywords: Chronic subdural haematoma ; craniostomy ; neomembranes ; cerebral cortex expansion ; subdural pressure ; clinical grading ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The post-operative clinical course of a series of 201 patients with chronic subdural haematoma has been analyzed with respect to neomembranous organisation, cortical expansion and subdural pressure in the form of a prospective (53 cases) and retrospective (148 cases) study. With the exception of one patient (primary craniotomy and membranectomy) all other 200 cases were treated according to a standarized treatment protocol consisting of burr-hole craniotomy with (170 cases) or without (30 cases) closed-system drainage. Post-operative mortality (within one month after surgery) was 2%. There was a 4.5% recurrency rate and a 2% infection rate. Morbidity solely related to chronic subdural haematoma was 2% and was characterized by a mild neurological deficit. The level of subdural pressure had no influence on the post-operative clinical course, whereas marked intra-operative cerebral re-expansion favoured a more rapid clinical improvement. Although standard deviations were within a broad range, a nearly linear inverse relation could be assumed between the amount of peri-operative cerebral expansion and the degree of neomembranous organisation of the haematomas. Subdural neomembranes seem to represent the crucial opponents to cerebral re-expansion and they prolong the duration of neurological restitution.
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  • 6
    ISSN: 0942-0940
    Keywords: Cervical disc disease ; myelography ; Cloward's operation ; outcome ; cervical spondylosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary During a fifteen-year period 1,106 patients with symptoms and signs of cervical disc disease underwent Cloward's operation. Plain x-rays were performed in 94%, but the severity and extension of degenerative changes had no prognostic value. In 91 % of the patients myelography was performed and in recent years mainly metrizamide was used as it was found to be more accurate. The findings on the myelograms were correlated according to age, severity and number of affected disc levels, but were independent of the duration of symptoms. Patients with medullary symptoms were found more often than not to have an anterior indentation into the spinal canal whereas most patients with radicular symptoms had wide cervical root sleeves or lateral compression. The best outcome was found among patients with monosegmental symptoms and signs and one affected disc level on the myelogram underlining that the indication for surgery in cervical disc disease should be based on both clinical and radiological findings.
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  • 7
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    Springer
    Acta neurochirurgica 90 (1988), S. 111-116 
    ISSN: 0942-0940
    Keywords: Acute epidural haematoma ; acute subdural haematoma ; closed head injury ; intracranial mass lesion ; computed tomography ; mortality ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a series of 171 patients suffering acute subdural haemorrhage (SDH) (111 patients) or epidural haemorrhage (EDH) (60 patients) after closed head injury accumulated during the years 1978–1985 at the University Hospital of Graz, the mortality rate and the grade of clinical recovery were evaluated. The overall mortality in acute SDH was 57%, in acute EDH 25%, the percentages of good recoveries—full recovery and minimal neurologic deficit—25 and 58%, respectively. Outcome was found to be predominantly influenced by the preoperative state of consciousness, associated brain lesions, and, in comatose patients, the duration of the time interval between onset of coma and surgical decompression. When this interval exceeded two hours, mortality from SDH rose from 47 to 80% (good outcomes 32 and 4%, respectively). In acute EDH an interval under two hours lead to 17% mortality and 67% of good recoveries compared to 65% mortality and 13% of good recoveries after an interval of more than two hours. Age and concomitant injuries of other body regions proved to be of secondary importance.
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