Head injury and intoxication: A diagnostic and therapeutic dilemma

Acta chirurgica Scandinavica 02/1983; 149(1):11-4.
Source: PubMed


One hundred patients admitted to a surgical clinic with a diagnosis of concussion of the brain were studied regarding the abuse of alcohol and narcotic drugs. 58% of the patients were assessed as intoxicated on admission. Psychiatric evaluation revealed a history of alcohol dependence in 43 of the patients and experience of narcotic drugs in 25. Forty-six of the patients reported recurrent defects of memory and nine suffered from epilepsy. Amnesia therefore seems to be a factor of limited diagnostic value in concussion of the brain. Because of diagnostic difficulties, in patients with alcohol intoxication a more liberal attitude towards cranial X-ray and CT-scanning will be justified. Blood ethanol determination, measurement of blood gamma glutamyl transpeptidase and the mean blood corpuscular volume are clinically important to elucidate the etiology in patients with head injury. Active rehabilitative measures should be initiated in collaboration between the surgeon, psychiatrist and social worker to prevent post-concussional syndromes.

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    • "Interestingly, in this series of trauma patients we found a relatively low percentage of dependent drinkers (8%) compared with frequent binge drinkers (61%). Previously, the methods used to detect alcohol problems have varied greatly (Rimel et al., 1982; Brismar et al., 1983; Sparadeo and Gill, 1989; Kreutzer et al., 1990; Ruff et al., 1990; Kreutzer et al., 1991; Drubach et al., 1993; Wong et al., 1993). The lowest incidences of alcohol-related accidents, such as 16% (Rimel et al., 1982), 25% (Sparadeo and Gill, 1989) and 36% (Wong et al., 1993) have been reported in studies in which the assessments have been based on retrospective chart reviews. "
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    ABSTRACT: To investigate the relationship of different patterns of alcohol intake to various types of trauma. We examined the associations of alcohol consumption in a series of 385 consecutive trauma admissions (278 men, 107 women, age range 16-49 years). Patients underwent clinical examinations, structured interviews on the amount and pattern of alcohol intake, and measurements of blood alcohol concentration (BAC). On admission, 51% of the patients had alcohol in their blood. Binge drinking was the predominant (78%) drinking pattern of alcohol intake. Assaults, falls and biking accidents were the most frequent causes of trauma. Dependent alcohol drinking and binge drinking were found to be significantly more common among patients with head trauma than in those with other types of trauma (77% vs 59%, OR=2.38; 95% CI 1.50 to 3.77). The OR for sustaining head injury increased sharply with increasing BAC: 1-99 mg/dl (1.24; 95% CI 0.55-2.01), 100-149 mg/dl 1.64; 95% CI 0.71-3.77), 150-199 mg/dl (3.20; 95% CI 1.57-6.53) and >199 mg/dl (9.23; 95% CI 4.79-17.79). Binge drinking is a major risk factor for head trauma among trauma patients. Assaults, falls and biking accidents are the commonest causes for such injuries. The relative risk for head injury markedly increases with increasing blood alcohol levels. Alcohol control measures should feature in policies aiming at the prevention of trauma-related morbidity and mortality.
    Alcohol and Alcoholism 04/2005; 40(4):269-73. DOI:10.1093/alcalc/agh159 · 2.89 Impact Factor
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    • "The occurrence of different drinking patterns in trauma patients has so far been poorly investigated. The methods used to detect alcohol misuse previously have varied greatly, and the incidences of hazardous drinking have therefore also varied from 10 to 66% (Peppiatt et al., 1978; Brismar et al., 1983; Rivara et al., 1993; Corrigan, 1995; Dikmen et al., 1995; McLeod et al., 1999; Ryb et al., 1999). The identification of alcohol misuse can be based on clinical history, specific questionnaires, and laboratory markers (Ewing, 1984; Skinner et al., 1986; Davis et al., 1987; Ross et al., 1990; Nilssen et al., 1994). "
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    ABSTRACT: To determine the most effective marker of hazardous alcohol drinking in trauma patients. A prospective study of 349 trauma patients aged 16-49 years admitted into a general hospital trauma centre. Information on the amount and pattern of alcohol drinking was obtained by interview. Blood or breath alcohol concentration (BAC), serum gammaglutamyl transferase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT) and the mean corpuscular volume (MCV) of erythrocytes were measured as markers of alcohol consumption. In this series, 8% of all trauma patients were found to be dependent drinkers, while 61% were frequent binge drinkers, 17% infrequent binge drinkers, 8% light-to-moderate drinkers and 6% nondrinkers. On admission, the BAC test was positive in 68% of the hazardous drinkers (i.e. dependent drinkers or frequent binge drinkers). Using a cut-off level of >0 mg/dl, the sensitivity and specificity of the BAC test for identifying hazardous drinking were 68% (95% confidence intervals [CI], 61-73%) and 94% (95% CI, 87-97%), respectively, and the positive predictive value was 96% (95% CI, 92-98%). GGT, MCV, CDT and AST were less accurate indicators of hazardous drinking. BAC was the least expensive marker. Two-thirds of trauma patients were hazardous drinkers, and blood alcohol on admission was an accurate indicator of this. BAC should be systematically used in trauma centres if patients are to be selected for an alcohol intervention.
    Alcohol and Alcoholism 11/2003; 39(4):340-5. DOI:10.1093/alcalc/agh064 · 2.89 Impact Factor
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    • "The acute form of WKS, Wernicke's encephalopathy , is notoriously difficult to diagnose clinically, with as few as one third of cases being diagnosed during life (Harper, 1979; Harper et al, 1995). Its diagnosis in the head-injured patient is made even more problematic as the primary symptoms and signs of confusion, ataxia, ophthalmoplegia and nystagmus, are also commonly seen as direct consequences of the head injury itself (Brismar et al, 1983). Memory disturbances, seen as part of both Wernicke's encephalopathy and the more chronic presentation , Korsakoff s psychosis, are also very common sequelae of head injury (Victor et al, 1989). "
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    ABSTRACT: Practice regarding the use of thiamine in head-injured patients at risk of Wernicke-Korsakoff syndrome in Scottish neurosurgical units was surveyed by questionnaire and revealed no clear policy. A 2 year retrospective study of 218 admissions to one of these units of patients who had taken alcohol shortly before sustaining head injury is also described. The minority (20.6%) of the total had been given thiamine, with just over half (56.1%) of those categorized as alcoholic receiving this treatment. Additional carbohydrate loads, in the form of i.v. dextrose or parenteral nutrition, had been given to 44.5% of patients and only 28.9% of this group had also been given thiamine. The dose and duration of thiamine given was inadequate in most cases. It is suggested that failure to ensure that head injury patients at risk of Wernicke-Korsakoff syndrome receive appropriate thiamine prophylaxis represents a missed and treatable additional insult to the damaged brain.
    Alcohol and Alcoholism 07/1997; 32(4):493-500. DOI:10.1093/oxfordjournals.alcalc.a008284 · 2.89 Impact Factor
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