Table 2 - uploaded by Amy Miner Ross
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Outcome in 17 Patients Number of Outcome patients
Source publication
Seventeen consecutive children with early clinical signs of tentorial herniation after head injury underwent immediate burr-hole exploration before computed tomography scanning. In nine children (53%), a subdural hematoma was discovered and immediately evacuated. In one, a small intracerebral hemorrhage was diagnosed by intraoperative ultrasonograp...
Context in source publication
Similar publications
Inconsistent data from the randomized trials ignites controversy on intensive blood pressure (BP) reduction for acute intracerebral hemorrhage (ICH). This study aims to examine the association between BP lowering and clinical outcomes among patients with acute ICH. We conducted this meta-analysis based on the published randomized controlled trials...
To compare the accuracy of formula 1/2ABC with 2/3SH on volume estimation for hypertensive infratentorial hematoma.
One hundred and forty-seven CT scans diagnosed as hypertensive infratentorial hemorrhage were reviewed. Based on the shape, hematomas were categorized as regular or irregular. Multilobular was defined as a special shape of irregular....
To evaluate whether delayed appearance of intraventricular hemorrhage (dIVH) represents an independent entity from intraventricular hemorrhage (IVH) present on admission CT or is primarily related to the time interval between symptom onset and admission CT.
A total of 282 spontaneous intracerebral hemorrhage (ICH) patients, admitted February 2009-M...
The 1/2ABC formula is the method most commonly used in clinical practice to rapidly estimate intracerebral hemorrhage (ICH) volume. We aimed to compare this method with the alternative '2/3Sh' formula for both regularly and irregularly-shaped hematomas.
Computed tomography (CT) images from 344 ICH patients (median volume: 16·66 ml) were retrospecti...
Citations
... Abnormalitas fungsi pupil, gangguan gerakan ekstraokular, pola-pola respons motorik yang abnormal seperti postur fleksor dan postur ekstensor, semuanya memprediksikan outcome yang buruk setelah cedera kepala berat. 1,4,5,6,12,15,19 Anisokori, refleks pupil yang tidak teratur atau pupil yang tidak bereaksi terhadap rangsang cahaya biasanya disebabkan karena kompresi terhadap saraf otak ketiga atau terdapat cedera pada batang otak bagian atas, biasanya karena herniasi transtentorial. 8 Dalam suatu tinjauan terhadap 153 penderita dewasa dengan herniasi transtentorial, hanya 18% yang mempunyai penyembuhan yang baik. ...
Menentukan prognosa pada penderita-penderita dengan cedera kepala berat seringkali sulit, sedangkan sebuah prognosa yang akurat sangat penting untuk membuat suatu keputusan apakah informed consent diberikan atau tidak. Demikian juga halnya dengan sejawat di unit gawat darurat dan para spesialis yang bekerja di unit perawatan intensif ingin mengetahui bila suatu tindakan penunjang secara agresif harus dilaksanakan atau hanya sekedar perawatan berdasarkan faktor kemanusiaan. Kenyataannya walau dokter-dokter yang paling berpengalaman pun sulit untuk menentukan prognosa akhir segera setelah cedera kepala. Hal ini disebabkan karena keterbatasan penilaian klinik (clinical assessment) awal, lamanya penyembuhan pada penderita cedera kepala berat, serta banyaknya faktor dan variabel yang mempengaruhi prognosa penderita cedera kepala berat. Aforisme Hippocrates di atas adalah cermin ketidakpastian apa sesungguhnya yang bakal terjadi setelah cedera kepala. Masih merupakan hal yang mustahil untuk mengatakan secara pasti apa yang bakal terjadi pada seseorang penderita cedera kepala berat, akan tetapi penelitian yang intensif selama dua dekade terakhir ini telah memungkinkan kita menjadi lebih yakin dalam menilai apa yang bakal terjadi, dan mempertimbangkan prognosa sebagai suatu kemungkinan (probability) ketimbang sebagai suatu ramalan (prophecy).
Severe traumatic brain injury has historically been a non-survivable injury. Recent advances in neurosurgical care, however, have demonstrated that these patients not only can survive, but they also can recover functionally when they undergo appropriate cerebral decompression within hours of injury. At the present, general surgeons are deployed further forward than neurosurgeons (Role 2 compared to Role 3) and have been provided with guidelines that stipulate conditions where they may have to perform decompressive craniectomies. Unfortunately, Role 2 medical facilities do not have access to computed tomography imaging or intracranial pressure monitoring capabilities rendering the decision to proceed with craniectomy based solely on exam findings. Utilizing a case transferred from downrange to our institution, we demonstrate the utility of a small, highly portable quantitative pupillometer to obtain reliable and reproducible data about a patient’s intracranial pressures. Following the case presentation, the literature supporting quantitative pupillometry for surgical decision-making is reviewed.
Craniocerebral gunshot wounds are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is 52-95% depending on the proportion of suicide victims in the series. The devastating nature of this lesion is accentuated by the fact that predominantly affects young and healthy patients. The most important predictive factor is the post-resuscitation Glasgow Coma Score (GCS). Early aggressive resuscitation, surgery and vigorous control of intracranial pressure offers the best chance of achieving a satisfactory outcome. In this paper the authors performed a critical literature review about this issue and
discuss the clinical aspects and management in these patients.
An approach to the initial evaluation, resuscitation, and treatment of the patient with severe traumatic brain injury is presented in terms of the underlying physiology and literature support. The primary importance of rapid and complete systemic resuscitation in terms of the 'ABCs' is stressed, with the goal of optimizing cerebral perfusion and preventing secondary insults to the injured brain. The integration of brain-specific treatments and diagnostic maneuvers into resuscitation protocols is discussed, including the role of mannitol and hyperventilation as well as the prioritization of CT imaging of the brain.
In an attempt to improve and expedite the care of head-injured children, data have been published recommending burr hole exploration in lieu of computed tomography for children with signs of brain stem compression or with a Glasgow Coma Scale score of 3. Exploratory burr holes revealed a high incidence of subdural hematomas, and removal of the hematomas improved survival. We are reporting 19 consecutive children with Glasgow Coma Scale scores of 3. Coma score evaluation was confounded by intubation, sedation, pharmacological paralysis, and posttraumatic seizures. We found no radiographical or postmortem pathological evidence of intracranial hemorrhage, which would warrant operative intervention. A high incidence of multisystem injuries and high cervical spine injuries would have made early intervention both dangerous and inappropriate. Although there is a definite role for emergency trephination, routine exploratory burr holes for children with a Coma score of 3 is not justified.
Guidelines relating to non neurosurgical operative intervention in head-injured patients are not available for the British Isles. We present a series of seven patients with extradural haematoma operated upon in the referring hospital prior to transfer to our unit. The cases were analysed in an attempt to elucidate the efficacy of the emergency procedures and the associated problems. Recommendations are made in order to generate discussion on this aspect of head injury management.
Infrared pupillary scans have been used extensively as an objective measure of pupillary reflexes during pharmacological studies of human subjects, but no previous scans have documented the pupillary changes during transtentorial uncal herniation. We present infrared pupillary scans from three patients with brain stem compression secondary to expanding intracranial mass lesions. The scans were made with a portable device permitting infrared pupillometry at the patient's bedside. Portable infrared pupillometry records objective measurements of pupillary light reflexes, which provides information useful for diagnosing transtentorial herniation and affords objective measurements of an important endpoint in the management of patients with head trauma or supratentorial mass lesions.
