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MDCT can show definitive findings of CEH, and diagnostic problems can be solved through the utilization of MDCT. We consider that CEH may be more common than previously thought.

Neuronal cell injury after global cerebral ischemic insult is not well understood in humans. We performed serial examination of diffusion-weighted imaging and magnetic resonance spectroscopy in three patients after cardiopulmonary resuscitation. The presence of the signal for lactate in magnetic resonance spectroscopy in the acute stage after cardiopulmonary resuscitation was closely correlated to irreversible damage. In addition, high intensity in diffusion-weighted magnetic resonance image in the acute stage also predicted a poor outcome. Lesions that were positive for these factors in the acute stage led to serious brain damage in the subacute and chronic stages. The results indicated that after cardiopulmonary resuscitation, diffusion-weighted magnetic resonance imaging and magnetic resonance spectroscopy is an extremely useful modality to estimate the prognosis of patients, which is not always easy using conventional methods.

Seven patients were treated with brain hypothermia following acute major cerebral artery occlusion to utilize the suppressive effect against brain swelling. Five patients had internal carotid and two had proximal middle cerebral artery occlusion. Except for the first two cases, hypothermia was introduced early and the temperature reached 35.09 C within 6 hours after the onset. The core temperature finally stabilized between 329 C to 349 C. Hypothermia had a suppressive effect against brain swelling and the temperature showed a significant correlation to intracranial pressure. Recurrence of brain swelling was observed during the rewarming process, but two patients became independent and three patients were moderately disabled in wheelchairs. Only two patients died. Brain hypothermia is an effective treatment for acute major cerebral artery occlusion through the relief of brain swelling. The overall outcome may be improved by combining brain hypothermia with other conventional therapies such as osmotherapy and external decompression implemented with an extended period of rewarming.

No abstract

Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients.

Background and objectives: The optimal mode of treatment in spontaneous supratentorial intracerebral hemorrhage (SICH) is controversial. We assessed the value of hematoma evacuation in SICH in a case-control study. Methods: One hundred and forty-five patients with SICH without tumor or vascular abnormalities. Indication for surgery were made upon admission in 11 and after clinical deterioration in 13 patients. Assessed were age, sex. Glasgow Coma Scale (GCS), pupillary reaction on admission, localisation, etiology and hematoma volume, presence of ventricular blood, and Glasgow Outcome Scale on discharge. From further analysis patients > 80 years or with hematoma volume < 10 ml were excluded. Statistical analysis included: (i) a multiple regression model to determine prognostic factors; (ii) comparison between medical and surgical patients; (iii) matching the 24 evacuated with 24 medical patients according to those parameters retained from the regression model and additionally to other suspected factors influencing outcome; (iv) comparison between both groups to confirm comparability; and (v) testing for different outcome between the groups. Results: Prognostic factors were GCS, hematoma volume and location. All 24 evacuated patients could be matched to a medically treated patient regarding age, hematoma volume and location. GCS and pupillary reaction. Differences between both groups could not be detected. Outcome was not different between the medical and surgical group. Conclusions: Hematoma evacuation does not improve outcome in supratentorial spontaneous hemorrhages. Since mainly deteriorating patients were evacuated, the only effect of hematoma evacuation may be to stop deterioration rather than to improve overall outcome. P002 Is 'brain swelling' a clinical particular kind of severe brain injury?

Objectives: Neurological recovery in patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA) is affected by the cerebral circulatory collapse time from the cardiac arrest to the return of spontaneous circulation. According to recent studies, the cerebral circulatory collapse time is estimated to be 30 min. or less in order to successfully recover neurologically. In addition, percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the pts with OHCCA refractory to advanced cardiovascular life support (ACLS), and we have been positively performing cardiopulmonary cerebral resuscitation and rapidly cooling of the brain using PCPB. In this treatment, the cerebral circulatory collapse time is the duration from cardiac arrest to the start of PCPB, we discovered the fact that there are many neurologically successful cases of recovery even though the cerebral circulatory collapse time has exceeded 30 min. In the present study, we investigated the neurological prognosis in relation to the cerebral circulatory collapse time. Methods: From January 2006 to April 2008, 77 consecutive pts with OHCCA, who have been treated with brain hypothermia at 34 degree C were included. 77 pts were divided into two groups. Brain hypothermia (BH) groups (n=34) were treated with only brain hypothermia after the return of spontaneous circulation, and PCPB groups (n=33) were treated with hypothermia using PCPB against refractory to ACLS. The relation between the cerebral circulatory collapse time and the neurological prognosis were assessed. Results: The cerebral circulatory collapse time were from 8 min. to 78 min. in the BH groups, whereas it lasted from 22 min. to 91 min. in PCPB groups. In BH groups, the cases with the favorite neurological outcome were 23 cases (67.6%) and the average collapse time was 19.2 min. (8 to 35 min.) In contrast, in the PCPB groups, the successful neurological cases were 15 cases (45.5%), the average collapse time was 43.6 min (22 to 60 min.) In the cases who received PCPB, there were cases of neurologically successful prognoses even though the cerebral circulatory collapse time was long. Conclusions: These results suggest that a rapid cooling of the brain using PCPB permits a cerebral circulatory collapse time.