Initial CT findings in 753 patients with severe head injury

Hm, Eisenberg; He, Gary J.; Ef, Aldrich; Saydjari, Christy; Turner, Buffy; Ma, Foulkes; Ja, Jane; Marmarou, Anthony; Lf, Marshall; Hf, Young

doi:10.3171/jns.1990.73.5.0688

Cited by 544 publications

(249 citation statements)

References 32 publications

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“…Clinical studies reported that incidence of tSAH increased with severity of head injury. In severe head injury, it was shown in 12-39% of patients (2,3), whereas in mild head injury it was seen in 2-4% (4,5). Levi et al (6) found presence of tSAH in 20% of patients with diffuse axonal injury.…”

Section: Introductionmentioning

confidence: 99%

“…It is well known that the presence of tSAH causes significant worsening of the outcome of patients with head injury (2,8,9). This may be due to vasospasm after tSAH, or tSAH may be an important factor initiating secondary insult after trauma.…”

Section: Introductionmentioning

confidence: 99%

“…Traumatic Coma Data Bank showed that presence of tSAH on first CT after trauma was related to a significant increase of the rate of worse outcome (2,8,9). Therefore, patients with tSAH were recorded as a separate category in HIT 3 and 4 (14).…”

Section: European Head Injury Studies (Hit I and Ii) And The Americanmentioning

confidence: 99%

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Factors affecting the outcome in traumatic subarachnoid hemorrhage

Güzey¹,

Eren²,

Alataş³

et al. 2016

Bagcilar Medical Bulletin

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Objective: To define risk factors affecting the outcome in traumatic subarachnoid hemorrhage. Material and Methods: Forty-four patients with traumatic subarachnoid hemorrhage were evaluated retrospectively. They were divided into three groups according to their age: elderly (≥65 years), adult (16-64 years), and children (<16 years). The clinical picture on admission was evaluated using the Glasgow Coma Scale. The patients were also divided into three groups according to their coma grading on admission: mild injury (Glasgow Coma Scale score 13-15), moderate injury (8-12), and severe injury (3-7). The amount of subarachnoid blood shown in computerized tomography was evaluated according to the Fisher index, and additional tomography findings were recorded. At last follow-up, presence of headache and neurological deficits as well as return to work or school were investigated, and the last clinical picture was evaluated with the Glasgow Outcome Scale. Results: There were 11 children, 23 adults and 10 elderly patients. Twelve patients died between 1-49 days after trauma; the others were followed for a mean of 14.6 months (from 10 to 30 months). In the children group, Glasgow Coma Scale score was significantly higher (p=0.004), subarachnoid blood amount was significantly lesser, and Glasgow Outcome Scale score was significantly better compared to the other groups. For all groups, higher trauma severity on admission was associated with higher Fisher index (p=0.016). Most important factors affecting clinical results were severity of head injury on admission (p=0.0001), Fisher index (p=0.003), and presence of additional findings on computerized tomography (p=0.0001). Conclusion: Traumatic subarachnoid hemorrhage usually has a good clinical outcome in children; however, in elderly patients, the outcome is worse, and there are usually additional intracranial traumatic lesions. Most important factors affecting outcome are blood amount on first computerized tomography, head trauma severity, and presence of additional intracranial traumatic lesions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors affecting the outcome in traumatic subarachnoid hemorrhage

Güzey¹,

Eren²,

Alataş³

et al. 2016

Bagcilar Medical Bulletin

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“…Several neuroimaging and blood proteins are used as prognostic biomarkers. Using the Marshall classification, the presence of significant brain swelling on head CT predicts poor outcome [56]. Further refinement on the classification of abnormalities on admission head CT have suggested that presence of subarachnoid blood, "massive" focal, or diffuse injury are independent prognostic variables for death [57].…”

Section: Biomarkers For Prognosismentioning

confidence: 99%

Biomarkers in Neurocritical Care

Kimberly

2012

Neurotherapeutics

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The gold standard for assessing neurological function is the bedside clinical examination. However, in neurocritical patients, the signs and symptoms related to the severity of illness can often be ambiguous. It can be hard to distinguish between a severe but stable disease state and one that is dynamic and in a critical decline. Clinicians and family members alike may struggle with the uncertainty of functional outcome prediction. Intermediate biomarkers of brain injury can assist with ongoing clinical management of patients, and in some circumstances can guide prognosis. Used in the right setting, biomarkers in neurocritical care can also aid with decisions to intensify treatment or avoid prolonged and unnecessary therapy. The term biomarker is used in various ways, and here we use it to refer to 3 general types: 1) circulating blood macromolecules, 2) brain imaging, and 3) continuous invasive monitors. Despite its promise, biomarkers have several limitations and should be interpreted in the context of the overall clinical assessment.

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“…The quality of the functional outcome is influenced by the severity of neurotrauma as diagnosed on early CT scans (Blackman et al, 2003;Eisenberg et al, 1990;Kampfl et al, 1998;Kido et al, 1992;Marshall et al, 1991;Toutant et al, 1984). In severe neurotrauma where the prognosis for brain survival in a functional state is approaching zero, any novel therapeutic intervention that produces better than expected results can be judged by the unexpected change in recovery slope.…”

Section: Observations About Responses To Rmnsmentioning

confidence: 99%

Electrical treatment of reduced consciousness: Experience with coma and Alzheimer's disease

Cooper

Scherder

Cooper

2005

Neuropsychological Rehabilitation

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The right median nerve can be stimulated electrically to help arouse the central nervous system for persons with reduced levels of consciousness. The mechanisms of central action include increased cerebral blood flow and raised levels of dopamine. There is 11 years of experience in the USA of using nerve stimulation for acute coma after traumatic brain injury. There is a much longer period of experience by neurosurgeons in Japan with implanted electrodes on the cervical spinal cord for persons in the persistent vegetative state (PVS). But the use of right median nerve electrical stimulation (RMNS) for patients in the subacute and chronic phases of coma is relatively new. Surface electrical stimulation to treat anoxic brain injury as well as traumatic brain injury is evolving.Novel applications of electrical stimulation in Amsterdam have produced cognitive behavioural effects in persons with early and mid-stage Alzheimer's disease employing transcutaneous electrical nerve stimulation (TENS). Improvements in short-term memory and speech fluency have also been noted.Regardless of the aetiology of the coma or reduced level of awareness, electrical stimulation may serve as a catalyst to enhance central nervous system functions. It remains for the standard treatments and modalities to retrain the injured brain emerging from reduced levels of consciousness.

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Initial CT findings in 753 patients with severe head injury

Cited by 544 publications

References 32 publications

Factors affecting the outcome in traumatic subarachnoid hemorrhage

Factors affecting the outcome in traumatic subarachnoid hemorrhage

Biomarkers in Neurocritical Care

Electrical treatment of reduced consciousness: Experience with coma and Alzheimer's disease

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