Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field

Mauritz, W; Leitgeb, Johannes; Wilbacher, Ingrid; Majdán, Marek; Janciak, Ivan; Bražinová, Alexandra; Rusňák, Martin

doi:10.1097/mej.0b013e32832a0864

Cited by 35 publications

(27 citation statements)

References 17 publications

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“…[19][20][21][22][23][24][25][26][27][28][29][30][31] However, these research findings are mixed. [19][20][21][22][23][24][25][26][27][28][29][30][31] Our study focused on the specific executive functions deficit in SA after TBI, which not been well studied with regard to gender. The study purpose was to examine (1) possible gender differences in SA of injury-related deficits and (2) possible causes for these gender differences.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18] Mixed findings are typical in studies comparing broad post-TBI outcomes for men and women. [19][20][21][22][23][24][25][26][27][28][29][30][31] On the one hand, research has shown that women with TBI outperform men in executive functions, 1 working memory, 27 delayed visual memory, 20 and written language, 21 as well as in rehabilitation outcomes 21 and community integration. 22,23 Investigators have also noted that women are more likely to survive their injuries and less likely to have postinjury complications than men.…”

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confidence: 99%

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Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

Perrin¹,

Holcomb²,

Rolston³

et al. 2014

Journal of Women's Health

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Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

Perrin¹,

Holcomb²,

Rolston³

et al. 2014

Journal of Women's Health

View full text Add to dashboard Cite

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“…The animal and human brain injury literatures chronicle high scientific interest in a possible female gender advantage in recovery from traumatic brain injury (TBI) based on sex hormone neuroprotection (Groswasser, Cohen, & Keren, 1998;Kokiko, Murashov, & Hoane, 2006;Mauritz et al, 2009;Niemeier, Marwitz, Lesher, Walker, & Bushnik, 2007;Stein, 2001;Stein & Wright, 2010;Wagner et al, 2004). One rationale is that progesterone is neuroprotective following TBI, prompting clinical trials on the efficacy of exogenous administration acutely (Davis & Hoyt, 2006;Farin, Deutsch, Biegon, & Marshall, 2003;Gordon et al, 2006;Parks, Diaz-Arrastia, Gentilello, & Shafi, 2010;Slewa-Younan, van den Berg, Baguley, Nott, & Cameron, 2008;Stein & Wright, 2010).…”

Section: Introductionmentioning

confidence: 98%

Are there cognitive and neurobehavioural correlates of hormonal neuroprotection for women after TBI?

Marwitz¹,

Walker²,

Davis³

et al. 2013

Neuropsychological Rehabilitation

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This study examined possible cognitive correlates of hormonal neuroprotection following traumatic brain injury (TBI) using archival neuropsychological findings for 1563 individuals undergoing acute TBI rehabilitation between 1989 and 2002. Presumed age of menopause was based on the STRAW (Stages of Reproductive Aging) staging system (Soules, 2005; Soules et al., 2001) and general linear model (GLM) analysis of performance on neuropsychological testing by participants across gender and age groups (25-34, 35-44, 45-54, and 55-64) was performed. Hypotheses were (1) women with TBI in the oldest age group would have lower scores on neuropsychological tests and functional outcome measures than women in the younger groups, and (2) men in the oldest age group would have higher scores than women of the same age group. Analyses revealed that oldest females had significantly worse Trails B and SDMT written and oral scores than the youngest females. In addition, oldest females had significantly better Trails B, Rey AVLT and SDMT written scores than the oldest males. Possible cohort exposure to hormone replacement therapy, unknown hormonal status at time of testing, and sample-specific injury characteristics may have contributed to these findings.

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“…Despite their overall dismal prognosis, some patients with a traumatic intracranial hematoma who present with a GCS score of 3 and fixed and dilated pupils can survive with treatment. [14][15][16] Moreover, survival and even functional neurological recovery has been reported following predominantly medical reversal of transtentorial herniation secondary to a supratentorial mass lesion from a variety of causes. [17][18][19] Survival with good outcome has even been reported after advanced cerebral herniation with Duret hemorrhage (a secondary brainstem hemorrhage that results from stretching and rupture of pontine perforating vessels during herniation), a condition commonly linked with brain death.…”

Section: Discussionmentioning

confidence: 99%

Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

Roberts

MacCulloch

Versnick

et al. 2010

Can J Anesth/J Can Anesth

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Purpose We present two patients who regained spontaneous respiration following clinical neurological determination of death (NDD) while ancillary radiological imaging demonstrated brain blood flow. Clinical features A 26-yr-old male with chronic otitis media presented with a Glasgow Coma Scale (GCS) score of 3 and fixed 7-mm pupils. Computed tomography demonstrated right-sided mastoiditis and a temporal lobe abscess associated with uncal herniation. The patient was diagnosed brain dead seven-hr later when motor responses and brainstem reflexes were absent and his apnea test was positive. Approximately 28-hr after NDD, during post-declaration organ resuscitation, the patient regained spontaneous respiration and magnetic resonance imaging revealed brain blood flow. Spontaneous respirations persisted for five-days before cardiovascular collapse occurred. In the second case, a 50-yr-old female presented with a GCS score of 3 and fixed 6-mm pupils following a traumatic brain injury and a five-minute cardiac arrest. The patient was deemed clinically brain dead six-hr later when physical examination revealed absent motor responses and brainstem reflexes and her apnea test was positive. As confirmation of brain death, a cerebral radionuclide angiogram was performed, which surprisingly revealed intracranial arterial flow. During organ resuscitation, 11-hr after NDD, the patient regained spontaneous respiration. She expired hours after family decision to withdraw treatment. Conclusion For both patients, several unrecognized confounding factors for NDD were present. These cases illustrate the difficulties encountered by experienced clinicians in determining brain death using clinical criteria alone, and they suggest that more routine use of ancillary brain blood flow analyses should be recommended. RésuméObjectif Nous pre´sentons les cas de deux patients qui ont recommence´a`respirer spontane´ment apre`s avoir reçu un diagnostic de de´ce`s neurologique clinique alors que l'imagerie radiologique secondaire de´montrait un de´bit sanguin ce´re´bral. É léments cliniques Un homme de 26 ans souffrant d'otite moyenne chronique s'est pre´sente´avec un score de 3 sur l'e´chelle de coma de Glasgow (GCS) et des pupilles fixes a`7 mm. La tomodensitome´trie a montre´une

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Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field

Abstract: Patients with a GCS of 3 and BFDP in the field should be resuscitated aggressively, especially if the trauma seems to be not too severe.

Cited by 35 publications

References 17 publications

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

Are there cognitive and neurobehavioural correlates of hormonal neuroprotection for women after TBI?

Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

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