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Severe Head Injury (severe + head_injury)
Selected AbstractsFall-related brain injuries and the risk of dementia in elderly people: a population-based studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2005H. Luukinen Severe head injury in early adulthood may increase the risk of dementia in older age, but it is not known whether head injury in later life also increases the risk of dementia. A representative sample (82%) of persons aged 70 years or older with a Mini-Mental State Examination (MMSE) test score of ,26 (n = 325) were followed-up for 9 years to record all their fall-related head injuries resulting in traumatic brain injury (TBI). At the end of the follow-up period, 152 persons (81% of the surviving population) were examined for clinical dementia, according to DSM-IV criteria. Eight persons sustained a TBI and 34 developed dementia. Brain injury was associated with younger age at detection of dementia even when adjusted for sex and educational status (low educational status significantly associated with dementia); age-specific hazard ratio (95% confidence interval) 2.80 (1.35,5.81). In a population scoring ,28 points in the baseline MMSE an apolipoprotein E (ApoE) ,4 phenotype was also associated with younger age at the time of detecting dementia; 3.56 (1.35,9.34), and the effect of brain injury and ApoE ,4 phenotype was synergistic; 7.68 (2.32,25.3). We conclude that fall-related TBI predicts earlier onset of dementia and the effect is especially high amongst subjects who carry the ApoE ,4 allele. [source] Commentary: Brunker C. (2006).NURSING IN CRITICAL CARE, Issue 2 2008Assessment of sedated head-injured patients using the Glasgow Coma Scale: an audit The Glasgow Coma Scale (GCS) is widely used to assess head-injured patients. However, patients with acute severe head injury are typically managed with varying doses of sedative drugs that may interfere with GCS assessments. There is a question as to whether GCS assessments are useful and justified when the patient is sedated. The limited literature available is briefly reviewed. The aim of the audit described in this paper was to gain an overview of current practice among the neuroscience intensive care units in the UK, in search of any consensus. Thirty questionnaires were distributed and 23 returned (a 77% response). The results show considerable variations in practice and, in particular, differences between those units that treat only neuroscience patients and those that manage general intensive care patients as well. This audit demonstrates a lack of clear consensus and highlights the need for more research. Abstract reprinted from the British Journal of Neuroscience Nursing, volume 2, Brunker C, ,Assessment of sedated head-injured patients using the Glasgow Coma Scale: an Audit.', pages 276,280. © 2006, reproduced with permission from MA Healthcare Limited. [source] MANAGEMENT AND HOSPITAL OUTCOME OF THE SEVERELY HEAD INJURED ELDERLY PATIENTANZ JOURNAL OF SURGERY, Issue 7 2008Biswadev Mitra Introduction: Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population. Materials and Methods: A retrospective review of all elderly patients (age >64 years) with a Glasgow Coma Scale (GCS) score of 8 or less, and confirmed intracranial pathology or fractured skull, was undertaken over a period of 40 months from July 2001 to September 2005. Data on patient demographics, injury cause, presenting clinical features and interventions were collected. In-hospital mortality was used as the primary outcome. Results: There were 96 patients who met the inclusion criteria. One-third of the patients were managed palliatively, one-third supportively without surgery and another third underwent surgery. Overall mortality was 70.8% (n = 68). Older age and brainstem injuries were identified as independent predictors of mortality. Mortality was reported in all patients aged 85 years or older. Conclusions: Although overall outcomes were poor, careful consideration should be given to active treatment as favourable outcomes were possible even in the presence of extremely low GCS scores. Prediction of outcome on the basis of age and anatomical diagnoses may help in this decision-making. [source] Applying circular posterior-hinged craniotomy to malignant cerebral edemasCLINICAL ANATOMY, Issue 3 2002H. Traxler Abstract Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9,21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% (±0.4%) or 78 cm3 with a 10 mm elevation and by 12.4% (±0.7%) or 160 cm3 with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P , 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = ,0.507; P , 0.004). Clin. Anat. Month:173,181, 2002. © 2002 Wiley-Liss, Inc. [source] A response to ,Temperature measurement after severe head injury', Childs C et al.ANAESTHESIA, Issue 9 2004Anaesthesia 2004; 59: 19 No abstract is available for this article. [source] | ||||||||||