Patients who talk and deteriorate: a new look at an old problem.
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BACKGROUND AND METHODS: We sought to review established prognostic indicators applied to Asian population, and to identify new risk factors for deterioration in patients who talked and deteriorated after traumatic brain injury (TBI). This retrospective study used our prospectively maintained TBI database. From August 1999 to July 2001, 324 patients were admitted to the neurosurgical intensive care unit (ICU). Thirty-eight patients (11.8%) talked between injury and subsequent deterioration into coma. Independent outcome predictors were studied. RESULTS AND CONCLUSION: Fourteen patients had subdural haematomas, 9 extradural haematomas, 19 contusions/haematomas and 3 subarachnoid haemorrhages. 81.5% of the patients had mass lesions potentially requiring surgery. Twenty patients had good functional recovery at 6 months (Glasgow Outcome Score 4 and 5); 18 were dead or vegetative. Age, gender, type of intracranial lesion and presence of coagulopathy were significantly correlated with outcome. Intracranial haematomas continue to be most significant in patients who talk and deteriorate. Coagulopathy was the strongest prognostic predictor of poor outcome with fibrinolytic parameters being reliable prognostic markers of head injury. Early identification, continued monitoring and treatment of coagulopathy should be our new look at improving outcome of these patients. (+info)
Recovery process of immediate prolonged posttraumatic coma following severe head injury without mass lesions.
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The recovery process of immediate posttraumatic coma was investigated in 24 patients with severe head injury. The correlation between poor outcome in the recovery process and magnetic resonance (MR) imaging findings was analyzed. MR imaging was performed within the first 7 days for all patients. The recovery process was classified into phase 1 for recovery to moderately disabled and phase 2 to good recovery (GR) according to the Glasgow Outcome Scale. The median of phase 1 was 21.0 days. Four patients did not recover to GR and had poor outcome. Twenty patients recovered to GR. Thirteen patients had short phase 2 of under 10 days and seven patients had long phase 2 of over 60 days. All patients had abnormal lesions on MR imaging considered to be diffuse axonal injury. The number of lesions ranged from two to 10, with a mean of five. Lesions in the dorsal upper brainstem were significantly associated with poor outcome (p < 0.05). The combination of focal lesions in the callosal splenium and dorsal upper brainstem was most common in patients with poor outcome. Patients with long phase 2 had significantly more lesions than patients with short phase 2. (+info)
Search for clinical and neurophysiological prognostic patterns of brain coma outcomes in children.
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OBJECTIVE: The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients. MATERIAL AND METHODS: A total of 43 children in coma with severe acute head trauma were included in the study. They were investigated and treated in pediatric intensive care unit using standard evaluation and treatment protocol. Evaluation of coma was performed using Glasgow Coma Scale. Electroencephalography for 35 patients and brainstem auditory-evoked potentials for 24 patients were recorded. RESULTS: Glasgow coma scale statistic pool median was equal to 4 points as measured in presence of brain edema, meanwhile it was 6 as measured in absence of edema. In case of supratentorial damage, median duration of consciousness recovery was 10 days. In absence of above-mentioned supratentorial damage, recovery of the consciousness was earlier - median was 5 days. Determined duration of artificial lung ventilation was statistically significantly shorter for those who had edema (P=0.048). In 20 patients (57% of all cases), constant or alternating slow wave activity was observed during the first electroencephalographic recording. In other cases, "alpha coma" or low amplitude of arrhythmic activity and local slowing activity corresponding to brain damage seen on computerized tomography were recorded. For 24 patients, brainstem auditory-evoked potentials were recorded. In 9 cases, they were abnormal; in these cases, the consciousness of the patients recovered after 44 days or did not recover. CONCLUSIONS: Glasgow coma scale results alone may have limited prognostic value in absence of other objective neurophysiologic investigation data concerning the coma outcome in children. Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan. (+info)
Usefulness of functional MRI associated with PET scan and evoked potentials in the evaluation of brain functions after severe brain injury: preliminary results.
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