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Roman Hlatky, Alex B. Valadka, Shankar P. Gopinath, and Claudia S. Robertson

Award for Resident Research on Brain and Craniofacial Injury: normoxic ventilatory resuscitation after controlled cortical impact reduces peroxynitrite-mediated protein nitration in the hippocampus . Clin Neurosurg 52 : 348 – 356 , 2005 2 Bardt TF , Unterberg AW , Härtl R , Kiening KL , Schneider GH , Lanksch WR : Monitoring of brain tissue PO2 in traumatic brain injury: effect of cerebral hypoxia on outcome . Acta Neurochir Suppl 71 : 153 – 156 , 1998 3 Dings J , Jager A , Meixensberger J , Roosen K : Brain tissue pO2 and

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Charles F. Contant, Alex B. Valadka, Shankar P. Gopinath, H. Julia Hannay, and Claudia S. Robertson

pulmonary capillary permeability. 8, 14 Therefore, the patients with severe traumatic brain injury who are at greatest risk of developing ARDS include those with a history of drug abuse and those with midline shift on their admission CT scan. Nevertheless, because the incidence of these findings was not significantly different between the two treatment groups, these risk factors probably do not explain the increased risk of ARDS in the CBF-targeted group. 2) The treatment-related variables that were associated with an increased risk of ARDS reflected the goals of the

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Manuela Cormio, Alex B. Valadka, and Claudia S. Robertson

adequacy of cerebral oxygen metabolism. It has been shown that cerebral hemodynamic and metabolic variables in traumatic brain injury do not necessarily correlate with CPP. In a porcine model of cryogenic brain injury, Zhuang, et al., 30 found persistent posttraumatic ischemia despite normalization of CPP. They proposed a significant increase in CVR as the cause of the ischemia. A relationship between clinical condition, CMRO 2 , and outcome after traumatic coma has been noted by several authors. 10, 17–19, 26 Shalit, et al., 26 found that CMRO 2 values below 1.4 ml

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Alex B. Valadka, Jaclyn S. Valadka, Patrick R. Valadka, and Patricia C. Valadka

as neurosurgeons when we give a patient a diagnosis of glioblastoma, or tell a family that their loved one has just suffered a devastating stroke or traumatic brain injury, or similar types of encounters. Our patients’ and their family members’ lives are turned upside down by such diagnoses. Our minimum responsibility is to describe for them the diagnosis, prognosis, treatment plan, and what to expect in the coming days and weeks. But at such emotional moments, it would be very charitable to take some extra time with these patients and families and answer questions

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Loyola V. Gressot, Roukoz B. Chamoun, Akash J. Patel, Alex B. Valadka, Dima Suki, Claudia S. Robertson, and Shankar P. Gopinath

Object

Prediction of outcome from initial presentation after a gunshot wound to the head (GSWH) is essential to further clinical decision making. The authors' goals are to report the survival and functional outcomes of these patients, to identify prognostic factors, and to propose a scoring system that can predict their outcome.

Methods

The records of 199 patients admitted with a GSWH with dural penetration between 1990 and 2008 were retrospectively reviewed. The inclusion criterion was a CT scan available for review. Patients declared brain dead on presentation were excluded, which yielded a series of 119 patients. Statistical analysis was performed using a logistic regression model.

Results

Fifty-eight (49%) of the 119 patients died. Twenty-three patients (19%) had a favorable outcome defined as a 6-month Glasgow Outcome Scale (GOS) score of moderate disability or good recovery, 35 (29%) had a poor outcome (GOS of persistent vegetative state or severe disability), and 3 (3%) were lost to follow-up. Significant prognostic factors for mortality were age older than 35 years, nonreactive pupils, bullet trajectory of bihemispheric (excluding bifrontal), and posterior fossa involvement compared with unihemispheric and bifrontal. Factors that were moderately associated with higher mortality included intracranial pressure (ICP) above 20 mm Hg and Glasgow Coma Scale (GCS) score at presentation of 3 or 4. Upon multivariate analysis, the significant factors for mortality were bullet trajectory and pupillary response. Variables found to be significant for good functional outcome were admission GCS score greater than or equal to 5, pupillary reactivity, and bullet trajectory of unihemispheric or bifrontal. Factors moderately associated with good outcome included age of 35 years or younger, initial ICP 20 mm Hg or lower, and lack of transventricular trajectory. In the multivariate analysis, significant factors for good functional outcome were bullet trajectory and pupillary response, with age moderately associated with improved functional outcomes. The authors also propose a scoring system to estimate survival and functional outcome.

Conclusions

Age, pupils, GCS score, and bullet trajectory on CT scan can be used to determine likelihood of survival and good functional outcome. The authors advocate assessing patients based on these parameters rather than pronouncing a poor prognosis and withholding aggressive resuscitation based upon low GCS score alone.

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John Dickerson, Alex B. Valadka, Tina LeVert, Kimberly Davis, Mary Kurian, and Claudia S. Robertson

and Methods The BTGH is a Level I trauma center serving the greater Houston metropolitan area. Patients with neurosurgical emergencies are admitted to the 16-bed NICU, which is managed by the Neurosurgery Service. As a general practice, patients with traumatic brain injury, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, and other life-threatening conditions undergo aggressive resuscitation and stabilization, including surgical intervention and use of blood products, mechanical ventilation, and pharmacological agents as necessary. We have adopted

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Roman Hlatky, Yu Furuya, Alex B. Valadka, Jorge Gonzalez, Ari Chacko, Yasu Mizutani, Charles F. Contant, and Claudia S. Robertson

. Kelly DF , Martin NA , Kordestani R , et al : Cerebral blood flow as a predictor of outcome following traumatic brain injury. J Neurosurg 86 : 633 – 641 , 1997 Kelly DF, Martin NA, Kordestani R, et al: Cerebral blood flow as a predictor of outcome following traumatic brain injury. J Neurosurg 86: 633–641, 1997 13. Kety SS , Schmidt CF : The nitrous oxide method for quantitative determination of cerebral blood flow in man: theory, procedure and normal values. J Clin Invest 27 : 476 – 483