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L. W. Freeman, J. MacDougall, C. C. Turbes and D. E. Bowman

sex, most were adults and all too often they were more aged than would have been desired. Puppies were avoided when possible since experience has shown difficulties in maintaining them in the suspension apparatus. Another 8 were eliminated from final consideration because of difficulties with the plastic tube. In some, it migrated through the spinal cord and in others it pulled from the dura mater. This left 48 for final consideration. Many factors appeared to influence the ultimate functional outcome. Not the least of these was the emotional character of the

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The pathophysiological response to spinal cord injury

The current status of related research

Jewell L. Osterholm

, lethal hypoxia develops within hours. In this context, extrinsic mechanical pressure becomes an unrelated factor because the injury was produced by an immediate, direct blow without protracted neural deformation. Traumatic cord autodestruction depends on an inherent process which, when activated, can proceed without axial tissue distortion. These basic facts help explain the failure of decompression laminectomy to influence the functional outcome of severe injuries that leave the cord in continuity. Vascular Versus Neurovascular Traumatic Hypoxia Two separate

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Neurological prognosis after traumatic quadriplegia

Three-year experience of California Regional Spinal Cord Injury Care System

Frederick M. Maynard, Glenn G. Reynolds, Steven Fountain, Conal Wilmot and Richard Hamilton

of patients meeting those criteria who received treatment can be meaningfully compared to a group who do not receive that treatment. These two groups should then be compared according to extent of neurological deficit seen before treatment with neurological and functional outcomes at 1 year. By pooling data from many centers using the same strict criteria, sufficient numbers could be obtained in each category to produce statistical significance and finally create a rational scientific basis for the treatment of spinal cord injuries. TABLE 10 Proposed

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Kenneth Shapiro and Anthony Marmarou

, but the remaining four, or 24% of survivors, were severely disabled. Discussion In contrast to adult head-injury victims in whom control of intracranial hypertension may not significantly affect outcome, control of ICP in pediatric head injury clearly influences survival and functional outcome. 3, 4 However, with conventional techniques of ICP monitoring, at least 50% of children with GCS scores of less than 8 will have normal ICP at the outset, as shown in this study. Further, our experience shows that clinical signs of impending intracranial

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J. Bob Blacklock, Terry W. Hood and Robert E. Maxwell

brain abscess. 7, 11 The functional outcome of patients with surgically treated cervical spinal cord abscess has been good in the survivors. The CSF analysis of patients with intramedullary cervical cord abscess varies; CSF protein ranges from normal to very high. The leukocytic reaction in the CSF is also variable. Cervical spinal cord abscesses have been associated with sterile CSF in all but one case, in which a single colony of Escherichia coli grew on CSF cultures from a patient with Klebsiella and Streptococcus in the abscess. The peripheral white blood

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Mitsuo Kaneko, Keisei Tanaka, Tsutomu Shimada, Kengo Sato and Kenichi Uemura

✓ In the past 10 years, the authors performed microsurgical evacuation of hypertensive intracerebral hematoma in 100 cases during the ultra-early stage (within 7 hours) after the apoplectic attack. Operative indications were the presence of obvious hemiplegia and disturbed consciousness (from stupor to semicoma). Functional outcomes at 6 months postoperatively were as follows: 15 patients had returned to a full social life, 35 were capable of self-care at home, 33 required partial care at home, two were bedridden and in a vegetative state, and seven had died.

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Cerebral circulation after head injury

Part 4: Functional anatomy and boundary-zone flow deprivation in the first week of traumatic coma

Jørn Overgaard and William A. Tweed

reduction or inversion of reactivity was only detected in patients who died or became vegetative. For survivors, no relationship between the reduction of CO 2 reactivity and eventual functional outcome could be calculated. It would be incorrect to adjust all the 3080 rCBF values to a standard PaCO 2 because this would assume that all regional flows would change in an identical manner. The present study is concerned with the distribution of regional flows and their deviations from normal patterns. The low-flow areas in patients who did not recover brain function (dead

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Guy A. O'Connor and Theodore S. Roberts

release of the spinal cord compression, nerve conduction traffic through the area of involvement improved dramatically, with the P 1 latency decreasing to 37.44 msec and the amplitude increasing to 1.15 µ V. A multitude of factors can influence and increase variation in the amplitude of these recordings, yet the P 1 waveform and its latency are constant and reliable measurements, change only with changes in discrete lesions, and are considered reliable correlates of functional outcome. References 1. Aergerter E , Kirkpatrick JA

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Michael J. Rosner and Donald P. Becker

suggests that lactic acidosis may potentiate cellular injury, or prevent its repair, although not necessarily cause it. Rehncrona, et al. , 65 and Kalimo, et al. , 33 have shown the biochemical alterations induced by glucose loading and subsequent acidosis to be associated with morphological changes as well. In summary, ischemia research has shown that in sufficiently severe hypoxic-ischemic insults, tissue glucose supply is directly related to tissue lactic acidosis. This acidosis relates to poorer recovery of energy charge 26 and impaired functional outcome. 33

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Outcome 1 year after SAH from cerebral aneurysm

Management morbidity, mortality, and functional status in 112 consecutive good-risk patients

Allan H. Ropper and Nicholas T. Zervas

T he management of patients with ruptured intracranial aneurysms has passed through a phase of rapid evolution and modification in the past two decades. Despite advanced surgical technique, however, the overall morbidity and mortality rates following aneurysmal rupture remain high. This report presents the long-term results in a group of 112 consecutive patients without initial neurological deficits that may facilitate comparison of management protocols using different pharmacological or surgical strategies. The functional outcome and morbidity at 1 year are