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John C. Van Gilder and William S. Coxe

the common carotid artery. Summary The unusual occurrence of a metallic embolus in the middle cerebral artery following a gunshot wound to the head and neck has been reported. The patient had a severe right hemiplegia and aphasia. Embolectomy resulted in postoperative patency of the artery and clinical improvement. References 1. Chou , S. N. Embolectomy of middle cerebral artery; report of a case. J. Neurosurg. , 1963 , 20 : 161 – 163 . Chou , S. N. Embolectomy of middle cerebral artery; report of a case. J

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Nonketotic hyperglycemic hyperosmolar coma

Report of neurosurgical cases with a review of mechanisms and treatment

Bert E. Park, William F. Meacham and Martin G. Netsky

remained normal. The physical findings, including coma with decerebrate response to noxious stimuli, remained unchanged. He died on the sixth hospital day with a glucose of 510 mg%, BUN 90 mg%, Na 165 mEq/l, negative acetonuria, osmolarity 390 mOsm/kg, and pH 7.5 with bicarbonate of 24 mEq/l. Autopsy revealed encephalomalacia of the cerebral hemispheres and brain stem, with basilar, and C-6 compression fractures. Case 5 . This 52-year-old man was admitted with a gunshot wound to the head, in coma with extensor responses to noxious stimuli. He was not known to be a

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Joel B. Kirkpatrick and Vincent Di Maio

such weapons, and the important differences from high-velocity missile wounds do not seem to be widely recognized. Most literature on gunshot wounds to the head falls into three categories: military injuries, clinical series, and experimental papers. Each war has produced several papers on military injuries. These, for the most part, report shell-fragment or high-velocity-rifle wounds. For example, the analysis by Hammon 26 stressed the importance of complete debridement of the necrotic tissue and debris within the missile track. Sukoff, et al., 47 disagreed

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The outcome with aggressive treatment in severe head injuries

Part II: Acute and chronic barbiturate administration in the management of head injury

Lawrence F. Marshall, Randall W. Smith and Harvey M. Shapiro

verbally and were unable to obey commands on admission, and 12 deteriorated during the first 48 hours of admission. All were admitted within 8 hours of their injury and 60 of these 100 within 2 hours of injury. Patients below the age of 10 years were excluded from the study. No patients with gunshot wounds to the head were admitted during the period of the study. Intracranial pressure monitoring was established in each of these patients either upon admission or later in their hospital course in the 12 patients who deteriorated following admission. Despite aggressive

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wound to the head. Multiple pulmonary infarcts and not DIC were observed in this patient. While not disputing the pathogenetic mechanism suggested by Clark, et al. , I would like to point out that DIC may not occur in such cases. The main difference between these two cases seems to be that the cerebral tissue was located in midstream (in the venous sinuses) in the patient with DIC and at the end of the stream (occluding the pulmonary arterial branches) in the patient without DIC. Perhaps this determines the amount of thromboplastic material reaching the circulating

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Thomas G. Saul and Thomas B. Ducker

60 minutes after injury. Patients were excluded from this study if they: did not undergo ICP monitoring, died within 24 hours, or sustained gunshot wounds to the head. Series I The first series (Series I) consisted of patients admitted during 1977 and 1978, as previously reported by Byrnes and Ducker 6 ( Table 1 ). There were 127 patients with severe head injuries who had GCS scores of 7 or less. They all underwent ICP monitoring with either an intraventricular catheter or subarachnoid screw. There were 96 males and 31 females. The ages ranged from 14 to 66

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Roy A. E. Bakay and Arthur A. Ward Jr.

indicated the need for ventricular or lumbar puncture. In no case was the procedure performed solely for obtaining CSF for enzymatic study. Follow-up enzymatic determinations (more than 72 hours after injury) were made as the clinical course directed. In addition, CSF and serum enzyme evaluation was performed in cases of special interest. These included six patients with spinal cord trauma, eight with gunshot wounds to the head, four with pseudotumor cerebri, five with posterior fossa masses and herniation, and two with hysterical paralysis. Control CSF enzymatic levels

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The National Traumatic Coma Data Bank

Part 1: Design, purpose, goals, and results

Lawrence F. Marshall, Donald P. Becker, Sharon A. Bowers, Carol Cayard, Howard Eisenberg, Cynthia R. Gross, Robert G. Grossman, John A. Jane, Selma C. Kunitz, Rebecca Rimel, Kamran Tabaddor and Joseph Warren

hours after injury were also included in the Data Bank. Seventy-six patients (13%) deteriorated to a GCS score of 8 or less and were included on the basis of this latter category. Patients with gunshot wounds to the head were excluded from the pilot study. Data Collection Instruments Data collection instruments were designed to generate information from pre-admission, emergency room, computerized tomography (CT), intensive care unit (ICU), and operating room phases, as well as follow-up neuropsychological and social adjustment testing and postmortem reports

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Melville R. Klauber, Lawrence F. Marshall, Belinda M. Toole, Sharen L. Knowlton and Sharon A. Bowers

. Population and Methods In this study, we defined deaths due to head injury in San Diego County as those deaths determined by the County Coroner to have stemmed from head injury as an initiating or integral part of the chain of events leading to death. These deaths are included in N-Codes N800, N801, N803, N804, and N850–N854 of the ICDA (International Classification of Diseases, Adapted for Use in the United States). 9 However, deaths involving penetrating gunshot wounds to the head were excluded. Deaths due to multiple trauma were included if head injury was present to

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Neurosurgical complications after apparently minor head injury

Assessment of risk in a series of 610 patients

Ralph G. Dacey Jr., Wayne M. Alves, Rebecca W. Rimel, H. Richard Winn and John A. Jane

this study, N 15 = 590 (no. of patients with a GCS score of 15); N sxr = 488 (no. of patients with a GCS score of 15 and normal skull films); and N ct = 535 (no. of patients with a GCS score of 15 and normal CT scans). Statistical Analysis The chi-square test was used to draw statistical inferences from categorical data. The level of statistical significance (alpha) was 0.05. Results Patient Population During the study period, 611 patients fulfilled both inclusion criteria. One patient had sustained a gunshot wound to the head and was