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Dexamethasone and severe head injury

A prospective double-blind study

Paul R. Cooper, Sarah Moody, W. Kemp Clark, Joel Kirkpatrick, Kenneth Maravilla, A. Lawrence Gould, and Wanzer Drane

T he efficacy of corticosteroid administration in the management of the edema associated with primary and metastatic brain tumors is well established. 4, 12, 24, 26 The results of studies to investigate the effects of corticosteroids on experimental brain injury are, however, contradictory. 5, 16, 20, 21, 25, 28, 29, 31, 35 Similarly, the usefulness of corticosteroids in the management of severe head injury in humans remains controversial. Sparacio, et al., 32 Gobiet, et al., 13 Faupel, et al., 9 and Ransohoff 30 believe that corticosteroids are

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Prognosis of severe head injuries

Anna Levati, Maria L. Farina, Giuseppe Vecchi, Marina Rossanda, and Marialuisa B. Marrubini

I n common with other researchers, 1, 2, 4, 8 we attribute great importance to determining the prognosis of severely head-injured patients. Several prognostic factors have been identified previously, and their comparative effectiveness in predicting outcome has been evaluated. In the series of patients presented here, the factors of greater prognostic significance have been studied as a contribution to the common goal of identifying methods for the stratification of cases into homogeneous classes of injury severity. We believe that this classification should

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Steroids in severe head injury

A prospective randomized clinical trial

Thomas G. Saul, Thomas B. Ducker, Michael Salcman, and Eric Carro

I n 1961, Galicich and French 6 documented the beneficial effect of steroids in the management of cerebral edema due to primary and metastatic brain tumors. Subsequently, this effect has been confirmed by other investigators, and steroids are now a universal part of the treatment of intracranial neoplasms. 14, 15 However, the efficacy of steroid therapy in the management of patients with severe head injury remains controversial. The results of both experimental and clinical investigations have been contradictory. Studies can be found that support the

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Outcome after severe head injury

Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients

Anthony M. Alberico, John D. Ward, Sung C. Choi, Anthony Marmarou, and Harold F. Young

I t has been a widely held tenet that, after sustaining a similar insult, children are more resilient and recover better than adults. This thinking is certainly prevalent in the literature on head injury. Several reports have appeared in the literature that suggest that children do better than adults following severe head injury. 2, 7, 8, 12, 15, 20, 23, 25, 31 Miller, et al. , 23 showed a steady increase in mortality rate with age. Pazzaglia, et al. , 25 have suggested that age clearly influences the clinical course with regard to both mortality rate and

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Prophylactic phenytoin in severe head injuries

Richard N. W. Wohns and Allen R. Wyler

with severe head injuries. Of these 120 either died during the first week after admission or could not meet unequivocally the above requirements for inclusion into this study; 41 patients were sent to nursing homes in a comatose state and were lost to follow-up review; 72 patients were lost to follow-up review after 3 months as they were referred to their private physicians. Of the remainder, 50 met the criteria and were treated with phenytoin, whereas an additional 12 who met the criteria were not treated with phenytoin. The diagnoses for these 62 patients are

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Cardiovascular response to severe head injury

Guy L. Clifton, Claudia S. Robertson, Kathy Kyper, Addison A. Taylor, Ramesh D. Dhekne, and Robert G. Grossman

C ardiovascular abnormalities in severe head injury have long been recognized. Elevations of blood pressure (BP) over 160 mm Hg have been found in one-fourth of patients with severe head injury, and elevation of pulse greater than 120 beats/min and tachypnea have been found in one-third. 9 The mortality rate in patients with severe head injury increases proportionally with the age of the patient. Patients over 50 years of age may die of myocardial infarction after severe injury without elevation of intracranial pressure (ICP). In an autopsy study of 50

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Creatine kinase isoenzymes in severe head injury

Pol Hans, Jacques Daniel Born, Jean-Pierre Chapelle, and Germain Milbouw

disorders and severe head injuries. 6, 7, 9, 14 It has also been found in the CSF after cardiac arrest and resuscitation, and its presence correlated with cerebral damage. 13 In the present study, we measured CK isoenzyme activity in the serum and the ventricular CSF of patients with severe head injury within 13 hours following trauma. The study was carried out 1) to compare values in blood and CSF; 2) to correlate CK-BB activity in CSF with brain dysfunction; 3) to see if that activity could be correlated with changes in intracranial pressure (ICP); and 4) to assess

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The outcome of severe closed head injury

Lawrence F. Marshall, Theresa Gautille, Melville R. Klauber, Howard M. Eisenberg, John A. Jane, Thomas G. Luerssen, Anthony Marmarou, and Mary A. Foulkes

(NINDS) entered into the main phase of the TCDB. The objective of this study was to gather prospective data on a large number of patients suffering severe head injury so that specific questions regarding particular subsets of these patients could be addressed. All patients admitted to the hospital with a Glasgow Coma Scale 20 (GCS) score of 8 or less, or who deteriorated to a GCS score of 8 or less within 48 hours of admission, were included. The TCDB centers agreed that in all cases where the patient was felt to be salvageable intracranial pressure (1CP) would be

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Extracranial complications of severe head injury

Jürgen Piek, Randall M. Chesnut, Lawrence F. Marshall, Marjan van Berkum-Clark, Melville R. Klauber, Barbara A. Blunt, Howard M. Eisenberg, John A. Jane, Anthony Marmarou, and Mary A. Foulkes

A major objective of the Traumatic Coma Data Bank is to evaluate the determinants of recovery in patients with severe head injury. As the fate of many patients suffering from severe head injury is determined at the time of impact by the type of brain lesion, previous studies have generally focused on the type and severity of the anatomical brain injury as predictors of outcome when coupled with a neurological examination. Of course, many clinical, 2, 4, 5, 7–9, 11, 14, 20, 21, 28–30, 33, 36, 42, 49, 52–54, 57 neurophysiological, 23, 44, 46, 48, 50

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Outcome following severe head injuries in children

Derek A. Bruce, Luis Schut, Leonard A. Bruno, James H. Wood, and Leslie N. Sutton

the Glasgow Coma Scale, and who appeared to have suffered about the same range of injuries and had a similar mean injury scale as the patients reported by the Glasgow group. The mortality rate was 32%. Even more encouraging than this reduction in mortality was the fact that the incidence of severe disability and vegetative state was only slightly higher than the results reported by the Glasgow group. Thus, the outcome was rated as good recovery or moderate disability in 57% of the patients. Clinical experience indicates that children recover from head injury