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Biomedical subjects

D P Becker

Publications and source records attributed to D P Becker.

At least 181 records · Page 10Linked to original sources
PubMed1979

The morphopathologic substrates of concussion?

Neuronal inundation with i.v. infused horseradish peroxidase was studied following concussive brain injury by means of both light and electron microscopy. In animals sustaining mechanical brain injury of insufficient intensity as to elicit either microscopic intraparenchymal hemorrhage or other neuropathological change, yet of sufficient intensity as to provoke a physiological concussive response, vascular peroxidase exudation concomitant with neuronal peroxidase inundation occurred throughout the raphe and reticular core. Initially such inundated neurons were totally flooded with the tracer and as such appeared reminiscent of cells visualized in Golgi preparations. However, over the course of a 24-h period these peroxidae flooded neurons apparently organized the peroxidase into vesicles and vacuoles which assumed a perinuclear position from where the peroxidase ultimately reached both the nucleus and nucleolus. It was remarkable that these events occurred without any evidence of subcellular alteration. We interpret such initial inundation with this protein tracer, its ultimate reorganization, and its nuclear and nucleolar uptake as being consistent with some form of subtle and transient neuronal perturbation. We speculate that as such this neuronal perturbation may constitute a morphological correlate of the concussive episode.

Animals↗
PubMed1979

Delayed intracranial hematoma in patients with severe head injury.

Serial computed tomography was peformed on 119 consecutive patients suffering from severe head injury. The development of delayed intracranial hematomas, both intra- and extraaxial, was evaluated by comparing the initial scan with subsequent studies. Ten delayed intracerebral hematomas and nine delayed extracerebral collections were encountered. The occurrence of delayed intracerebral hemorrhage is more frequenct than previously reported and is associated with a poor outcome.

Cerebral Hemorrhage↗
PubMed1979

Surgical removal of bilateral papillomas of the choroid plexus of the lateral ventricles with resolution of hydrocephalus. Case report.

The authors report a patient with bilateral papillomas of the choroid plexus of the lateral ventricles with documentation of cerebrospinal fluid (CSF) hypersecretion causing hydrocephalus. Special attention is given to the large volume of CSF produced by these tumors (removal of one tumor reduced CSF outflow by one-half) and to the fact that CSF diversion was not required after both tumors were removed. Since tumor removal alone was sufficient to stop the progression of hydrocephalus, we feel that this case supports the concept that elevated CSF production by itself is sufficient to cause hydrocephalus in patients with papillomas of the choroid plexus.

Cerebral Ventricle Neoplasms↗
PubMed1979

Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury.

While corticosteroids in standard neurosurgical dosage do not appear to influence recovery from severe head injury or elevated intracranial pressure (ICP), some reports claim that a much higher dose is effective. A resultant hypothesis is that an abrupt increase in corticosteroid dosage in patients with severe head injury should cause a detectable reduction in ICP and in cerebral elastance within 48 hours. To test this hypothesis 20 consecutive patients with severe head injury, 12 of whom had had surgical decompression of mass lesions, were studied. All patients were artificially ventilated, and had continuous monitoring of ICP and intermittent testing of elastance by measurement of the volume-pressure response (VPR). For the first 12 hours after admission, patients received methylprednisolone, 40 mg every 6 hours. The dose was then increased abruptly by giving a single dose of 2 gm and 500 mg every 6 hours for the next 24 hours, then tapering rapidly. No significant change in ICP or VPR could be detected after 24 or 48 hours of high-dose steroid therapy. Of the 20 patients, 50% had good recovery or were moderately disabled, 15% were severely disabled or vegetative, and 35% had died. The course of ICP and the outcomes in these patients were not significantly different from those observed in a previous group of 262 patients managed in the same way for the high-dose regimen. There was, however, high incidence of gastric hemorrhage (50%) and of hyperglycemia with glucosuria (85%) in these 20 patients. These negative results in patients with head injury stand in marked contrast to our experience of the benefit of methylprednisolone in patients with brain tumors.

Adolescent↗
PubMed1979

The genesis and significance of delayed traumatic intracerebral hematoma.

During a 34-month period, 12 cases of delayed traumatic intracerebral hematoma (DTICH) were diagnosed among 162 consecutive prospectively studied patients admitted to the Medical College of Virginia with severe closed head injuries. All patients were unresponsive to command and unable to utter formed words at the time of admission. The interval from injury to diagnosis of DTICH by computerized tomography (CT) was within 48 hours in 11 of the 12 cases. Six patients had no decompressive surgery before the development of the lesion. Four patients had undergone decompressive surgery and then developed DTICH on the contralateral side. Two patients developed lesions in the vicinity of the operative site that were thought not to be the result of operation. The development of DTICH was not heralded by neurological deterioration nor by elevation of intracranial pressure. Eleven of the 12 patients had suffered a secondary hypoxic insult soon after the head injury. We suggest that the CT appearance of DTICH is likely to represent hemorrhage into an existing traumatized area and is an epiphenomenon rather than a cause of severe primary and secondary brain damage.

Adolescent↗
PubMed1979

The value of serial computerized tomography in the management of severe head injury.

A consecutive series of 107 comatose patients with head injury was studied with regard to the proper role of serial computerized tomography for clinical management and as a research tool for studying the pathophysiology of severe head trauma. In this prospective study patients had serial CT scans on days 1, 3, 5, 7, 14, at 3 months, and at 1 year (day 1 is the day of admission). In seven instances CT scanning was responsible for detection of late intracranial lesions requiring surgical decompression two weeks to one year after injury. No surgically significant lesions were, however, detected by routine scanning on the pre-determined days in the early post-trauma period that had not already been signalled by changes in the neurological status, intracranial pressure, or volume pressure response. It is concluded that for purposes of clinical management, additional scans should be obtained in the following circumstances: 1) 1 day post-craniotomy, 2) no improvement by day 3, 3) at 2-3 weeks, and 4) at 3 months. All other scans should be obtained as needed. As a research tool, serial CT scanning is of value in studying post-traumatic hydrocephalus, delayed intracerebral hematomas, and intraventricular hemorrhage.

Adult↗
PubMed1979

Supratentorial arteriovenous malformation presenting with cerebellar dysfunction.

A young patient with classic clinical presentation and radiological findings of an arteriovenous malformation subsequently developed a spontaneous occlusion of the straight sinus. Although the lesion was supratentorial, thrombosis of the straight sinus and cerebellar cortical veins resulted in signs and symptoms of cerebellar dysfunction. Successful surgical excision was performed with good results.

Adult↗
PubMed1978

Vascular permeability alterations to horseradish peroxidase in experimental brain injury.

Protein uptake and transport within the brain stem vasculature of mechanically brain injured cats was studied by means of both light and electron microscopy utilizing intravenously injected horseradish peroxidase as the protein tracer. In animals sustaining low grade head injuries not of sufficient intensity to elicit either microscopic, intraparenchymal hemorrhages or subtle, neuropathological responses, peroxidase extravasation was noted both in the vascular walls and in the surrounding parenchyma of the ventromedial aspect of the brain stem. At the ultrastructural level as early as 3 min after brain injury, occasional arterioles, venules and capillaries displayed peroxidase leakage. In serial sections large endothelial segments of these vessels revealed the peroxidase reaction product within numerous vesicles which often shared continuity with tubular and vacuolar profiles. Such vesicular activity apparently moved the peroxidase from the luminal surface to extrude it into the basal lamina. From the perivascular basal lamina, the reaction product flooded the interstices of the surrounding brain stem parenchyma where occasional neural, glial and pericytic elements incorporated the peroxidase within coated invaginations, vesicles, tubules and vacuoles. In that protein leakage was consistently observed despite the apparent integrity of both the endothelial tight junctions and their cell membranes, it is concluded that the vesicular transport of horseradish peroxidase across the endothelia of the brain stem vasculature represents a possible mechanism of blood-brain barrier dysfunction in mechanical brain injury.

Animals↗
PubMed1978

Early insults to the injured brain.

Of 100 consecutive patients with severe head injury who arrived at a major trauma center, half of whom came direct from the accident site and half from another hospital, potentially serious systemic insults to the brain were present in 44 cases. Arterial hypotension (13 cases), anemia (12 cases), and hypercarbia (4 cases) were almost exclusively associated with multiple injuries, which were present in 57 patients and were caused usually by vehicular accidents. Hypoxia was seen in 30 patients, including several with brain injury alone. These systemic insults to the already injured brain were associated with an increase in mortality and morbidity. We believe that direct transfer to a trauma center that has full-time neurosurgical facilities for victims of automobile accidents and patients who have been rendered unconscious by a fall or blow on the head will increase survival. Care for the patient with head injuries should start at the roadside.

Accidents, Traffic↗
PubMed1978

Post-traumatic hydrocephalus in patients with severe head injury.

Computerized tomography was performed on 100 consecutive patients suffering from severe head injury, on admission, after 3, 5, 14, and 90 days and 1 year. Ventricular enlargement was evaluated in the surviving patients based upon serial CT examinations. The presence or absence of ventricular enlargement was correlated with the clinical outcome. The study indicates that a significant correlation does exist between the outcome and ventricular size. Hydrocephalus was seen in only four out of the 29 patients who developed ventriculomegaly.

Adolescent↗