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Biomedical subjects

K E Richard

Publications and source records attributed to K E Richard.

At least 19 recordsLinked to original sources
PubMed1995

[Autonomic dysfunction and the development of secondary brain death syndrome].

Vegetative disturbances were observed in 88 out of 102 patients, 86%, after a primary brain lesion during onset of brain death. Tachycardia was most common in 64%, hypotonia below 80 mm Hg and hypertonia above 170 mm Hg were present in about half of all cases. Hyperthermia above 40 degrees C was noted in 25%, hypothermia below 36 degrees C was observed in 31%. The kind of underlying brain lesion had no regular influence on the vegetative disturbances. In 5 out of 6 younger patients these disturbances were less pronounced.

Adolescent↗
PubMed1993

Primary brain stem lesions caused by closed head injuries.

Traumatic lesions of the brain stem are of two types: primary, which are considered to be caused at the moment of impact, and secondary, associated with supratentorial mass lesion. Of the 239 patients with a serious head injury who showed a severe disturbance of consciousness upon admission and who had CT scan carried out immediately, 21 cases were considered to have a primary brain stem lesion with initial CT scan. A primary brain stem lesion was found in 21 of 239 (8.8%) of patients with serious head injury. Their injuries were caused primarily by traffic accidents. Sixteen of the 21 cases showed not only brain stem lesions but also other brain injuries such as cerebral contusion of the white and gray matter, callosal injury, intraventricular hemorrhage, and subarachnoid hemorrhage, which are considered to be caused by a diffuse shearing injury. Five cases who showed a single injury to the brain stem with no other brain lesions were considered to have a pure brain stem lesion. Primary brain stem lesions were observed on the dorsal side of the midbrain, where they can be differentiated from secondary brain stem lesions. These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge, or to an injury of the lower brain stem by hyperextension of the cervical vertebrae. The prognosis of patients with a primary brain stem lesion was usually unfavorable, except in those with a single brain stem lesion.

Adolescent↗
PubMed1992

Rehabilitation after severe head injury.

123 survivors of severely head injured patients presenting with coma grade III show a decreasing mean duration of coma with increasing age. The numbers and frequency of good recovery decrease, whereas poor recovery increases with age. Increase of the duration of coma grade III produces an increase of the mean latency and time of recovery and of the frequency of poor recovery, regardless of the age of the patients. Increasing age does not increase the mean latency and time of recovery systematically. The important conclusion of this analysis is, that the clinical feature of coma grade III, corresponding to GCS score of 4 and RLS of 6 and 7, indicates a different kind of brain damage at various age groups. It represents a lesser degree of brain damage for younger patients under 20, than for those over 20. In our opinion our observations do not demonstrate a better capacity of recovery of the young patients: but the young patients show a more severe clinical picture than the older patients do, if only the clinical syndrome of coma grade III with extensor rigidity, is considered as a yardstick for comparison.

Activities of Daily Living↗
PubMed1991

Transcranial Doppler sonography and intracranial pressure monitoring in children and juveniles with acute brain injuries or hydrocephalus.

Transcranial Doppler sonography is a noninvasive method of obtaining information about changes in cerebral hemodynamics and intracranial pressure. After severe head injuries the development of brain swelling and brain edema can be assessed and the efficacy of treatment monitored. Development of severe brain edema accompanied by a rapid increase in intracranial pressure can be recognized by a decrease in blood flow velocity and rise in the pulsatility index. In hydrocephalic children the behavior of the cerebral blood flow velocity and the pulsatility index will warn of an increase of the ventricular fluid pressure or a shunt insufficiency.

Adolescent↗
PubMed1990

Cysts of the third ventricle.

Cysts of the third ventricle, predominantly being of congenital origin, are often summarized under the heading of ependymal or neuroepithelial cysts, if they contain an epithelial covering. Though surely they form a heterogeneous group, even by histochemistry and electron microscopy a differentiated classification on a histogenetic basis is difficult because of overlaps in structural details. The aim of this study is checking by immunohistochemistry with antibodies to cytokeratins (KL 1), epithelial membrane antigen (EMA), S 100 protein (S 100), and glial fibrillary acidic protein (GFAP). Fourteen colloid cysts showed clear reaction differences of their epithelium in relation to neuroepithelium, which render feasible the verification of the earlier presumed bronchogenic origin of the former. Two other "ependymal cysts" could be classified as diverticulum respectively meningeal glioependymal cyst. A review is given about localization, clinical and neuroradiological aspects of these partly extreme rare lesions together with differential diagnosis.

Adolescent↗
PubMed1990

[Cerebral blood flow velocity. A prognostic factor following severe craniocerebral trauma?].

Head injuries lead to changes in cerebral blood flow velocity (BFV)--measured with the transcranial Doppler ultrasonography--in 19 out of 31 patients, i.e. 61%. In 12 cases there was an immediate increase of BFV following the injury or within the first 7 days, often parallel with an increase of the intracranial pressure. On the other hand in 2 out of 4 cases with chronic subdural haemorrhage there was a decrease of the BFV. With routine use of transcranial doppler ultrasound in neurosurgical intensive care, acute changes in BFV along with clinical deterioration may indicate the need for a repeat CT and eventually a surgical intervention.

Adolescent↗
PubMed1989

Long-term follow-up of children and juveniles with arachnoid cysts.

In the vast literature on intracranial arachnoid cysts, communication of long-term follow-up is rare. Therefore, we studied the case histories of 60 children and juveniles operated on in our hospital since 1951. The most favorable cases were patients with temporal cysts: 93% recovered fully or with only slight deficits. In other locations (frontal, parietal, occipital, infratentorial), the percentages for a favorable course were lower. The reason cannot be attributed to the operation procedures. Independent of the surgical procedure, there were no postoperative deaths after 1969. Long-term follow-up revealed that, depending on the location of the arachnoid cyst, a high percentage (62%-93% of patients) had normal physical and social development with satisfactory quality of life.

Adolescent↗
PubMed1989

Humoral immunodeficiency syndrome in patients with severe head injury?

Twenty patients with severe head injury were analysed as to whether they developed a humoral immunodeficiency syndrome. In spite of the fact that 75% developed pyogenic complications all patients showed a polyclonal humoral activation of their immune system with an increase in IgG, IgA, IgM and the complement factors. Four patients died from cerebral complications partly associated with infections. Because our patients did not develop a humoral immune defect and because there is no proof so far of a cellular defect, we think that the cause of respiratory infections is a pulmonary disturbance primarily caused by hypothalamic factors, whose release is stimulated by traumatically induced cerebral lesions.

Adolescent↗
PubMed1988

Acute hydrocephalus in infectious spinal disorder.

Two patients with infectious spinal disorders and increased intracranial pressure are described. One patient with spinal empyema lapsed into coma but improved after external ventricular drainage to relieve increased intracranial pressure. The second patient, who had a severe wound infection after repeated operative stabilization of a cervical spine fracture, developed increased intracranial pressure and subsequent hydrocephalus 6 months after the trauma. The pathogenesis of hydrocephalus in infectious spinal disorder is discussed.

Adult↗
PubMed1987

[Clinical and prognostic aspects of congenital hydrocephalus].

Clinical data of 24 patients with congenital hydrocephalus are presented. 13 children died within the first 7 months of life; the average period of survival was 2 months. Associated malformations of the CNS or other organs, severely raised intracranial pressure in utero, and postnatal complications involving the CNS indicated a poor prognosis. The follow-up of the 11 surviving children showed severe neurologic sequelae and drug resistent epilepsy in 2 of them. Three others had neural tube defects and associated paraplegia. The 6 remaining children had mild or moderate cerebral palsy or were moderately mentally retarded. If possible, birth should not be induced before 36 weeks of gestation, and the hydrocephalus should be shunted soon after birth. Satisfactory results can be obtained in about one half of surviving patients by early shunting of congenital hydrocephalus.

Brain Damage, Chronic↗