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Biomedical subjects

R A Frowein

Publications and source records attributed to R A Frowein.

16 recordsLinked to original sources
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↗
PubMed1992

Brain death: practicability of evoked potentials.

Multimodally evoked potentials were registered in 85 patients who fulfilled the criteria for brain death. While somatosensory and visual evoked potentials have been found to be of limited value for the diagnosis of brain death, the stepwise abolition of brain stem auditory evoked potentials (BAEP) confirmed brain death in 26 out of 85 patients, i.e. 31%. Registration of the abolition of BAEP is concluded to be a safe and acceptable confirmatory test. It is, however, more feasible for institutions, in which BAEP are analysed routinely. In spite of all efforts sequential BAEP could not be used for the diagnosis of brain death in the majority of cases either because of absence of reproducible responses at the initial registration or because the patient was already apnoic at the time of the initial BAEP. Assuming that bilateral preservation of wave I has the same significance as the stepwise abolition of BAEP, since it also proves the integrity of the peripheral receptor, BAEP are relevant for the declaration of brain death in approximately 30% of patients.

Brain Death↗
PubMed1992

Cerebral reperfusion in brain death of a newborn. Case report.

A case of "sudden infant death" after 15 minutes of successful resuscitation of cardiovascular function is presented. While apnoic cranial nerve areflexia and electrocerebral silence persisted, angiography and transcranial Doppler sonography demonstrated nearly normal cerebral perfusion, which even increased day by day inspite of the persistence of other signs of brain death. The phenomenon "cerebral reperfusion" is concluded to be compatible with the diagnosis of brain death.

Blood Flow Velocity↗
PubMed1991

Cerebellar haemorrhage: management and prognosis.

Of 26 patients with CT confirmed intracerebellar haematoma, 17 had ventricular drainage performed and 7 patients had the haematoma evacuated. Eleven patients died. Mortality was clearly related to state of consciousness. Seven out of 8 non-comatose patients survived but 10 out of 18 comatose patients died. As there was no incidence of deterioration immediately following placement of a ventricular drainage, the actual risk of upward transtentorial herniation seemed low. Absence of evoked potentials in 6 patients accurately predicted a fatal outcome but normal SEP and BAEP were of lesser value for predicting survival.

Aged↗
PubMed1990

Multimodality evoked potentials and early prognosis in comatose patients.

In 112 comatose patients somatosensory, visual and auditory evoked potentials were registered within 36 hours after the onset of coma or admission. Main causes of coma were head injury, and intracerebral and subarachnoid haemorrhage. The initial bilateral loss of any evoked potential was associated with a mortality of 98%. Normal somatosensory evoked potentials were associated with a survival rate of 74%, while normal visual and normal auditory evoked potentials had a survival rate of 60% and 66%, respectively. It is concluded that SEPs can be valuable for the prognosis of coma after primary brain lesions.

Brain Injuries↗
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↗
PubMed1976

Classification of coma.

By order of the Head Injuries Committee of the W.F.N.S. the author and his coworkers give definitions of consciousness, clouding of consciouness and unconciousness or coma. Furthermore, they suggest a definition of the termination of unconsciousness, with particular reference to the transition into a stage of clouding of consciousness. Any statistical evaluation and comparison of different materials depend on the use of identical definitions. As an example, it has been shown that the duration of aa uninterrupted coma, which can be survived, becomes relatively short if in accordance with the proposed definitions the various stages of clouding of consciousness are excluded from "coma".

Brain Injuries↗