Head injuries--panel 3.
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Accidents, Aviation↗
Biomedical subjects
R L McLaurin
Publications and source records attributed to R L McLaurin.
Effect of furosemide on experimental traumatic cerebral edema.
The present study was designed to test the effectiveness of furosemide in reducing cerebral edema due to closed head trauma. A Remington Humane Stunner was used to deliver blows to the heads of anesthetized cats. Impacted animals were divided into three groups: (a) trauma, no drug, and ad lib. fluid intake after head injury; (b) trauma, no drug, and standardized fluid intake (0.9% NaCl; 10 ml/lb/day); and (c) trauma, furosemide (3 mg/lb/day), and standardized fluid intake. For the treated cats, we began furosemide therapy 1 hour after head injury and used three intramuscular injections/day. The animals were killed 48 hours after head trauma. From animals with unilateral contusion, we took bilateral white matter samples from five points along the centrum semiovale and tested for edema using density determinations with an organic density gradient. Serum electrolytes, blood urea nitrogen, and weight were determined before the cats were impacted and before they were killed. All impacted animals demonstrated weight loss. Density data showed a normal water content for white matter in the uncontused hemispheres of all impacted cats. Contused hemispheres showed a significant decrease in density (increase in brain water content) for both treated and untreated cats. In the furosemide-treated animals, however, the brain edema was significantly less than that found in the untreated groups. Analysis of data from individual brain sections of furosemide-treated animals suggested a reduction in the spread of edema fluid 48 hours after head injury.
Animals↗
Mechanisms of hyperventilation in head injury: case report and review.
We report the case of a head-injured patient with spontaneous hyperventilation who had recurrent episodes of relative hypoventilation associated with increases in intracranial pressure. Detailed ventilatory studies were performed during the 2nd week after injury. Our findings in this patient prompted us to review the possible mechanisms underlying the observed changes. We suggest that spontaneous hyperventilation in head injury is secondary to a decrease in cortical inhibitory influences on respiratory control mechanisms and that the transient episodes of relative hypoventilation observed in our patient may reflect modified ventilatory responses dependent on the altered state of consciousness. (Neurosurgery, 5: 701--707, 1979).
Adult↗
Remission of pes cavus in surgically treated spinal dysraphism. Report of a case.
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Clubfoot↗
Effect of dexamethasone on cerebral edema from cranial impact in the cat.
A Remington humane stunner was used to deliver blows to the skulls of anesthetized cats. Alternate animals were post-treated with either dexamethasone (4 mg/kg/day) or a comparable volume of saline. Each animal was tested for cerebral edema 48 hours after impact by measurement of the change in density of white matter from normal values. Dexamethasone therapy did not reduce the change in density of hemispheres with contusions involving both cortex and underlying white matter. For hemispheres with contusions limited to cerebral cortex, there was minimal edema of the white matter, which was reduced a slight amount by dexamethasone.
Animals↗
Asymptomatic subdural chondrosarcoma. Case report.
This report describes a large, asymptomatic, subdural skeletal-type condrosarcoma originating from the meninges. Distinction between the mesenchymal and skeletal types of intracranial chondrosarcoma is important since they have different prognoses.
Adult↗
Syndromes of vertebrobasilar insufficiency and their possible surgical treatment.
Occlusive disease of the vertebrobasilar system may cause a variety of syndromes depending on the artery or arteries involved and the available collateral circulation. Based on the clinical picture and the angiographic findings, some of the patients may benefit from a gross reconstructive surgical procedure in the vertebral or carotid arteries. When these arteries are not correctable by gross surgical techniques, an occipital artery-posterior inferior cerebellular artery microanastomosis may also prove beneficial. An early clinical diagnosis of the brain-stem and occipital lobes ischemia and angiographic studies of the cerebral arteries are of prime importance and the key to the surgical management of these patient.
Arterial Occlusive Diseases↗
The effects of phencyclidine on visually evoked potentials of rhesus monkeys.
Phenyclidine (Sernylan) was given intramuscularly to 12 rhesus monkeys and electroencephalograms and visually evoked potentials to photic stimulation were recorded. Phencyclidine has profound effects upon VEP's, particularly a marked enhancement of positive components maximal around 100 msec after stimulus presentation. Most likely these effects are related to the level of surgical anesthesia, Stage III, phase I. A correlation was suggested between the increased amplitude of VEP's and the psychotic clinical manifestations of visual perceptual distortions. Physicians and investigators should be aware of the striking effects of this compound, now widely used as a street drug "angel's mist" of "angel's dust", on neurophysiological functions.
Animals↗
Giant serpentine aneurysm. Report of two cases.
The authors describe two cases of giant middle cerebral artery aneurysms presenting as mass lesions. Angiograms in each case revealed a distinctive serpentine vascular channel surrounded by an avascular area causing a "mass effect." Both lesions were resected in toto with excellent clinical results. Similar lesions in the literature are noted and the pathophysiology and origin of this group of aneurysms are discussed.
Adult↗
Pulmonary compliance changes after experimental head injury.
Reduced static compliance has been reported in the lungs of experimental animals removed immediately after head injury. To relate these findings to clinical human experience, pulmonary dynamic compliance measurements were continuously made by clinically applicable methods in 18 monkeys subjected to severe head trauma. After a 2-hr control period, the monkeys were given a standard blow on the head and followed for 2 more hours. Two monkeys died immediately after trauma and two during the succeeding two hours. Pulmonary compliance significantly decreased in these animals only at time of death. No change in compliance was noted in animals which did not die during the 2 hours of observation after trauma were killed by further trauma. These animals did not demonstrate decreased compliance. The findings suggest that the mechanical characteristics of the lungs following head trauma in experimental animals can be measured by methods used clincally and may remain unaltered until immediately before the time of death.
Animals↗
Effect of dexamethasone on the brain edema of cranial impact.
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Animals↗
The edema of cerebral contusion.
A model is described for study of the cerebral edema associated with the contusion of closed head injury. A Remington Humane Stunner was used to deliver blows to the skulls of anesthetized cats. Forty-eight hours after impact, those cats demonstrating a one-sided contusion were tested for cerebral edema by measurement of the decrease in density (specific gravity) of white matter from normal values. Significant change in tissue density was seen in the white matter of contused hemispheres. Hemispheres with contusion limited to the cortex (gray matter) showed a change in tissue density which was considerably less than that seen in hemispheres with contusion involving both gray and white matter.
Animals↗
Metabolic monitoring of neurosurgical patients.
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Acid-Base Imbalance↗
Brain ultrastructure in Reye's syndrome.
Cerebral biopsies were obtained for electron microscopy 48 and 72 hours after the onset of encephalopathy from a child with severe Reye's syndrome. Gravely ill at the time of craniectomy to relieve cerebral hypertension, the child survived and recovered good brain function; therefore, the biopsy findings appear to reflect the organelle pathology of the brain at a severe yet reversible stage in the disease process. The cardinal ultrastructural changes in the brain in Reye's syndrome are astrocyte swelling and partial deglycogenation, myelin bleb formation and universal injury of neuron mitochondria. The mitochondrial injury consists of matrix disruption with moderate but not massive swelling. Dilatation of rough endoplasmic reticulum and nuclear changes occurred only in neurons with severely altered mitochondria. The organelle pathology of the brain in this case did not resemble the organelle pathology of the brain in human "hepatic encephalopathy" or in experimental ammonia intoxication in primates. The mitochondrial ultrastructure of the cerebral neurons resembled the unique mitochondrial ultrastructural changes seen in the liver parenchyma in Reye's syndrome.
Brain↗
ECG changes after experimental head trauma.
ECG changes have been recorded in 11 monkeys following experimental head injury. The principal changes include bradycardia, shortening of the Q-Tc interval, prolongation of the Q-T interval, and alterations of rhythm. The changes last from a few seconds to approximately 2 hours. It is concluded that the changes result from a massive autonomic out-flow from the injured brain and in occasional instances may result in death due to cardiac arrest.
Animals↗
Treatment of infected ventricular shunts.
25 shunt infections following 23 vascular and 2 peritoneal shunts are reviewed, thus enlarging a previous review. Intraventricular administration of antibiotics are essential to reach the CSF beyond the blood-SF barrier, the tubing and the valve. Methicillin in dosages of 25-50 mg/day, intraventricularly combined with systemic therapy, have been used most often in this series. The only death in this series occurred when the infection was cured. The remaining 24 have no evidence of residual infection following 6 months to 5 years. Only 14 have had shunt removal. The results indicate that shunt removal should not be the initial means of treating infected shunts.
Anti-Bacterial Agents↗
Medicolegal issues in pediatric neurosurgical practice.
The medical profession has an increasing interface with the profession of law and in no specialty is this more apparent than in pediatric neurosurgery. The areas of interface include the neurosurgeon as a defendant, as an expert witness, and as an ethicist. The role of a neurosurgical defendant may be eased if he/she is aware of the legal principles involved in malpractice litigation. This article discusses the doctrine of 'standard of care' as it applies presently in malpractice cases. The accepted defenses to a claim of breach of standard of care are outlined. The history of the principle of 'informed consent' is discussed briefly, as well as its present application. The position of the mature minor and emancipated minor in the process of informed consent is described. Finally, a few recommendations for avoidance of malpractice are suggested.
Child↗
Shunt-associated glomerulonephritis.
Six patients with glomerulonephritis in association with a ventriculovascular shunt were treated with three basic modes of therapy. Direct intraventricular instillation of antibiotic was used on seven occasions in five patients either as the definitive mode of therapy or as an adjunct to shunt removal. Ventricular fluid antibiotic concentrations were monitored in two patients and demonstrate that effective levels as compared to the specific minimal inhibitory concentration can only be achieved by this method. With resolution of the shunt infection, improvement in the clinical and laboratory parameters of renal function was noted. A recommended treatment protocol is outlined, including specific dosages for intraventricular antibiotics. The need for detailed and frequent post-treatment examination including serum immunoglobulin profile is stressed.
Anti-Bacterial Agents↗