SEARCH · PubMed Health

Results for “Neurologic Recovery”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources

PubMedDate not supplied

Update of neuropathology and neurological recovery after traumatic brain injury.

This review focuses on the potential for traumatic brain injury to evoke both focal and diffuse changes within the brain parenchyma, while considering the cellular constituents involved and the subcellular perturbations that contribute to their dysfunction. New insight is provided on the pathobiology of traumatically induced cell body injury and diffuse axonal damage. The consequences of axonal damage in terms of subsequent deafferentation and any potential retrograde cell death and atrophy are addressed. The regional and global metabolic sequelae are also considered. This detailed presentation of the neuropathological consequences of traumatic brain injury is used to set the stage for better appreciating the neurological recovery occurring after traumatic injury. Although the pathological and clinical effects of focal and diffuse damage are usually intermingled, the different clinical manifestations of recovery patterns associated with focal versus diffuse injuries are presented. The recognizable patterns of recovery, involving unconsciousness, posttraumatic confusion/amnesia, and postconfusional restoration, that typically occur across the full spectrum of diffuse injury are described, recognizing that the patient's long-term recovery may involve more idiosyncratic combinations of dysfunction. The review highlights the relationship of focal lesions to localizing syndromes that may be embedded in the evolving natural history of diffuse pathology. It is noted that injuries with primarily focal pathology do not necessarily follow a comparable pattern of recovery with distinct phases. Potential linkages of these recovery patterns to the known neuropathological sequelae of injury and various reparative mechanisms are considered and it is proposed that potential biological markers and newer imaging technologies will better define these linkages.

Brain Injuries↗

PubMed2004

Recovery of neurologic function following nontraumatic spinal cord lesions in Israel.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess neurologic recovery and the manner in which it is affected by various factors following nontraumatic spinal cord lesions (NTSCLs). SUMMARY OF BACKGROUND DATA: NTSCLs comprise a considerable portion of spinal cord lesions. However, information about neurologic recovery in these lesions is scarce. METHOD: The study sample included 1,085 patients with NTSCL treated between 1962 and 2000 at the premier referral hospital for rehabilitation in Israel. Demographic and clinical data were collected from hospital charts. The degree of neurologic recovery was determined by comparing each patient's Frankel grades of neurologic deficit at first admission to rehabilitation and at discharge from the same hospitalization. The study population was also compared with previously studied 250 patients with traumatic spinal cord lesions (TSCLs). RESULTS: Complete or substantial neurologic recovery (upgrade to Frankel Grade D or E) occurred during rehabilitation in 51% of patients who were Grade A, B, or C on admission, and in 57% of those who were Grade C. Neurologic recovery in NTSCL during rehabilitation was significantly affected by initial Frankel grade and by NTSCL etiology. Age had a borderline effect. Gender, lesion level, and the decade of rehabilitation did not affect recovery. Recovery rate was usually higher in NTSCLs than in TSCLs. CONCLUSIONS: The prognosis for neurologic recovery is affected mainly by SCL severity and etiology, and is usually better in NTSCLs than in TSCLs.

Adolescent↗

PubMed2001

Severe hypothermia with cardiac arrest: complete neurologic recovery in a 4-year-old child.

A 4-year-old girl was lost for 17 hours in a snowstorm. Upon discovery, her core temperature was 72 degrees F (22 degrees C). While undergoing endotracheal intubation in the emergency department, she experienced sudden ventricular fibrillation and cardiac arrest. Closed chest cardiopulmonary resuscitation (CPR) was instituted, and standard rewarming measures were begun. Despite this, neither core temperature, nor the patient's arrhythmia, changed. An infraumbilical "mini-laparotomy" incision was made, with placement of a large silicone peritoneal dialysis catheter into the abdomen. This was then connected to a rapid infuser device, with the delivery of 1L of warmed, normal saline every 90 seconds. The core temperature reached 29 degrees C in 15 minutes, and a palpable pulse was detected. Lavage was continued until core temperature reached 34 degrees C, at which time transport to the pediatric intensive care unit was arranged. She was extubated the next day and discharged home, on the fourth hospital day, with apparent complete neurologic recovery. This is the first report of the successful use of rapid high-volume peritoneal lavage for the treatment of accidental severe hypothermia in a pediatric patient.

Child, Preschool↗

PubMedDate not supplied

Neurologic recovery and functional improvement after vecuronium-induced quadriparesis.

Vecuronium bromide (Norcuron, Organon, Inc., West Orange, NJ) is a common neuromuscular blocking agent used to facilitate mechanical ventilation. Cases have been reported in which prolonged use of vecuronium resulted in severe motor neuropathy, with or without myopathy. However, the time course of recovery, the functional prognosis, and the use of inpatient rehabilitation is not well-established. We are reporting the functional recovery of two cases with the diagnosis of severe vecuronium motor neuropathy and/or myopathy. The patients presented with pneumonia and meningococcemia, respectively, and received vecuronium during ventilatory support, which lead to quadriparesis. In one patient, vecuronium toxicity occurred while neuromuscular junction monitoring was in place. Significant improvement was noted during an average of 3 to 4 wk in a comprehensive inpatient rehabilitation program, documented by the improvement in total motor Functional Independence Measure scores for patient 1 (from 15 to 71) and for patient 2 (from 65 to 84). In addition, the distal compound motor amplitudes showed a 4-fold increase for the ulnar, a 7-fold increase for the median, an 11-fold increase for the peroneal, and a 3-fold increase for the tibial nerves on follow-up nerve conduction studies correlating with neurologic recovery. In summary, even when patients present with quadriparesis, the recovery after vecuronium toxicity appears to be favorable.

Activities of Daily Living↗

PubMed1991

A comparison of cardiopulmonary resuscitation with cardiopulmonary bypass after prolonged cardiac arrest in dogs. Reperfusion pressures and neurologic recovery.

Resuscitability and outcome after prolonged cardiac arrest were compared in dogs with standard external cardiopulmonary resuscitation (CPR) vs. closed-chest emergency cardiopulmonary bypass (CPB). Ventricular fibrillation (VF) was with no blood flow from VF 0 min to VF 10 min. Subsequent CPR basic life support (BLS) was from 10 min to VF 15 min. Then, group I (n = 13) received CPR advanced life support (ALS) from VF 15 min until restoration of spontaneous circulation to occur not later than VF 40 min. Group II (n = 14) received CPR-ALS from VF 15 min to VF 20 min without defibrillation, and then total CPB to defibrillation attempts started at VF 20 min, followed by assisted CPB to 2 h. Total ischemia time (no-flow time plus CPR time of MAP less than 50 mmHg) was unexpectedly shorter in group I (14.3 +/- 2.5 min) than in group II (18.6 +/- 2.3 min) (P less than 0.01). During CPR-BLS, coronary perfusion pressures were 25 +/- 9 mmHg in group I and 18 +/- 8 mmHg in group II (NS). Epinephrine during CPR-ALS, before countershock, raised coronary perfusion pressure to 40 +/- 10 mmHg in group I and 27 +/- 10 mmHg in group II (NS). In group II, coronary perfusion pressure increased during total CPB to 58 +/- 16 mmHg (P less than 0.01 vs. group I). Spontaneous normotension was restored in 11/13 dogs of group I and all 14 dogs of group II (NS). Ten dogs in each group followed protocol and survived to 96 h. Five of ten in group I and six of ten in group II were neurologically normal (NS). We conclude that: (1) Reperfusion with CPB yields higher coronary perfusion pressures than reperfusion with CPR-ALS; and (2) even after no blood flow for 10 min, optimized CPR can result in cardiovascular resuscitability and neurologic recovery, similar to those achieved by CPB.

Animals↗

PubMed2004

Effect of combined treatment with melatonin and methylprednisolone on neurological recovery after experimental spinal cord injury.

Spinal cord injury (SCI) results in the loss of function below the lesion. Secondary injury following the primary impact includes a number of biochemical and cellular alterations leading to tissue necrosis and cell death. Methylprednisolone (MP), by reducing edema and protecting the cell membrane against peroxidation, is the only pharmacological agent with a proven clinically beneficial effect on SCI. Melatonin, known as a free radical scavenger, has been shown to have an effect on lipid peroxidation following experimental SCI. The purpose of this study was to examine the effect of MP and melatonin on neurological, ultrastructural, and electrophysiological recovery. Female albino rats weighing 200-250 g were randomized into five groups of 18 rats each and six rats for the control group. Weight-drop trauma was performed for each group and a 30-mg/kg single dose of MP for rats in group 1, a 10-mg/kg single dose of melatonin for rats in group 2, and MP and melatonin in the same doses for rats in group 3 were administered immediately after trauma. The rats in group 4 were the vehicle group (treated with ethanol) and group 5 was the trauma group. The motor and somatosensory evoked potentials were recorded at the 4th hour, the 24th hour, and on the 10th day of the study for six rats in each group. Posttraumatic neurological recovery was recorded for 10 days using "motor function score" and inclined plane test. After electrophysiological study the rats were terminated for an analysis of lipid peroxidation level of the injured site of the spinal cord. Electron microscopic studies were performed to determine the effects of melatonin, MP, and the combined treatment with MP and melatonin on axons, neurons, myelin, nucleus, and intracytoplasmic edema. The groups treated with MP, melatonin, and a combination of both had significantly enhanced electrophysiological, biochemical, and neurological recovery and also showed better ultrastructural findings than the trauma and vehicle groups. Although combined treatment was significantly more effective on lipid peroxidation than melatonin or MP treatments alone, at the 10th day, neurobehavioral, electrophysiological, and ultrastructural recovery were at the same level. In conclusion, MP, melatonin, and MP and melatonin combined treatment modalities improved functional recovery at the same level. Future studies involving different doses of melatonin and different dose combinations with MP could promise better results since each drug has a different anti-oxidative mechanism of action.

Animals↗

PubMedDate not supplied

Early (99m)Tc-ethylcysteinate dimer brain SPECT patterns in the acute phase of stroke as predictors of neurological recovery.

OBJECTIVES: Accurate prediction of outcome in acute stroke would help in identifying subgroups of patients for therapeutic trials and intravenous thrombolysis. The purpose of this study was to prospectively test the hypothesis that brain SPECT, with (99m)Tc-L, L-ethylcysteinate dimer (ECD), a tracer sensitive to cell function, performed in the first hours after stroke onset, adds predictive power to concomitant neurological evaluation. METHODS: Twenty-four patients with a first-ever middle cerebral artery stroke were prospectively studied with ECD-SPECT within 12 h after stroke onset. Neurological evaluation was performed using Orgogozo's scale at admission and 3 months later in order to calculate the percent Martinez-Vila evolution indices (EI%). Semiquantitative visual analysis of SPECT images was performed in 6 cortical regions relevant for carotid artery territory. Both the extent and the intensity of cortical reduced ECD uptake were calculated, leading to an 'ischemia' score, corresponding to the sum of regions of interest (ROI) where ECD uptake was between 40 and 80% of the contralateral healthy hemisphere, and an 'irreversibly damaged tissue' (IDT) score, corresponding to an uptake below 40%, and a total score (ischemia + IDT). Each patient was assigned to one of three patterns: (1) pattern I with severe ECD cortical uptake reduction defined by at least one ROI with uptake under 40%, (2) pattern II with moderate ECD cortical uptake reduction (40-80%) only and (3) pattern III with normal ECD uptake. RESULTS: There were 11 patients (46%) with pattern I ECD-SPECT. This group had almost invariably (10/11 patients) a poor outcome. The 12 patients (50%) classified in pattern II had a variable clinical outcome, ranging from improvement to deterioration. The single patient with a normal SPECT (pattern III) had a full clinical recovery. Both total score and IDT score were strongly significantly correlated with neurological recovery EI% (respectively p = 0.006 and 0.004). Their predictive value was significantly higher than, and independent of, day 0 neurological evaluation. No patient had an increased ECD uptake. CONCLUSION: Our results show that the degree of ECD cortical uptake reduction, measured on early brain SPECT, is a strong predictor of neurological recovery. ECD-SPECT data have a higher predictive value than day 0 neurological evaluation. The apparently better predictive value of ECD over hexamethylpropyleneamine oxime may reflect this tracer's brain retention mechanisms which are weighted more towards cell function than towards perfusion. ECD-SPECT is easily obtainable and may help in selecting out from therapy those patients who are likely to have either very good or very poor spontaneous outcome, and thus improve the assessment of acute stroke and the choice of therapeutic strategy.

Acute Disease↗

PubMed1991

The influence of long-term nifedipine or indomethacin therapy on neurologic recovery from experimental spinal cord injury.

Inhibition of prostaglandin pathways and calcium channel conduction has been shown to improve neurological outcome after spinal cord injury. Functional recovery from such intervention has been routinely evaluated by a simple motor examination or somatosensory evoked potentials (SSEPs) after short-term drug administration. We comprehensively evaluated the influence of continuously administered indomethacin and nifedipine on functional outcome after impact spinal cord injury. SSEP and cortico-motor evoked potential records and neurologic examinations were obtained over 6 weeks after injury. Terminal histopathologic changes within the spinal cord were also examined. Only indomethacin significantly improved neurological function and reduced the severity of histopathologic change. Evoked potential analysis was not found to be of prognostic value. Modulation of prostaglandin pathways may enhance neurological recovery after spinal cord injury.

Animals↗

PubMed1985

Cardiopulmonary resuscitation, brain blood flow, and neurologic recovery.

A review of survival rates and neurologic outcome after cardiac resuscitation indicates the importance of rapid initiation of cardiopulmonary resuscitation (CPR) and of finding ways to further improve cerebral blood flow during CPR. Mechanisms for generating blood flow to the brain during CPR and experimental strategies for enhancing cerebral viability are discussed.

Cerebrovascular Circulation↗

PubMed1993

Improved neurological recovery of cerebral infarctions after plasmapheretic reduction of lipids and fibrinogen.

BACKGROUND AND PURPOSE: High fibrinogen levels have been assessed in cerebrovascular disease with a direct relation to both plasma and whole-blood viscosity, as well as cerebral blood flow. Heparin-induced extracorporeal low density lipoprotein precipitation (HELP) is a new method that safely and effectively reduces fibrinogen and plasma lipoproteins and improves blood flow properties. METHODS: We studied 26 patients with acute embolic stroke and 22 with multi-infarct dementia. Each received two treatments with HELP within 8 days. Each patient had measurement of the important blood constituents and evaluation of changes in clinical signs and symptoms related to their cerebrovascular disease. RESULTS: Each HELP treatment safely produced an immediate and significant reduction in rheological measures, including fibrinogen (P < .001), whole-blood viscosity at high and low shear rates, plasma viscosity, and red cell transit time (P < .01 each). Total cholesterol, low density lipoprotein (P < .0001 each), lipoprotein(a) (P < .003), and triglycerides (P < .0001) were also reduced. The treated group in both the acute stroke group and the multi-infarct group showed improvement relative to the untreated control subjects in Mathew scale, Mini-Mental State Examination, and activities of daily living test scores. These uniform improvements persisted at least 3 days past the second HELP treatment. CONCLUSIONS: These results support the hypothesis that the improved hemorheologic property of blood is an important factor in clinical recovery as well as basic neurological function.

Activities of Daily Living↗

PubMed1978

Neurological recovery distal to the zone of injury in 172 cases of closed, traumatic spinal cord injury.

The Southwest Regional System for Treatment of Spinal Cord Injury (Good Samaritan Hospital and St Joseph's Hospital, Phoenix, Arizona) treated 325 cases of traumatic spinal cord injury during the period June 1970 through December 1975. Of these, 172 met the study population criteria of the cases reported by Frankel et al. (1969) in their paper 'The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia'. These cases are compared with those reported by Frankel et al. (1969). Cases were divided into neurological categories. The demography of the two study populations was amazingly similar as was the neurological results. The means for the reported neurological changes show that the average recovery for patients treated at Stoke Mandeville was slightly greater for each neurological category; however, this difference was statistically significant only for cervical cases (P less than 0.01). One of the differences in the treatment given by the two centres was that the Southwest Regional System performed surgery on 39% of its cases and Stoke Mandeville none. The Southwest Regional System's non-operated cervical cases showed less average neurological recovery than Stoke Mandeville cervical cases (P less than 0.001). Comparison between the Southwest Regional System non-operated cases and operated cases revealed no significant differences within any neurological category. The average neurological change reported by both centres was relatively small, documenting that from the onset of injury the majority of people sustaining spinal cord injury are committed to living with paralysis, in most cases severe, for the rest of their lives.

Arizona↗

PubMed2001

The effect of 24 h blood pressure levels on early neurological recovery after stroke.

OBJECTIVES: To assess the influence of 24 h blood pressure (BP) levels on functional recovery 1 week after stroke and the effect of antihypertensive therapy on 24 h BP levels. DESIGN: Prospective study of patients admitted to hospital over 1 year with first in a lifetime stroke who underwent 24 h BP and casual measurements. Setting. Medical wards in a teaching hospital. Subjects. Of 160 patients, 72 patients admitted to hospital within 24 h of stroke onset were investigated. Patients with conditions and therapy that interfered with autonomic and sympathetic function were excluded. Interventions. All subjects underwent 24 h BP and casual recordings on admission to hospital and at day seven after stroke. The mean 24 h, day and night systolic BP (SBP) and diastolic BP (DBP) and their differences (nocturnal BP dip) were recorded. Patients were divided into three groups according to whether they were taking antihypertensive therapy during the first week: (i) no therapy, (ii) therapy continued after stroke, and (iii) new therapy introduced. Main outcome measures. Functional recovery (Rankin Scale 0-1) and neurological improvement [Scandinavian Stroke Scale (SSS) >/=3 points] by 1 week of stroke. Change in circadian 24 h BP over 1 week. RESULTS: For each 10 mmHg difference between day and night time DBP, the odds for making a complete recovery were 4.63 (95% CI: 1.57-13.7, P=0.01). For each 10 mmHg difference between day and night SBP, the odds for making an improvement in neurological status was 2.24 (95% CI: 1.16-4.32; P=0.016). Significant falls in 24 h DBP (P=0.01), daytime SBP (P=0.005) and mean arterial BP (MABP) (P=0.04) over 1 week were demonstrated in patients who had just commenced antihypertensive therapy (P=0.001). CONCLUSION: An increase in day to night time BP change is favourable in short-term outcome after acute stroke. Significant falls in BP are more likely in patients started on antihypertensive therapy for the first time. Further research is required to understand the effects of circadian BP rhythm on stroke outcome.

Aged↗

PubMed1989

Prediction of language and neurologic recovery after cerebral infarction with SPECT imaging using N-isopropyl-p-(I 123) iodoamphetamine.

Fourteen patients (10 with left-sided and 4 with right-sided cerebral infarction) were prospectively studied with single-photon emission computed tomography (SPECT) using N-isopropyl-p-(I 123) iodoamphetamine (IMP, SPECTamine) to determine its usefulness in predicting neurologic/language recovery after cerebral infarction. All neuro-SPECT imaging was performed within 30 days after infarction. Detailed assessment of neurologic and/or language recovery (after 3 months) was carried out prospectively in each patient. Patients with smaller volume IMP defects in the region of infarction demonstrated significantly better neurologic and language recovery than patients with large IMP defects. Analysis of the IMP "redistribution" phenomenon failed to demonstrate definitively a relationship with clinical recovery. It was concluded that the volume of the IMP defect can aid in predicting recovery potential after cerebral infarction.

Aged↗

PubMed2003

Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy.

PURPOSE: To compare the recovery profiles, efficacy and safety of remifentanil and morphine for transitional analgesia with fentanyl in patients undergoing elective craniotomy for supratentorial mass lesions. METHODS: Ninety-one patients were enrolled in this prospective, randomized, multicentre study. Anesthesia was induced with thiopental and remifentanil (1.0 micro g x kg(-1) bolus and a 1 micro g x kg(-1) x min(-1) infusion) or fentanyl (1 micro g x kg(-1) bolus and a 1.0 micro g x kg(-1) x min(-1) infusion). The opioid infusion continued until the level of anesthesia was deemed appropriate for intubation. Anesthesia was maintained with N(2)O/O(2), isoflurane 0.5 MAC and remifentanil 0.2 micro g x kg(-1) x min(-1) or fentanyl 0.04 micro g x kg(-1) x min(-1). At bone flap replacement, either morphine 0.08 mg x kg(-1) (remifentanil group) or saline (fentanyl group) was given. RESULTS: Systolic blood pressure was greater in those receiving fentanyl during induction (145.6 +/-17.5 mmHg vs 128.8 +/-18.3 mmHg; P = 0.006) and intubation (126.9 +/-17.1 vs 110.9 +/-16.5 mmHg; P < 0.001). Median time to tracheal extubation was similar but less variable in the remifentanil group (remifentanil = 8 min: range = 2-44 min; fentanyl = 8 min: range = 1-732 min). The fentanyl patients required a longer time to achieve the first normal neurological score (fentanyl = 38.0 min; remifentanil = 26.0 min; P = 0.035). Both the anesthesiologists and the recovery room nurses rated remifentanil better with respect to level of consciousness. Analgesics were required earlier in patients receiving remifentanil; median time 0.5 vs 1.08 hr, P < 0.001. CONCLUSIONS: Remifentanil is a suitable alternative to fentanyl in supratentorial craniotomy. Time to preoperative neurological recovery is faster and morphine provides some transitional analgesia without compromising the quality of recovery.

Adult↗

PubMed1980

Effect of postcirculatory-arrest life-support on neurological recovery in monkeys.

The existence of treatable postischemic (PI) changes which influence neurological outcome has been documented by this group before. A global brain ischemia model without cardiac arrest was developed in monkeys. It includes high-pressure neck tourniquet inflation plus hypotension for a reproducible ischemic insult; survival with reproducible neurological deficit (ND) under continuous PI life-support for 7 days with control of extracranial variables; and new ND and histopathological damage scoring systems. Hypoxemia, hypercarbia, hypotension, uremia, sepsis, and other extracranial complications PI in 50 unsatisfactory experiments led to immediate worsening in ND and brain death (ND = 100%) in most of these monkeys. In contrast, all monkeys with the same initial insult, with life-support according to protocol, survived with a 7 day ND of 60% or less. In 46 experiments of seven treatment groups, after 16 or 18 min ischemia, life support was according to protocol for 7 days. The control 1 protocol (spontaneous breathing when feasible) resulted in a mean 7-day ND score of 53% (including quadriplegia). Immobilization with pancuronium and controlled ventilation ameliorate deficit to an ND score of 19% (P less than 0.05) (including quadriparesis); this became control 2 protocol. Immobilization resulted in less neuronal damage in the neocortex. Severe repetitive hypertension worsened ND to 46%, versus 19% in controls (P less than 0.05). In separate series, neither heparinization over 72 hours PI, nor hemodilution to hematocrit 25% with dextran 40, changed final ND significantly from that of their control groups. Histopathological damage scores correlated with ND scores.

Animals↗

PubMed2002

[Post-ischemia neurologic recovery].

Stroke is one of the most common affliction of patients with neurological symptoms. Rehabilitation of stroke patients is a difficult task. Our knowledge on rehabilitation has recently improved with the emergence of data from new neuroimaging techniques. A prospective, double blind, cross over, placebo, controlled study on 8 patients with pure motor hemiparesia, is conducted to determine the influence of a single dose of fluoxetine on motor performance and cerebral activation of patients recovering from stroke. Each patient undergoes two functional magnetic resonance imaging (fMRI) examinations, one under fluoxetine and one under placebo. A single dose of fluoxetine is enough to modulate cerebral sensori-motor activation and significantly improves motor skills of the affected side. Further studies are required to investigate the effect of chronic administration of fluoxetine on motor function.

Cross-Over Studies↗

PubMed1993

EEG and prognosis of neurologic recovery of dogs under profound hypothermic circulatory arrest.

Deep hypothermia (18-20 degrees C) (DH) during prolonged circulatory arrest and cardiopulmonary bypass is used to repair complex intracardiac lesions and vascular neurosurgical lesions. DH diminishes the risk of ischemic damage and multiorgan failure after circulatory arrest. Profound hypothermia (PH) to 6-7 degrees C has recently been reported to improve the neurological outcome of dogs after 2 h of circulatory arrest. There are no reports of the possible utility of EEG activity to predict the neurological outcome. As a part of a controlled study of cardiopulmonary bypass and 2 h of circulatory arrest we compared EEG recovery to the neurological outcome in 2 groups of dogs: 4 under DH and 4 under PH. All of the dogs under PH had a good outcome: mean neurodeficit score was 6.25/500 in PH and 139.25/500 in DH dogs (P < 0.03); mean histopathological score was 19.25/100 for DH and 47.75/100 in PH dogs (P < 0.03). EEG activity 2 h after reperfusion and starting of rewarming correlated with eventual neurological outcome. EEG variables associated with good outcome were: main final frequency and degree of rhythmicity of the activity. We conclude that PH exerted a protective effect for animals undergoing 2 h of circulatory arrest. EEG was a useful tool for predicting neurological outcome under the studied conditions.

Animals↗

PubMed1997

Course of neurological recovery and cerebral prognostic signs during cardio-pulmonary resuscitation.

The recovery of cranial nerve reflexes was evaluated sequentially in time during the efforts at resuscitation in 111 victims of circulatory arrest of primary cardiovascular or pulmonary origin. Fifty-seven patients had some brain function when life support was initiated (Group I) while 54 had at first no such function (Group II). Recovery occurred in a fixed order, irrespective of the initial neurological status or subsequent outcome: spontaneous respiratory movements were either present or were the first function to return; thereafter followed pupillary light reflexes, coughing-swallowing, and ciliospinal reflexes, in that order. Orderly recovery was featured by a time-related return of reflexes and consciousness while abnormal courses were characterized by stagnation of the recovery process, lack of time-related return of and loss of function. Prognostic rules were similar for the two population groups. Reflex tests at 10-60 min of resuscitation differentiated patients who would regain consciousness from those remaining unconscious with sensitivities and specificities > or = 80. A positive pupillary response or coughing-swallowing at 10 min, or ciliospinal reflex at 20 min predicted return of consciousness with positive predictive values of 0.85-1.00 (prior odds 0.29) while negative tests at 20-30 min indicated failure of complete recovery with values of 0.94-100 (prior odds 0.89).

Brain Stem↗