ABSTRACT
Hyponatraemia and hypoosmolality in patients with central nervous system (CNS) disease or trauma are often ascribed to inappropriate secretion of antidiuretic hormone. A "cerebral" aetiology has been postulated. A review of published reports and data from the present study indicate that the increase in antidiuretic activity in these conditions is generally to be expected and is therefore appropriate. It is suggested that the hyponatraemia observed is the result of excessive administration of fluids. In patients with CNS disease or injured brains intravenous fluid intake should be limited to about 1 litre (of 2.5% glucose in 0.45% saline for a 70 kg adult) per day during the acute stress.
Subject(s)
Brain Diseases/etiology , Fluid Therapy/adverse effects , Hyponatremia/etiology , Arginine Vasopressin/metabolism , Brain Diseases/metabolism , Craniocerebral Trauma/complications , Craniocerebral Trauma/metabolism , Craniocerebral Trauma/therapy , Humans , Hyponatremia/metabolism , Iatrogenic Disease , Inappropriate ADH Syndrome/metabolismABSTRACT
Five examples of subdural air under tension after surgical evacuation of chronic subdural hematoma are presented. This complication can account for lack of improvement of worsening. The diagnosis is easily made with skull X-rays or computed tomography. A simple treatment using a percutaneous catheter connected to negative pressure is suggested.
Subject(s)
Hematoma, Subdural/surgery , Pneumocephalus/etiology , Postoperative Complications , Aged , Female , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/therapy , Humans , Male , Middle Aged , Radiography , SuctionABSTRACT
Persistent headaches after lumbar puncture or myelography can be due to intracranial hematoma. This possibility should be evaluated by computerized tomography, keeping in mind the difficulty in the diagnosis of the isodense subdural hematoma.
Subject(s)
Hematoma, Subdural/etiology , Myelography/adverse effects , Adult , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/surgery , Humans , Male , Tomography, X-Ray ComputedSubject(s)
Emergency Service, Hospital/standards , Neurosurgery , Trauma, Nervous System , Humans , United StatesABSTRACT
A zero to 100 digital scoring system for brain injury has been devised. Items scored are vital signs, ability to speak and follow commands, or when unable to do so, a nonverbal response to pain, pupillary reactivity and equality, eyelid opening, and extremity strength. Certain parameters are weighted more heavily than others. The system also allows the examiner to modify serial scores by up to four points in a positive or negative direction based on clinical judgment of improvement or worsening. Over 100 adult patients have been scored, and when evaluated simultaneously by two physicians, the two objective scores usually are within 1 to 3 points of each other and the subjective score varies less. It is possible to express the clinical course of brain-injured patients numerically. Those with an initial score of 25 or less have an extremely poor prognosis and those with 75 or more do very well.
Subject(s)
Brain Injuries/diagnosis , Neurologic Examination , Consciousness , Humans , Medical Records , Orientation , Pain , PrognosisABSTRACT
Water balance studies in postcraniotomy patients indicate that restriction of fluid intake to 1 liter daily maintains the patient in homeostatic balance. A larger fluid intake will expand the extracellular space and presumably unfavorably influence cerebral edema. Daily observation of serum sodium and osmolarity and blood urea nitrogen, and preserving their normalcy, is a rational way of regulating fluid intake of the brain-injured patient. Fluid restriction should be used with caution if hyperosmolar agents, diuretics, or dexamethasone are also administered.
