ABSTRACT
The records of 159 severely head-injured patients (all in coma for longer than 6 hours) from Sydney, Australia, were studied. The clinical course, charted over a 2-week period, indicated that 60% of deaths occur by Day 3 and that 12% of patients remain in coma (Glagow Coma Scale (GCS) score less than 7) for more than 2 weeks. Overall, at long-term follow-up review more than 2 years after injury, 51% of patients were dead, 7% were severely disabled or vegetative, and 42% had a good to moderate recovery. Outcome of the patients in prolonged coma was assessed separately, with only one-third making a good or moderate recovery; two-thirds of the severely disabled patients came from this group. The high proportion of poor outcomes associated with prolonged coma suggests that this group of patients should be specifically targeted in research. One appropriate intervention with this group would be the restructuring and intensification of early rehabilitation. However, the GCS score lacks the precision needed for this type of study, and a better measure of recovery should be developed.
Subject(s)
Brain Injuries/physiopathology , Adult , Brain Injuries/mortality , Coma/mortality , Coma/physiopathology , Female , Humans , Male , Neurologic Examination , PrognosisABSTRACT
A child is described who presented with a large right vascular acoustic neuroma causing raised intracranial pressure and brain-stem compression. Ventriculoperitoneal shunting and arterial embolization were performed prior to total tumor excision. Acoustic neuromas are a rarity in childhood, and preoperative arterial embolization has infrequently been described as an adjunct to acoustic neuroma surgery.
Subject(s)
Embolization, Therapeutic , Neuroma, Acoustic/surgery , Cerebral Arteries/surgery , Child , Humans , Male , Neuroma, Acoustic/therapy , Preoperative CareABSTRACT
On the basis of observation of 26 patients, we consider that the common cause in trigeminal neuralgia and hemifacial spasm is compression of the nerve-root entry zone at the brainstem by a blood vessel, usually an artery. By mobilising the vessel, and securing it away from the nerve, symptoms were relieved in 16 of 17 patients with trigeminal neuralgia and in seven of nine patients with hemifacial spasm for a follow-up period of up to four years. Trigeminal microvascular decompression had few complications, but three patients treated for facial hemispasm had postoperative deafness and one had a probable small brainstem infarct. The major advantage of this surgical approach is that is possible to relieve the symptoms without facial anaesthesia or paralysis.
Subject(s)
Facial Muscles , Microsurgery/methods , Spasm , Trigeminal Neuralgia/surgery , Adult , Deafness/etiology , Female , Humans , Male , Middle Aged , Postoperative Complications , Radiography , Trigeminal Nerve/surgery , Trigeminal Neuralgia/diagnostic imagingSubject(s)
Biopsy, Needle/instrumentation , Brain Neoplasms/pathology , Stereotaxic Techniques/instrumentation , Tomography, X-Ray Computed/instrumentation , Aged , Astrocytoma/pathology , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Cerebral Ventricle Neoplasms/pathology , Female , Humans , Male , Middle Aged , Oligodendroglioma/pathology , Temporal LobeABSTRACT
Amygdaloidotomy was performed bilaterally on 15 and unilaterally on three patients exhibiting severe aggressive or self-mutilating behaviour. Nine subjects (50%) were improved a year after operation; improvement was maintained in seven (39%) for periods ranging from 27 months to nearly six years. Four non-epileptic cases had convulsions during the period of review; one of them has a persistent mild hemiparesis dating from the postoperative period. There was a tendency for epileptics to respond better than non-epileptics and for mentally retarded patients to respond poorly, but none of the differences was statistically significant.
