✓ Previous studies have suggested that only a small proportion (< 15%) of comatose head-injured patients whose initial computerized tomography (CT) scan was normal or did not show a mass lesion, midline shift, or abnormal basal cisterns develop intracranial hypertension. The aim of the present study was to re-examine this finding against a background of more intensive monitoring and data acquisition.
Eight severely head-injured patients with a Glasgow Coma Scale score of 8 or less, whose admission CT scan did not show a mass lesion, midline shift, or effaced basal cisterns, underwent minute-to-minute recordings of arterial blood pressure, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) derived from blood pressure minus ICP. Intracranial hypertension (ICP ≥ 20 mm Hg lasting longer than 5 minutes) was recorded in seven of the eight patients; in five cases the rise was pronounced in terms of both magnitude (ICP ≥ 30 mm Hg) and duration. Reduced CPP (≤ 60 mm Hg lasting longer than 5 minutes) was recorded in five patients.
Severely head-injured (comatose) patients whose initial CT scan is normal or does not show a mass lesion, midline shift, or abnormal cisterns nevertheless remain at substantial risk of developing significant secondary cerebral insults due to elevated ICP and reduced CPP. The authors recommend continuous ICP and blood pressure monitoring with derivation of CPP in all comatose head-injured patients.
AndrewsPJD,,PiperIR,&DeardenNM,et al:Secondary insults during intrahospital transport of head-injured patients.Lancet335:327–330,1990Andrews PJD, Piper IR, Dearden NM, et al: Secondary insults during intrahospital transport of head-injured patients.Lancet 335:327–330, 1990
BakerSP,&O'NeillB:The Injury Severity Score: an update.J Trauma16:882–885,1976Baker SP, O'Neill B: The Injury Severity Score: an update.J Trauma 16:882–885, 1976
BeckerDP:Selecting patients for intracranial pressure monitoring in severe head injury, inIshiiS,,NagaiH,&BrockM(eds):Intracranial Pressure V.New York:Springer-Verlag,1983, pp512–516Becker DP: Selecting patients for intracranial pressure monitoring in severe head injury, in Ishii S, Nagai H, Brock M (eds):Intracranial Pressure V.New York: Springer-Verlag, 1983, pp 512–516
BeckerDP,,MillerJD,&WardJD,et al:The outcome from severe head injury with early diagnosis and intensive management.J Neurosurg47:491–502,1977Becker DP, Miller JD, Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management.J Neurosurg 47:491–502, 1977
CliftonGL,,GrossmanRG,&MakelaME,et al:Neurological course and correlated computerized tomography findings after severe closed head injury.J Neurosurg52:611–624,1980Clifton GL, Grossman RG, Makela ME, et al: Neurological course and correlated computerized tomography findings after severe closed head injury.J Neurosurg 52:611–624, 1980
ColquhounIR,&BurrowsEH:The prognostic significance of the third ventricle and basal cisterns in severe closed head injury.Clin Radiol40:13–16,1989Colquhoun IR, Burrows EH: The prognostic significance of the third ventricle and basal cisterns in severe closed head injury.Clin Radiol 40:13–16, 1989
CooperPR,,MaravillaK,&MoodyS,et al:Serial computerized tomographic scanning and the prognosis of severe head injury.开云体育app官方网站下载入口5:566–569,1979Cooper PR, Maravilla K, Moody S, et al: Serial computerized tomographic scanning and the prognosis of severe head injury.Neurosurgery 5:566–569, 1979
EisenbergHM,,GaryHEJr,&AldrichEF,et al:Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank.J Neurosurg73:688–698,1990Eisenberg HM, Gary HE Jr, Aldrich EF, et al: Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank.J Neurosurg 73:688–698, 1990
FrenchBN,&DublinAB:The value of computerized tomography in the management of 1000 consecutive head injuries.Surg Neurol7:171–183,1977French BN, Dublin AB: The value of computerized tomography in the management of 1000 consecutive head injuries.Surg Neurol 7:171 - 183年,1977年
GennarelliTA,,SpielmanGM,&LangfittTW,et al:Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system.J Neurosurg56:26–32,1982Gennarelli TA, Spielman GM, Langfitt TW, et al: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system.J Neurosurg 56:26–32, 1982
HollidayPOIII,,KellyDLJr,&BallM:Normal computed tomograms in acute head injury: correlation of intracranial pressure, ventricular size, and outcome.开云体育app官方网站下载入口10:25–28,1982霍利迪阿宝三世,凯莉DL Jr,球M:正常的计算机ted tomograms in acute head injury: correlation of intracranial pressure, ventricular size, and outcome.Neurosurgery 10:25–28, 1982
JennettB,&BondM:Assessment of outcome after severe brain damage. A practical scale.Lancet1:480–484,1975Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale.Lancet 1:480–484, 1975
JennettB,,TeasdaleG,&FryJ,et al:Treatment for severe head injury.J Neurol Neurosurg Psychiatry43:289–295,1980Jennett B, Teasdale G, Fry J, et al: Treatment for severe head injury.J Neurol Neurosurg Psychiatry 43:289–295, 1980
JonesPA,,AndrewsPJ,&MidgelyS,et al:Assessing the burden of secondary insults in head injured patients during intensive care.J Neurol Neurosurg Psychiatry56:571–573,1993(Abstract)Jones PA, Andrews PJ, Midgely S, et al: Assessing the burden of secondary insults in head injured patients during intensive care.J Neurol Neurosurg Psychiatry 56:571–573, 1993 (Abstract)
KishorePRS,,LipperMH,&BeckerDP,et al:Significance of CT in head injury: correlation with intracranial pressure.AJNR2:307–311,1981Kishore PRS, Lipper MH, Becker DP, et al: Significance of CT in head injury: correlation with intracranial pressure.AJNR 2:307–311, 1981
LobatoRD,,CordobesF,&RivasJJ,et al:Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study.J Neurosurg59:762–774,1983Lobato RD, Cordobes F, Rivas JJ, et al: Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study.J Neurosurg 59:762–774, 1983
LobatoRD,,SarabiaR,&RivasJJ,et al:Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications.J Neurosurg65:784–789,1986Lobato RD, Sarabia R, Rivas JJ, et al: Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications.J Neurosurg 65:784–789, 1986
MarmarouA,,AndersonRL,&WardJD,et al:Impact of ICP instability and hypotension on outcome in patients with severe head trauma.J Neurosurg75:S59–S66,1991Marmarou A, Anderson RL, Ward JD, et al: Impact of ICP instability and hypotension on outcome in patients with severe head trauma.J Neurosurg 75:S59–S66, 1991
MarshallLF,,MarshallSB,&KlauberMR,et al:A new classification of head injury based on computerized tomography.J Neurosurg75:S14–S20,1991Marshall LF, Marshall SB, Klauber MR, et al: A new classification of head injury based on computerized tomography.J Neurosurg 75:S14–S20, 1991
MarshallLF,,SmithRW,&ShapiroHM:结果积极的treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring.J Neurosurg50:20–25,1979马歇尔低频,史密斯RW,夏皮罗嗯:智慧的结果h aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring.J Neurosurg 50:20–25, 1979
MarshallLF,,SmithRW,&ShapiroHM:结果积极的treatment in severe head injuries. Part II: Acute and chronic barbiturate administration in the management of head injury.J Neurosurg50:26–30,1979马歇尔低频,史密斯RW,夏皮罗嗯:智慧的结果h aggressive treatment in severe head injuries. Part II: Acute and chronic barbiturate administration in the management of head injury.J Neurosurg 50:26–30, 1979
MillerJD,,BeckerDP,&WardJD,et al:Significance of intracranial hypertension in severe head injury.J Neurosurg47:503–516,1977Miller JD, Becker DP, Ward JD, et al: Significance of intracranial hypertension in severe head injury.J Neurosurg 47:503–516, 1977
MillerJD,,ButterworthJF,&GudemanSK,et al:Further experience in the management of severe head injury.J Neurosurg54:289–299,1981Miller JD, Butterworth JF, Gudeman SK, et al: Further experience in the management of severe head injury.J Neurosurg 54:289–299, 1981
MillerJD,,SweetRC,&NarayanR,et al:Early insults to the injured brain.JAMA240:439–442,1978Miller JD, Sweet RC, Narayan R, et al: Early insults to the injured brain.JAMA 240:439–442, 1978
NarayanRK,,KishorePRS,&BeckerDP,et al:颅内压:显示器或监视器r? A review of our experience with severe head injury.J Neurosurg56:650–659,1982Narayan RK, Kishore PRS, Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury.J Neurosurg 56:650–659, 1982
PiperIR,,LawsonA,&DeardenNM,et al:A computerised data collection system for a head injury intensive care unit.Br J Intens Care1:73–78,1991Piper IR, Lawson A, Dearden NM, et al: A computerised data collection system for a head injury intensive care unit.Br J Intens Care 1:73–78, 1991
RobersonFC,,KishorePRS,&MillerJD,et al:The value of serial computerized tomography in the management of severe head injury.Surg Neurol12:161–167,1979Roberson FC, Kishore PRS, Miller JD, et al: The value of serial computerized tomography in the management of severe head injury.Surg Neurol 12:161–167, 1979
RosnerMJ,&BeckerDP:ICP monitoring: complications and associated factors.Clin Neurosurg23:494–519,1976Rosner MJ, Becker DP: ICP monitoring: complications and associated factors.Clin Neurosurg 23:494–519, 1976
SadhuVK,,SampsonJ,&HaarFL,et al:Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients.Radiology133:507–509,1979Sadhu VK, Sampson J, Haar FL, et al: Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients.Radiology 133:507–509, 1979
StuartGG,,MerryGS,&SmithJA,et al:Severe head injury managed without intracranial pressure monitoring.J Neurosurg59:601–605,1983Stuart GG, Merry GS, Smith JA, et al: Severe head injury managed without intracranial pressure monitoring.J Neurosurg 59:601–605, 1983
TabaddorK,,DanzigerA,&WisoffHS:Estimation of intracranial pressure by CT scan in closed head trauma.Surg Neurol18:212–215,1982Tabaddor K, Danziger A, Wisoff HS: Estimation of intracranial pressure by CT scan in closed head trauma.Surg Neurol 18:212–215, 1982
TeasdaleE,,CardosoE,&GalbraithS,et al:CT scan in severe diffuse head injury: physiological and clinical correlations.J Neurol Neurosurg Psychiatry47:600–603,1984Teasdale E, Cardoso E, Galbraith S, et al: CT scan in severe diffuse head injury: physiological and clinical correlations.J Neurol Neurosurg Psychiatry 47:600–603, 1984
TeasdaleG,&JennettB:Assessment of coma and impaired consciousness. A practical scale.Lancet2:81–94,1974Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale.Lancet 2:81–94, 1974
ToutantSM,,KlauberMR,&MarshallLF,et al:Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury.J Neurosurg61:691–694,1984Toutant SM, Klauber MR, Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury.J Neurosurg 61:691–694, 1984
van DongenKJ,,BraakmanR,&GelpkeGJ:The prognostic value of computerized tomography in comatose head-injured patients.J Neurosurg59:951–957,1983van Dongen KJ, Braakman R, Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients.J Neurosurg 59:951–957, 1983
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 633 | 151 | 8 |
Full Text Views | 165 | 9 | 0 |
PDF Downloads | 112 | 9 | 0 |
EPUB Downloads | 0 | 0 | 0 |