Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO2) and outcome. The results were as follows; The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases(61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 29 cases(85%), 17 cases(50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occurred in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5 ml/100 ml in AVDO2 was developed in 32 cases(94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20 mmHg in 15 cases(44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases(15%), prothrombin time(PT) prolongation in 11 cases(32%), activated partial thromboplastin time(APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO2 was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading(NG), GOS IV was developed in 8 cases(NG score 3-6), GOS III in 5 cases(NG score 7-9), GOS II in 2 cases(NG score 10). Total mortality rate was 56%.
Axons* ; Barbiturates ; Blood Platelets ; Cerebral Infarction ; Coma ; Coma, Post-Head Injury ; Diffuse Axonal Injury ; Emergency Service, Hospital ; Female ; Fibrinogen ; Head ; Humans ; Male ; Mortality ; Oxygen ; Prothrombin ; Pupil ; Resuscitation ; Thromboplastin

Sixty-seven patients with moderate to severe cerebral diffused sxonal injuries(that is, in post-traumatic coma for over 24 hours without mass lesions or ischemic insults) were admitted during past four years and four months period ending April 30, 1991. A retrospective study of these patients was done for identification of prognostic factor. The ratio of male to female was 2.7 to 1 and the peak incidence was at the second decade. The most common cause of trauma was traffic accident and pedestrian trauma was the most common event among that. Forty-nine patients(73%) recovered from coma, nine(13%) remained in vegetative state and another nine(13%) died. The median duration of coma was 13 days. The age, initial Glasgow Coma scale(GCS), prolonged duration of coma, initial motor reactivities, signs of hypothalamic damage, corpus callosum and brain stem lesions on brain MRI were proved as adverse factors for prognosis.
Accidents, Traffic ; Brain Stem ; Brain* ; Coma ; Coma, Post-Head Injury ; Corpus Callosum ; Diffuse Axonal Injury* ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Retrospective Studies

OBJECTIVETo determine the effect of arousal methods for prolonged coma of 175 patients with severe traumatic brain injury and related factors.

METHODSThere were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs.

RESULTSIn the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness (72.9%); in 42 cases with coma of 4-6 months, 20 cases recovered consciousness (47.6); and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness (26.7%). The recovery of consciousness depended on patient's primary brain stem damage, cerebral hernia, GCS score, and age.

CONCLUSIONSApplication of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.

Adolescent ; Adult ; Aged ; Brain Injuries ; therapy ; Child ; Child, Preschool ; Coma, Post-Head Injury ; therapy ; Female ; Glasgow Coma Scale ; Humans ; Male ; Middle Aged ; Recovery of Function ; Treatment Outcome

We investigated neurobehavioural sequelae after head injury in consecutive 104 patients who were evaluated by psychometric examinations from 1990 to 1994. Organic brain syndrome(OBS), posttraumatic stress disorder(PTSD), and others were observed in 55 patients(52.9%), 37 patients(35.6%), and 12 patients(11.5%), respectively. OBS was more common when the initial Glasgow Coma Score was low or when there was an intradural demage(p<0.025). OBS and PTSD did not differ significantly in age, sex, cause of injury, interval from injury to psychometric examination, skull fracture, cranial operation, or the Injury Severity Score. In OBS, the mean verbal Intellegence Quotient(IQ) was 91.3, performance IQ 77.8, total IQ 84.9 and memory quotient 70.7. In PTSD, it was 101.4, 100.1, 100.9 and 77.8, respectively. Performance IQ and total IQ of OBS and PTSD differed significantly, but verbal and memory quotient did not. In OBS, the mean verbal IQ of patients with right hemispheric damage was generally higher than that of patients with the left hemispheric damage, except in vocabulary and comprehension. But that of performance IQ was the reverse. In OBS, simplification, distortion, rotation, omit, impaired judgement, labile affect, impulsivity, depression, flatness, apathy, and bluntedness were commonly observed. While somatization, hostility, frustration, faking bad, and retarded manner were more frequently found in PTSD. The burden imposed on the family is primarily attributable to neurobehavioral sequelae rather than motor or sensory deficits. We should concerned about the adequate management of neurobehavioral sequelae as much as the proper treatment of head injury during the acute period.
Apathy ; Brain ; Coma ; Comprehension ; Craniocerebral Trauma* ; Depression ; Frustration ; Head* ; Hostility ; Humans ; Impulsive Behavior ; Injury Severity Score ; Memory ; Psychometrics* ; Skull Fractures ; Stress Disorders, Post-Traumatic ; Vocabulary