OBJECTIVETo seek consciousness regaining methods at early stage for coma patients in neurosurgery.

METHODSPatients whose Galsgows Coma Scale (GCS) < 8 including cerebral contusion, cerebral hemorrhage and brain tumor were randomly divided into an observation group (218 cases) and a control group (237 cases). Conventional medicine and/or surgery were used in two groups. After vital signs became stable, Xingnao Kaiqiao needling method was applied at Shuigou (GV 26), Baihui (GV 20), Neiguan (PC 6), etc. and combined with exercise therapy in observation group, while no rehabilitation therapy was used in control group. The therapeutic effect between two groups was compared.

RESULTSAfter 30 days' treatment, the conscious rate of observation group (80.7%, 176/218) was higher than that of control group (46.8%,111/237), and there was statistics significance between them (P < 0.001).

CONCLUSIONEarly acupuncture combined with exercise therapy can improve the conscious rate of coma patients in neurosurgery, thereby decrease their mortality and disability rate.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Child ; Coma ; therapy ; Consciousness ; Exercise Therapy ; Female ; Humans ; Male ; Middle Aged

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

Acute methanol poisoning harms the optic nerve and central nervous system, can cause irreversible damage, even coma or death in severe cases. This article reported four cases of methanol poisoning. 3 patients mistakenly ingested industrial alcohol containing methanol, the most serious patient suffered from coma, vision loss and other symptoms, the blood methanol concentration was 869.3 μg/ml. Another patient was poisoning caused by inhalation of methanol, with symptoms such as total blindness in the right eye and decreased visual acuity in the left eye. After active supportive treatment, 2 patients had partial recovery of visual acuity, and 2 patients had no sequelae. This article discussed the clinical features, treatment and prognosis of optic nerve damage caused by methanol poisoning, in order to raise awareness of this disease.
Coma ; Follow-Up Studies ; Humans ; Methanol ; Optic Nerve ; Optic Nerve Injuries ; Poisoning/therapy*

Head injuries are the commonest cause of death in the surgical wards in Port Moresby and the commonest cause of death in road accidents. Three prospective and retrospective studies performed over the last decade aimed to determine the pathology and outcome in 274 head injuries admitted to Goroka in 1988-1991 (4 years) and Port Moresby in 1984-1985 and 1992-1993 (total 2.5 years). Head injuries were managed by general surgeons without CT scanning or intracranial pressure monitoring. There were 196 adults and 78 (28%) children; 195 were male and 79 female. Assaults (32%), motor vehicle accidents (49%) and falls (17%) were the commonest modes of injury. The case fatality rate was 21% (57 of 274 cases). Six of the deaths were avoidable. The fatality rates for admission Glasgow Coma Scores of 3-5, 6-8 and over 9 were 81%, 21% and 3% respectively. Two patients died of infection complicating open depressed fractures. The case fatality rate for extradural haematoma was 20% and subdural haematoma 67%. Nine patients died of associated abdominal injuries. Most of the deaths were unavoidable because of the severity of primary brain injury. The speed of diagnosis and quality of care could have been improved but the most important area is management of the airway. General surgeons properly trained in trauma care (which includes emergency airway management) are well able to cope with the majority of head-injured patients in Papua New Guinea.
Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - therapy ; Glasgow Coma Scale ; Retrospective Studies

PURPOSE: This study was conducted to test criterion-related validity of the Critical Patients' Severity Classification System (CPSCS) developed by the Hospital Nurses' Association by examining relationships with brain injury severity measured by Glasgow Coma Scale (GCS), recovery state measured by Glasgow Outcome Scale (GOS), and days of stay in ICU of brain injury patients. METHODS: Prospective correlational research design was adopted by including 194 brain injury patients admitted to ICU of one university hospital. RESULTS: The score of CPSCS appeared to significantly discriminate the severity of brain injury. Among nursing activities in CPSCS, Respiratory therapy, IV Infusion and Medication, Monitoring, Activities of Daily Living (ADL), Treatment and Procedure were significant to discriminate the severity of brain injury. Respiratory therapy, Vital Signs, and Monitoring appeared to significantly discriminate the recovery states of 1- and 3-months. Nursing activities significantly contributed to predict the days of ICU stay were Respiratory therapy, ADL, and Teaching and Emotional Support. CONCLUSION: CPSCS developed by the Hospital Nurses Association appeared to be valid to discriminate or predict brain injury severity, recovery states, and days of stay in ICU for brain injury patients.
Activities of Daily Living ; Brain Injuries ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Prospective Studies ; Research Design ; Respiratory Therapy ; Vital Signs

The potential of hypothermia in reducing neuronal damage has been demonstrated in several animal models of focal cerebral ischemia. The feasibility and safety of this technique for acute stroke has been only examined in one study, describing a total of 25 patients. We analyzed the data from 50 consecutive patients with acute stroke treated with moderate hypothermia in neurocritical care units of 4 university clinics to evaluate the feasibility and safety of moderate hypothermia.
Acute Disease ; Adult ; Aged ; Cerebral Infarction ; therapy ; Female ; Glasgow Coma Scale ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo observe the promoting consciousness effect of electroacupuncture therapy on the patients with long-term coma caused by severe craniocerebral trauma.

METHODSTwenty-nine cases with coma more than 3 weeks and Glasgow Coma Scales (GCS) of 8 or less were divided into an observation group (n=15) and a control group (n=14). They were treated with the same western medicine. In addition to ordinary treatment, the observation group was treated with electroacupuncture at Baihui (GV 20), Shuigou (GV 26), Yongquan (KI 1) etc. for 30 min and the needles were retained for 30 min, once each day.

RESULTSThe average awake time and awake rate were 40.1 days and 73.3% (11/15) respectively in the observation group, which were higher than 51.8 days and 28.6% (4/14) in the control group.

CONCLUSIONElectroacupuncture therapy combine with western medicine is more effective in improving consciousness of patients in coma caused by severe craniocerebral trauma.

Acupuncture Points ; Adolescent ; Adult ; Coma ; psychology ; therapy ; Consciousness ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: The authors present their experiences with stereotactic multiplanar reformatted (MPR) computed tomography (CT)-guided catheter placement for thrombolysis of spontaneous intracerebral hematoma (sICH) and their clinical results. METHODS: In 23 patients with sICH, MPR CT-guided catheter placement was used to select the trajectory and target point of hematoma drainage. This group was comprised of 11 men and 12 women, and the mean age was 57.5 years (range, 31-79 years). The patients' initial Glasgow Coma Scale scores ranged from 7 to 15 with a median of 11. The volume of the hematoma ranged from 24 mL to 86 mL (mean 44.5 mL). A trajectory along the main axis of the hematoma was considered to be optimal for thrombolytic therapy. The trajectory was calculated from the point of entry through the target point of the hematoma using reformatted images. RESULTS: The hematoma catheter was left in place for a median duration of 48.9 hours (range 34 to 62 hours). In an average of two days, the average residual hematoma volume was 6.2 mL (range 1.4 mL to 10.2 mL) and was reduced by an average of 84.7% (range 71.6% to 96.3%). The residual hematoma at postoperative seven days was less than 5 mL in all patients. There was no treatment-related death during hospitalization. CONCLUSION: The present study indicates that stereotactic MPR CT-guided catheter placement for thrombolysis is an accurate and safe procedure. We suggest that this procedure for stereotactic removal of sICH should be considered for the optimization of the trajectory selection in the future.
Axis, Cervical Vertebra ; Catheters ; Drainage ; Female ; Glasgow Coma Scale ; Hematoma ; Hospitalization ; Humans ; Hypogonadism ; Male ; Mitochondrial Diseases ; Ophthalmoplegia ; Thrombolytic Therapy

A retrospective study of 90 cases of small-sized (less than 3 mm on the printed CT film) acute (within 24 hours) subdural hematoma (SASDH) is presented. From March 1985 to December 1986, the SASDH were immediately operated on (operation rate: 86.0%). From January 1988 to December 1989, we attempted to treat them conservatively (operation rate: 49.1%). The patient population for this study consisted of 38 surgically-treated patients in the first period (Group I), 26 surgically-treated patients in the second period (Group IIs), and 26 conservatively-treated patients in the second period (Group IIc). We compared the clinical features, radiologic findings, and outcome of these 3 groups. The clinical features of Group I, including age, sex, Glasgow Coma Scale (GCS) score on admission, pupillary status on arrival, and interval from injury to the CT, did not differ significantly from those of Group II (P greater than 0.01). The only difference was the timing of the operation. In Group I, 20 patients (52.6%) received an operation within 4 hours, while in Group IIs, only 7 patients (26.9%) underwent surgery within 4 hours (P less than 0.05). The radiologic findings of Group I, including the thickness and volume of the hematoma, the degree of midline shift, and the frequency of skull fracture, also did not differ from those of Group II (P greater than 0.1). However, the outcome of Group II strikingly differed from that of Group I. The mortality rate was 76.3% in Group I, while it was 44.2% in Group II (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease ; Adult ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/mortality/pathology/radiography/*therapy ; Humans ; Male ; Time Factors ; Treatment Outcome

OBJECTIVE: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs. METHOD: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program. RESULTS: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation. CONCLUSION: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.
Adult ; Brain ; Brain Injuries* ; Comprehension ; Glasgow Coma Scale ; Humans ; Incidence ; Language Disorders* ; Language Therapy ; Mass Screening ; Prognosis ; Writing