No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

Since Teasdale and Jennet published a method that had been evolved in Glasgow for assessing the so-called "conscious level" in 1974, the method has undergone extensive evaluation, has been adapted widely and has come to be known as the "Glasgow Coma Scale". However some investigators raised a question about interpretation of the scale in argument, particularly in terms of analysis of prognosis. It may be indispensable for clinicians and investigators to come to an agreement in interpretation of each other's investigational result with the same idea about "Glasgow Coma Scale". So the authors now review some of the factors that contributed to the design of the scale, how it has withstood the test of both scientific study and practical usage, and also to set into context its offspring, the "Glasgow Coma Scale".
Coma ; Craniocerebral Trauma ; Glasgow Coma Scale* ; Humans ; Prognosis ; Research Personnel

The author studied the relationship of age, Glasgow coma scale, Glasgow outcome scale and appearance of basal cisterns as seen on intial computerized tomography on 95 patients with severe diffuse head injury. The results were as follows : 1) The poor outcome rates were 76.8%, 41.2% and 16.6% among those absent, compressed, and normal basal cisterns, respectively. 2) The correlation with the initial GCS score and the status of basal cistern indicated significant difference of poor outcome rate in the patients with absent or compressed basal cisterns between GCS score 3-5 group and GCS 6-8 group while the patients with normal basal cisterns indicated significantly reduced poor outcome rate regardless of GCS score. 3) When outcome was observed in connection with the patient's age and the status of the basal cisterns, a good recovery was significantly increased in the children with normal basal cisterns while the poor outcome rate was very high in the elderly patients even if the basal cisterns were normal. Therefore, the status of the basal cisterns on CT Scan should be used as non-invasive method for predicting the outcome of severe diffuse head injured patients.
Aged ; Child ; Craniocerebral Trauma* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head* ; Humans ; Tomography, X-Ray Computed*

OBJECTIVE: Acute cerebral infarction is often accompanied by transtentorial herniation which can be fatal. The aim of this study is to determine the timing of surgical intervention and prognostic factors in patients who present with acute cerebral infarction. METHODS: We reviewed retrospectively 23 patients with acute cerebral infarction, who received decompressive craniectomy or conservative treatment from January 2002 to December 2004. We divided patients into two groups according to the treatment modalities (Group 1: conservative treatment, Group 2: decompressive craniectomy). In all patients, the outcome was quantified with Glasgow Outcome Scale and Barthel Index. RESULTS: Of the 23 patients, 11 underwent decompressive craniectomy. With decompressive craniectomy at the time of loss of pupillary light reflex, we were able to prevent death secondary to severe brain edema in all cases. Preoperative Glasgow Coma Scale and loss of pupillary light reflex were significant to the clinical outcome statistically. With conservative treatment, 9 of the 12 patients died secondary to transtentorial herniation. The clinical outcomes of remaining 3 patients were poor. CONCLUSION: This study confirms the value of life-saving procedure of decompressive craniectomy after acute cerebral infarction. We propose that the loss of pupillary light reflex should be considered one of the most important factors to determine the timing of the decompressive craniectomy.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Reflex ; Retrospective Studies

OBJECTIVE: Acute subdural hematoma (ASDH) with good initial Glasgow Coma Scale (GCS) score 13-15 is generally regarded as a mild head injury. However, the risk increases when significant amount of hematoma with midline shift exists. This study is to evaluate the clinical outcomes of patients with good neurological scores in spite of significant amounts of ASDH, and to compare the outcomes according to the treatment modalities. METHODS: Sixty patients with initial GCS score 13-15 in spite of significant amounts of ASDH and midline shifts were enrolled. They were divided into groups according to age, sex, side of location, initial GCS score, midline shift, and hematoma thickness. According to the therapeutic modalities, early craniotomy and initially conserved groups were identified, and initially conserved group was further classified into persistently conserved and delayed operation groups. The outcomes were measured by Glasgow Outcome Scale. RESULTS: Initial GCS score was a significant factor that influenced the final outcome (p=0.001). The outcomes were good in both early craniotomy and initially conserved groups without significant differences (p=0.268). Fifteen of initially conserved 49 patients underwent delayed operations from neurological deteriorations, but the outcomes were good without significant differences from persistently conserved group (p=0.481). CONCLUSION: Initial GCS score is an important factor that influences the clinical outcome. These patients can be conserved under close observations without early preventive craniotomies if no deteriorations are seen in the acute stage. Only those with delayed deteriorations may require simple operations such as burr hole trephinations which still guarantee good outcomes.
Craniocerebral Trauma ; Craniotomy ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hematoma, Subdural, Acute ; Humans

OBJECTIVE: Epidural hematoma of posterior fossa is less common than epidural hematoma of supratentorial area, and there are not many articles about epidural hematoma of posterior fossa. This study investigated patients who underwent surgery of epidural hematoma of posterior fossa, and the relation between the clinical manifestation and postoperative outcome. METHODS: A retrospective analysis performed of 27 patients who underwent operation for acute traumatic epidural hematoma of posterior fossa from January 2004 to December 2011. Analyzed factors were gender, age, Glasgow Coma Scale (GCS) measured upon presentation to the hospital, preoperative GCS score, cause of trauma, time elapsed from the accident to the presentation to the hospital, time elapsed from the presentation to the hospital to the surgery, radiographic findings (brain CT findings), and Glasgow Outcome Scale (GOS). RESULTS: Two patients (7.4%) had GCS score on admission of 3-8, 11 (29.6%) had 9-12, and 17 (66.7%) had 13-15. In 1 (3.7%) patient, GCS score changed from 13 to 10, and preoperative GCS score was significantly correlated with GOS score (p<0.05). Mean thickness of hematoma was 19.3+/-7.5 mm, and was significantly correlated with GOS score (p<0.05). GOS score was 4-5 in 24 patients (88.9%), 3 (severe disability) in 1 patient (3.7%), and 1 (death) in 2 patients (7.4%). CONCLUSION: In the patients underwent surgery for epidural hematoma of posterior fossa, 88.9% had favorable outcome (in GOS score of 4 or more). Preoperative GCS score and thickness of hematoma on brain computed tomography are important determinants of prognosis.
Brain ; Cranial Fossa, Posterior ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Humans ; Prognosis ; Retrospective Studies

OBJECTIVE: Spontaneous cerebellar hemorrhage (SCH) is less common than supratentorial intracerebral hemorrhage. This study investigated the treatment of SCH and the relation between its clinical and radiological manifestation and outcome. MATERIALS AND METHODS: We presented a SCH management protocol in our institute and analyzed the clinical and radiological findings in 41 SCH patients. The outcomes of each method (surgery and conservative treatment) were compared among patients with initial Glasgow Coma Scale (GCS) score of 9-13 and hematoma volume greater than 10 mL. RESULTS: Two (4.9%), 16 (39%), and 23 (56.1%) patients had an initial GCS score of 3-8, with 3-8, 9-13, and 14-15, respectively. Initial GCS score showed significant correlation with Glasgow Outcome Scale (GOS) score (p = 0.005). The mean largest hematoma diameter was 3.2 +/- 1.5 cm, and the mean volume was 11.0 +/- 11.5 mL. Both of them showed significant inverse correlation with GOS score (p < 0.001). Among patients with an initial GCS score of 9-13 and hematoma volumes greater than 10 mL, 3 (50%) had good outcome and 3 (50%) had poor outcome in the surgical, and all of those in the conservative treatment group had poor outcomes. The outcome distribution differed significantly in the surgical and conservative groups (p = 0.030). CONCLUSION: Initial GCS score and largest hematoma diameter and volume on brain computed tomography are important determinants of outcome in SCH patients. The surgery group showed better outcome than the conservative treatment group among those with an intermediate neurological status and large hematomas.
Brain ; Cerebellum ; Cerebral Hemorrhage ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage* ; Humans

OBJECTIVE: Spontaneous cerebellar hemorrhage (SCH) is less common than supratentorial intracerebral hemorrhage. This study investigated the treatment of SCH and the relation between its clinical and radiological manifestation and outcome. MATERIALS AND METHODS: We presented a SCH management protocol in our institute and analyzed the clinical and radiological findings in 41 SCH patients. The outcomes of each method (surgery and conservative treatment) were compared among patients with initial Glasgow Coma Scale (GCS) score of 9-13 and hematoma volume greater than 10 mL. RESULTS: Two (4.9%), 16 (39%), and 23 (56.1%) patients had an initial GCS score of 3-8, with 3-8, 9-13, and 14-15, respectively. Initial GCS score showed significant correlation with Glasgow Outcome Scale (GOS) score (p = 0.005). The mean largest hematoma diameter was 3.2 +/- 1.5 cm, and the mean volume was 11.0 +/- 11.5 mL. Both of them showed significant inverse correlation with GOS score (p < 0.001). Among patients with an initial GCS score of 9-13 and hematoma volumes greater than 10 mL, 3 (50%) had good outcome and 3 (50%) had poor outcome in the surgical, and all of those in the conservative treatment group had poor outcomes. The outcome distribution differed significantly in the surgical and conservative groups (p = 0.030). CONCLUSION: Initial GCS score and largest hematoma diameter and volume on brain computed tomography are important determinants of outcome in SCH patients. The surgery group showed better outcome than the conservative treatment group among those with an intermediate neurological status and large hematomas.
Brain ; Cerebellum ; Cerebral Hemorrhage ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage* ; Humans

OBJECTIVE: Patients with severe spontaneous cerebellar hemorrhage typically undergo treatment with suboccipital craniectomy and hematoma evacuation. However, this is a stressful procedure for patients due to the long operating time and operation-induced tissue damage. In addition, the durotomy can result in pseudomeningocele. We investigated the efficacy of stereotactic or navigation-guided burr hole aspiration surgery as a treatment for spontaneous hypertensive cerebellar hemorrhage (SHCH). METHODS: Between January 2002 and December 2011, 26 patients with SHCH underwent surgery using the stereotactic or navigation-guided burr hole aspiration and catheter insertion technique in our institution. RESULTS: Mean hematoma volume was 21.8 +/- 5.8 cc at admission and 13.1 +/- 5.4 cc immediately following surgery. Preoperative Glasgow Coma Scale (GCS) score was 12.5 +/- 1.3 and postoperative GCS score was 13.1 +/- 1.2. Seven days after surgery, the mean hematoma volume was 4.3 +/- 5.6 cc, and there was no occurrence of surgery-related complications during the six-month follow-up period. The mean operation time for catheter insertion was 43.1 +/- 8.9 min, and a mean 31.3 +/- 6.0 min was also added for extra-ventricular drainage. The mean Glasgow Outcome Scale (GOS) score after six months was 4.6 +/- 1.0. CONCLUSION: Stereotactic burr hole aspiration surgery for treatment of SHCH is less time-consuming and invasive than other interventions, and resulted in no surgery-related complications. Therefore, we suggest that this surgical method could be a safe and effective treatment option for selected patients with SHCH.
Catheters ; Drainage ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans

OBJECTIVE: To determine the advantages of parietal approach compared to Kocher's point approach for spontaneous, oval-shaped intracerebral hemorrhage (ICH) with expansion to the parietal region. METHODS: We divided patients into two groups : group A had burr holes in the parietal bone and group B had burr holes at Kocher's point. The hematoma volume, Glasgow coma scale (GCS) score, and modified Barthel Index (mBI) score were calculated. At discharge, we evaluated the patients' Glasgow outcome scale (GOS) score, modified Rankin Scale (mRS) score, motor grade, and hospitalization duration. We evaluated the patients' mBI scores and motor grades at 6 months after surgery. RESULTS: The hematoma volume in group A was significantly less than that in group B on postoperative days 1, 3, 5, 7, 14, and 21. Group A had significantly higher GCS scores than did group B on postoperative days 1 and 3. Group A had higher mBI scores postoperatively than did group B, but the scores were not significantly different. No differences were observed for the GOS score, mRS score, motor grade at discharge, or duration of hospitalization. The mBI score of group A at 6 months after surgery was significantly higher, and more patients in group A showed muscle strength improvement. CONCLUSION: In oval-shaped ICH with expansion to the parietal region, the parietal approach is considered to improve the clinical symptoms at the acute phase by removing the hematoma more effectively in the early stages. The parietal approach might help promote the long-term recovery of motor power.
Cerebral Hemorrhage* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma* ; Hospitalization ; Humans ; Muscle Strength ; Parietal Bone ; Rabeprazole*