Traumatic brain injury: the silent epidemic.

It is difficult to accurately determine the number of people affected annually by the devastating effects of traumatic brain injury. It is clear, however, that the impact of traumatic brain injury exceeds the financial cost of acute health care. The long-term outcome of patients with traumatic brain injury has been targeted specifically for improvement during this decade. The initial brain injury--known as the primary injury--may occur in one area of the brain (focal injury) or may affect the entire brain (diffuse injury). The outcome depends on many factors, including the severity of the brain injury and the effectiveness of the interventions received. Accurate assessment of the scope of the problem would be improved by the development of a national database and the standardization of assessment practices. Critical care nurses can contribute skill and knowledge in the care of patients with traumatic brain injury and in efforts to prevent the accidents and violence that cause traumatic brain injury.     

颅脑损伤患者血清促红细胞生成素的测定及其意义

目的:探讨急性颅脑损伤患者血清促红细胞生成素(EPO)含量与颅脑损伤程度的关系.方法:选择颅脑损伤120例,按损伤程度分轻、中、重三型,即颅脑损伤轻型组、中型组、重型组;选择30位健康武警战士作为对照组.均采用酶联免疫吸附法(ELISA法)检测血清EPO含量,并进行对比分析.结果:血清EPO含量:颅脑损伤轻型组、中型组与对照组比较差异具有非常显著的统计学意义(P＜0.01);重型组与对照组比较差异有显著性统计学意义(P＜0.05). 结论:急性颅脑损伤,尤其是轻、中型急性颅脑损伤可刺激机体产生EPO,EPO的含量可提示急性颅脑损伤的程度.     

黄体酮对大鼠外伤性脑损伤后脑水肿及周围组织细胞凋亡和神经功能的影响

目的探究黄体酮对大鼠外伤性脑损伤后脑水肿及周围组织细胞凋亡和神经功能的影响。方法雄性Wistar成年大鼠随机分为假手术组(Sham组;开右侧顶部骨窗而无脑损伤)、脑损伤组(TBI组;开右侧顶部骨窗,且参照Freeney自由落体撞击致伤方法建造重型颅脑损伤模型)、脑损伤后接受黄体酮治疗组(P-TBI组;建立脑损伤模型后腹腔注射0.8 ml/kg黄体酮)、脑损伤后注射二甲基亚砜(DMSO)组(D-TBI组;建立脑损伤模型后腹腔注射0.8 ml/kg DMSO),每组24只,再将其分为损伤后1 d、3 d、5 d、7 d组,各6只。比较各组大鼠不同时间点环氧化物水解酶-2(COX-2)表达量,脑组织含水量、Bcl-2及Bax蛋白阳性细胞数及神经细胞凋亡情况。利用m NSS量表评价各组大鼠损伤后不同时间的神经功能。结果随着损伤时间延长,Sham组大鼠脑组织COX-2表达水平、脑组织含水量、神经细胞凋亡百分比及m NSS评分无明显变化(P>0.05)。TBI组大鼠随着损伤时间延长其脑组织COX-2表达水平、脑组织含水量、神经细胞凋亡百分比及m NSS评分均降低(P<0.05),且各时间点均高于Sham组(P<0.05)。D-TBI组及P-TBI组大鼠随着损伤时间延长其脑组织COX-2表达水平、脑组织含水量、神经细胞凋亡百分比及m NSS评分均降低(P<0.05),且P-TBI组高于TBI组(P<0.05)。损伤后7 d,TBI组大鼠脑组织Bcl-2、Bax阳性细胞数均高于Sham组(P<0.05);且P-TBI组大鼠脑组织Bcl-2阳性细胞数高于TBI组,Bax阳性细胞数低于TBI组(P<0.05)。结论黄体酮能有效缓解大鼠外伤性脑损伤后脑水肿情况、抑制周围组织细胞凋亡,对其神经功能有一定保护作用。     

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.     

急性颅脑损伤后血管内皮细胞钙黏蛋白和精氨酸加压素的动态变化

目的 研究急性颅脑损伤后血中血管内皮细胞钙黏蛋白(VE-cadherin)和精氨酸加压素(arginine vasopressin,AVP)的动态变化及其与继发性脑水肿的关系.方法 采用酶联免疫吸附法(ELISA)检测VE-cadherin含量,采用放射免疫法检测AVP含量,回顾性分析110例急性颅脑损伤住院患者伤后12 h、伤后3,5 d血中VE-cadherin和AVP含量,并结合临床表现、影像学检查及格拉斯哥预后评分(COS)进行比较分析.结果 本组110例急性颅脑损伤患者伤后早期(12 h内)血VE-cadherin和AVP含最随着格拉斯哥昏迷评分(GCS)下降均有不同程度的升高.颅脑损伤越严重,VE-eadherin和AVP升高越明显,脑水肿程度越重,脑水肿高峰持续时间越长(P<0.01).颅脑损伤早期血VE-cadherin和AVP含量与脑水肿严重程度(r=0.69,0.65,P<0.01)和脑水肿高峰持续时间(r=0.70,0.64,P<0.01)呈正相关.此外,不同GOS组之间VE-cadherin和AVP差异亦有统计学意义,其中预后不良组血VE-eadherin和AVP水平在伤后5 d持续升高,而且显著高于预后良好组和正常对照组(P<0.05或P<0.01).同时急性颅脑损伤后血VE-cadherin和AVP的含量呈正相关(r=0.72,P相似文献   

急性颅脑损伤后抵抗素和精氨酸加压素动态变化的临床研究

目的研究急性颅脑损伤后血中抵抗素和精氨酸加压素（AVP）的动态变化,探讨抵抗素和AVP与急性颅脑损伤后继发性脑水肿及其预后的关系。方法采用酶联免疫吸附法（ELISA）检测抵抗素含量,采用放射免疫法检测AVP含量,分别测定110例急性颅脑损伤住院患者伤后12h,伤后第3、5d血中抵抗素和AVP含量,并结合临床表现、影像学检查及格拉斯哥预后评分（GOS）进行比较分析。结果本组110例急性颅脑损伤患者伤后早期（12h内）,血抵抗素和AVP含量随着格拉斯哥昏迷评分（GCS）下降,均有不同程度的升高。颅脑损伤越严重,抵抗素和AVP升高越明显,脑水肿程度越重,脑水肿高峰持续时间越长（P均〈0．01）。颅脑损伤早期,血抵抗素和AVP含量与脑水肿严重程度（r=0．68,0．65,P均〈0．01）和脑水肿高峰持续时间（r=0．69,0．64,P均〈0．01）呈正相关。此外,不同GOS组之间抵抗素和AVP差异亦有统计学意义,其中预后不良组血抵抗素和AVP水平在伤后5d仍持续在较高水平,而且显著高于预后良好组和正常对照组（P〈0．05或P〈0．01）。同时急性颅脑损伤后血抵抗素和AVP的含量呈正相关（r=0．72,P〈0．01）。结论急性颅脑损伤后血抵抗素和AVP的动态变化与急性颅脑损伤预后密切相关,抵抗素和AVP参与了颅脑损伤后继发性脑水肿形成的病理生理过程。     

Microsensor and microdialysis technology. Advanced techniques in the management of severe head injury

Neuroscientists continue the search for the "magic bullet" that will prevent the deleterious effects of primary and secondary brain injury. Indirect measurement of the effects of primary and secondary brain injury through the study of ICP- or CPP-directed management, CBF monitoring, Sjo2 monitoring, and TCD monitoring has led to improved care of persons with brain injury. Although the findings from brain injury research using microsensor and microdialysis technology are only preliminary and extensive research is still needed, these technologies have dramatically expanded knowledge about brain injury at the cellular level. Extended neuromonitoring is poised to enter a new and exciting phase because of the growth in knowledge regarding the cellular events associated with brain injury. The recent approval of NeuroTrend by the FDA will further promote this growth. Applications of the technology have already expanded to include uses beyond the management of traumatic brain injury. Microsensor and microdialysis technology is being used intraoperatively to determine "safe" temporary clipping times for aneurysm surgery and is also being used within the critical care setting to improve the monitoring and management of subarachnoid hemorrhage patients who are experiencing vasospasm. The ultimate application of this new technology is to improve long-term outcomes for patients with brain injury through the reduction of secondary brain injury. If that goal is to be accomplished, then it will be important for nurses caring for patients with brain injury to become immersed in this exciting new phase in brain injury monitoring. Nurses must obtain a comprehensive knowledge base of brain injury pathophysiology and how extended neuromonitoring can lead to improved outcomes. Technical proficiency will also be important to ensure that treatment and research conclusions are based on accurate data. Finally and perhaps most importantly, it will be critical for nurses to participate in and develop research studies that explore the impact of interventions, especially nursing care activities, on the injured brain if these exciting new advances are to be translated into tangible benefits for brain-injured patients.     

儿童原发性脑干损伤导致脑萎缩20例分析

目的探讨儿童原发性脑干损伤与脑萎缩的关系。方法回顾性分析儿童原发性脑干损伤患者伤后2～6个月头颅CT扫描所见脑室、脑池、脑沟变化情况。结果 20例儿童原发性脑干损伤患者伤后2～6个月头颅CT扫描表现脑室、三脑室扩大、脑池增大、脑沟增宽。结论儿童原发性脑干损伤可导致脑萎缩。     

创伤性颅脑损伤后神经细胞凋亡的研究

目的：通过对创伤性颅脑损伤后神经细胞凋亡的研究，了解人脑创伤后脑组织中凋亡发生的情况及其所起的作用。方法：采用末端脱氧核苷酸转移酶介导的d-UTP生物素标记法(TUNEL法)检测细胞凋亡。同时显微镜观察病理切片。结果：66．7％出现TUNEL阳性，TUNEL阳性与阴性患者间的GCS评分(t=-2.88，P=O．01)、受伤时间(t=2．14，P=0．049)有显著差异。TUNEL阳性与阴性患者间性别、年龄、预后无显著差异。结论：人脑创伤后脑组织中存在凋亡，且与患者的病情严重程度及病程相关。其在颅脑创伤的病理过程中有一定作用，但只是颅脑损伤后复杂病理过程中的一种表现，即创伤后神经细胞死亡的一种方式。     

高压氧对大鼠颅脑创伤后脑水肿和脂质过氧化物丙二醛的影响

背景脑创伤后脑组织水肿与缺氧再灌注后氧自由基的产生有关.高压氧能减轻脑水肿,改善组织缺氧.目的观察大鼠颅脑创伤后高压氧对脑水肿和脂质过氧化物的影响.设计随机对照实验.单位第三军医大学大坪医院野战外科研究所.材料实验于2004-03/06在第三军医大学大坪医院野战外科研究所高压氧科、四室完成.选取3个月龄Wistar大鼠58只,体质量(256±23)g,清洁级.方法将58只大鼠随机分为对照组17只,脑创伤组22只和高压氧组19只.对照组不进行撞击试验.脑创伤组和高压氧组麻醉后均采用BIM-Ⅲ型撞击机撞击大鼠右侧颅顶,复制闭合性颅脑损伤.高压氧组致伤后置于2个绝对大气压的高压氧舱2 h,大鼠于伤后24 h心脏取血处死.主要观察指标观察大鼠颅脑创伤后脑组织含水率、伊文斯蓝含量及脑组织、血浆脂质过氧化物丙二醛含量.结果实验致伤动物41只,伤后24 h死亡7只.其中高压氧组2只,脑创伤组5只.进入结果分析34只.①脑组织含水率右脑脑创伤组.明显高于高压氧组和对照组[(79.06±0.52,78.38±0.37,78.21±0.25)%,t=3.022～3.285,＜0.01].脑创伤组右脑明显高于左脑[(79.06±0.52,78.57±0.14)%,t=2.651,P＜0.05].②脑组织丙二醛含量右脑脑创伤组明显高于高压氧组和对照组[(197.28±31.49,167.65±25.88,145.07±30.45)nmol/g,t=2.231～3.347,＜0.01～0.05].脑创伤组右脑明显高于左脑[(197.28±31.49,161.01±22.05)nmol/g,t=2.443,P＜0.05].③血浆中丙二醛含量脑创伤组明显高于对照组[(2.69±0.54,1.94±0.40)μmol/L,t=2.473,P＜0.05].结论脑创伤后行高压氧治疗,大鼠伤侧脑组织含水率、丙二醛及血浆丙二醛含量明显低于非治疗组,提示高压氧对颅脑创伤有治疗作用.     

Brain injury obscured by chronic pain: a preliminary report

Chronic pain patients and brain injured patients frequently exhibit anxiety, depression, perseveration, and fixed ideation about their injuries. Both populations also frequently suffer from decreased attention, impaired concentration, easy fatigability, personality changes, impaired relationships with family and friends, and difficulty maintaining a job. In cases where chronic pain coexists with traumatic brain injury, the brain injury is often obscured. Risk factors which should alert the medical team to possible coexisting brain injury include history of loss of consciousness at original injury, history of trauma to the head, whiplash injury to the neck, multisystem trauma, and admission of memory or attention deficits by the patient. When any of these risk factors are present, we have found that formal examination of cognitive function is required to explore the potential of coexisting brain injury; if pain is a prominent clinical feature, residual cognitive sequelae of mild brain injury is easily masked. Specific testing of attention, new learning ability, constructional ability, and higher cognitive functions are most helpful in this population, and they need to be included in the mental status examination when concomitant brain injury is suspected. In our study, seven patients were found to have undiagnosed brain injury in a series of 67 consecutive patient referrals to our pain rehabilitation program. Treatment failure is high in this subgroup of pain patients unless treatment is directed toward the sequelae of both brain injury and chronic pain.     

The meaning of feeling well in people with moderate or severe traumatic brain injury

Aim. The aim of this study was to elucidate the meaning of feeling well for people with moderate or severe traumatic brain injury. Background. Considerable attention has been given to research consequences, quality of life and satisfaction with life in people with traumatic brain injury. Most studies reveal negative aspects of living with traumatic brain injury. Knowledge that provides an understanding of the meaning of feeling well for people with a traumatic brain injury entails the possibility that they could receive support to feel well, despite their injury. Design. This study used a qualitative research approach, as the aim was to elucidate meaning. Methods. Data were collected through qualitative research interviews with two women and six men with moderate or severe traumatic brain injury who had lived with the injury for between 7–15 years. A phenomenological hermeneutic method was used to interpret the data. Results. The meaning of feeling well for people with moderate or severe traumatic brain injury was that the initially unfamiliar life with traumatic brain injury became familiar. This included finding strength, regaining control over everyday life, being close to someone and being good enough. People with traumatic brain injury felt well when they became reconciled with the circumstances of their life and created a new entity in that life, in which their complete health had been lost. Relevance to clinical practice. This study helps professionals to enhance their understanding and awareness of the possibilities for people with moderate or severe traumatic brain injury to feel well. The study showed that people with traumatic brain injury needed a lot of strength to achieve this. Professionals can help them to feel well by getting to know them and thus find ways to support the person’s feeling of wellbeing.     

大鼠股骨骨折合并脑外伤骨折愈合过程中IGF—Ⅰ在骨痂中的表达

目的研究大鼠股骨骨折合并脑外伤时胰岛素样生长因子-Ⅰ（Insulin-like Growth Factor-ⅠIGF-Ⅰ）在骨痂中的表达，探讨骨折合并脑外伤骨折愈合加快的机制。方法12周雄性Sprague-Daw-ley大鼠16只，随机分成8组，每组8只，即：2周单纯骨折组（G1）、2周骨折合并脑外伤组（G2）。建立大鼠脑外伤和骨折模型。分别于2周取材，骨痂作SP法免疫组化染色。结果免疫组化分析平均阳性细胞百分数骨折合并脑外伤组高于单纯骨折组。结论脑外伤对骨折愈合有促进作用，IGF-Ⅰ可能是脑外伤促进骨折愈合的原因。     

创伤性脑损伤后细胞凋亡的时相性研究

目的探讨创伤性脑损伤中细胞凋亡的发生发展过程,为脑损伤后的神经系统保护提供实验资料以及为法医学损伤经过时间推断提供帮助。方法以Feeney自由落体脑损伤大鼠模型为对象,采用DNA缺口末端标记法（TUNEL）染色观察不同损伤时间时脑损伤组脑组织、假手术对照组脑组织和正常对照组脑组织中细胞凋亡的情况。结果创伤性脑损伤后2h即可在伤侧皮层以及同侧的海马区可见细胞凋亡发生,随着损伤经过时间的延长,凋亡细胞逐渐增多,在48~72h凋亡达到高峰,随之逐渐减少,至7d时凋亡数仍显著高于正常对照组和假手术组,正常对照组和假手术组在伤侧对应区和海马区仅偶见凋亡细胞。结论检测损伤区凋亡细胞数对损伤经过时间的推断有重要价值,为法医学损伤诊断起重要作用。     

Functional neuroimaging and cognitive rehabilitation for people with traumatic brain injury

Cognitive deficits are a common consequence of traumatic brain injury. Although such deficits are amenable to rehabilitation, methods for individualizing cognitive interventions are still unrefined. Functional neuroimaging methods such as positron emission tomography and functional magnetic resonance imaging are emerging as possible technologies for measuring and monitoring the cerebral consequences of plasticity associated with brain injury and for evaluating the effectiveness of rehabilitation interventions. Functional neuroimaging may even enable more customized and efficient selection, design, or adaptation of individual cognitive rehabilitation programs. We review the current literature on functional neuroimaging after traumatic brain injury, relating these findings to cognitive rehabilitation. Overall, functional neuroimaging after traumatic brain injury has shown reliable differences in brain activity within several regions of frontal cortex, partly but not uniformly consistent with neuropsychological and structural findings in traumatic brain injury. We also outline a number of promising research opportunities for applying functional neuroimaging in traumatic brain injury settings, along with associated challenges.     

脑外伤的术中超声应用研究

目的探讨术中超声在颅脑外伤中的临床应用价值,并初步探讨超声造影对脑外伤的诊断价值。方法对12例脑外伤患者行术中超声检查,应用灰阶及彩色多普勒超声探测损伤灶,确定病灶的部位、深度、大小、内部回声及中线结构是否移位等。对血肿清除术中出现急性脑膨出的患者及时行超声检查,以观察是否有迟发性血肿出现。其中选取4例脑挫裂伤伴出血患者行术中超声造影检查,了解脑挫裂伤、脑出血及周围腑组织的造影增强情况。结果本研究中12例患者,术前CT检查发现病灶15个,术中超声探测发现病灶18个;术中超声探测发现迟发性硬膜外血肿4个,1个经急诊CT证实为对侧硬膜外血肿,另3个经超声诊断为迟发性硬膜外血肿后,在超声引导下清除血肿。不同类型的脑外伤有不同超声表现,超声能对病变进行定位。造影前脑挫裂伤病灶边界显示不清,超声造影后损伤灶边界显示清晰。结论术中超声可对脑外伤灶进行定位以指导手术,并可发现迟发性血肿。超声造影可了解脑外伤后损伤灶及周围脑组织灌注情况,为脑外伤后脑灌注提供了重要信息。     

大鼠骨折合并中型脑损伤胰岛素生长因子2及血小板源性生长因子对骨折愈合影响的实验研究

目的研究大鼠四肢骨折合并中型脑损伤时血清胰岛素生长因子2(IGF-2)及血小板源性生长因子(PDGF)水平,探讨其在中型脑损伤中对骨折愈合的影响。方法 SD大鼠随机分为:对照组、四肢骨折组、中型脑损伤组、四肢骨折合并中型脑损伤组,共4组,分别建立中型脑损伤和骨折模型,术后第2、4周拍X射线片,拍片后处死大鼠,取血酶联免疫吸附双抗体夹心法检测各组大鼠血清中IGF-2和PDGF水平。结果 X线片结果显示4周后中型脑损伤组和四肢骨折合并中型脑损伤组骨折处骨痂形成,骨折线模糊,而对照组和单纯四肢骨折组骨折线清晰。与对照组比较,中型脑损伤组和四肢骨折合并中型脑损伤组血清IGF-2和PDGF的浓度均显著性地升高(P<0.01),与2周时比较4周时上述因子的表达水平有所恢复(P<0.01),但仍高于对照组和四肢骨折组(P<0.05)。中型脑损伤组与四肢骨折合并中型脑损伤组之间血清IGF-2和PDGF水平无统计学差异(P>0.05)。对照组与四肢骨折组之间血清IGF-2和PDGF的浓度也无统计学差异(P>0.05)。结论中型脑损伤可促进骨折愈合加快,血液中IGF-2和PDGF水平的升高可能是其主要的作用机制。     

重型创伤性颅脑损伤患者自发性过度通气的研究进展

预防和减轻继发性脑损伤是重型创伤性颅脑损伤（sTBI）患者重症监护治疗过程中的重点和难点。诱导性过度通气（IHV）可通过减少脑血容量快速降低颅内压,但由于脑血管收缩带来的脑血流减少会加重脑组织的缺血缺氧,目前已不再推荐用于sTBI患者的常规治疗。与此同时,以不同程度的低碳酸血症为特征的自发性过度通气（SHV）在急性创伤性脑损伤患者中较为常见,且由于与患者的神经功能不良转归具有明显的相关性,近年来逐渐受到重视。本文从流行病学、病理生理学效应、临床预后及干预措施等角度对SHV在sTBI中的研究现状进行综述,以期提高重症医师的认知水平,进而重视并推动相关临床及基础研究的开展。     

Effect of associated injuries and blood volume replacement on death, rehabilitation needs, and disability in blunt traumatic brain injury

OBJECTIVE: To examine the effects of associated injuries on death, disability, rehabilitation needs, and cost in patients with blunt traumatic brain injury. DESIGN: A retrospective case series analysis of 1,709 patients with blunt traumatic brain injury, or 37.2% of 4,590 consecutive blunt trauma patients, was combined with a prospective study of a subset of 202 of the 1,709 brain-injured patients obtained during the same time period with regard to need for rehabilitation services, residual disability, and costs at 1 yr after discharge from the acute trauma center. SETTING: A level I regional trauma center that is also the statewide neurotrauma and multiple trauma unit serving a population of more than 3 million persons. RESULTS: Contingency table analysis showed the Glasgow Coma Scale to be highly predictive (p less than .0001) of likelihood of mortality, need for postacute inpatient rehabilitation, or discharge home. Of the blunt traumatic brain injury patients, 40.4% (691) had an isolated brain injury and 59.6% (1,018) had brain plus at least one other systemic injury. The mortality rate of the isolated brain injury group was 11.1% compared with 21.8% in all brain plus systemic injury groups (p less than .0001). Spine, lung, visceral, pelvis, or extremity injuries in blunt traumatic brain injury all increased mortality rate to greater than 25% (all simultaneously significant, p less than .0001). Analysis of the interaction of brain injury (quantified by Glasgow Coma Scale) with blood replacement in the initial 24 hrs showed that at any Glasgow Coma Scale range, percent mortality increased as the volume of blood increased. Hypovolemic shock increased the mortality rate from 12.8% to 62.1% (p less than .0001). The need for postacute inpatient rehabilitation in survivors also increased as blood replacement increased, and shock increased the percent of patients requiring post-acute inpatient rehabilitation from 39.7% to 60.3%. In 202 consecutive surviving brain trauma patients followed for 1 yr, isolated brain-injured patients with moderate brain injuries had a 4% need for posttrauma, postacute inpatient rehabilitation with a total cost per case of $12,489 compared with the brain plus extremity injury group, who had a 23% postacute inpatient rehabilitation rate and a total cost per case of $36,177 at 1 yr. With severe brain injury, isolated brain injury increased postacute inpatient rehabilitation to 29% and 1-yr cost to $59,274, but with the brain plus extremity injury group, postacute inpatient rehabilitation increased to 49% and cost to $84,950. CONCLUSIONS: In blunt traumatic brain injury, the addition of major visceral or extremity injuries, with need for blood replacement or shock, increases the risk of death, the need for rehabilitation, and the costs of disability.     

Brain injury in the infant: the old, the new, and the uncertain

Although neonatal brain injury occurs most frequently after a perinatal hypoxic-ischemic insult, recently studies have noted that variable causes such as metabolic and reperfusion events can result in, or aggravate, a brain insult. Current data suggest that about 2 to 5 of 1,000 live births in the United States and more so in developing countries experience a brain injury Approximately 20% to 40% of infants who survive the brain injury develop significant neurological and developmental impairments. The resulting impact on the child, family, and society presents a formidable challenge to health care professionals. Although several important insights have been gained in the last several years about the epidemiology, diagnosis, and mechanism of brain injury, management remains mostly a cocktail of controversial trials. This article provides a comprehensive review of the pathology, clinical manifestations, and timely management of infants with brain injury.