急性颅脑损伤134例手术后死亡原因分析

目的分析急性颅脑损伤患者手术治疗后的死亡原因。方法回顾性分析134例急性颅脑损伤手术死亡病人的临床资料。结果原发或继发性颅脑损伤过重为急性颅脑损伤病人经手术后死亡的主要原因：严重的合并伤和术后并发症是死亡的重要因素。结论颅脑损伤手术后死亡的原因是多方面的，需要对此类病人采取综合救治措施，以降低其死亡率。     

急性颅脑损伤死亡102例分析

回顾性分析了１０２例颅脑损伤死亡病人的临床资料。发现在同期３４０例颅脑损伤其死亡率为３０％,导致病人死亡的主要原因是原发性颅脑损伤过重,继发性脑水肿,并与并发症相关。同时结合文献对颅脑损伤的救治进行了分析讨论。     

重型颅脑损伤的亚低温治疗

目的分析92例重型颅脑损伤(GCS≤8分)病人的亚低温治疗体会。方法对我科1998年3月至2002年12月亚低温治疗重型颅脑损伤病人进行回顾性分析。结果92例重型颅脑损伤病人存活66例,死亡26例;其中恢复良好60例,中、重残疾6例。无植物生存。结论临床应用亚低温治疗重型颅脑损伤病人,能显著改善重型颅脑损伤病人的预后。     

重型颅脑损伤90例死亡原因分析

目的探讨重型颅脑损伤死亡原因和救治经验。方法2007年1月至2011年1月收治的重型颅脑损伤病人761例,死亡10例,对90例死亡患者的临床资料进行回顾性分析。结果重型颅脑损伤病人761例,死亡90例,死亡率11．8％。其中GCS3—5分死亡65例,GCS6~8分死亡25例。伤后1～3d内死亡24例,4～6d死亡19例,7~9d死亡26例,10～30d死亡21例。结论早期诊断,综合救治,积极预防并发症是救治重型颅脑损伤的关键。     

伴双侧瞳孔散大颅脑损伤病人的救治经验

目的 总结33例伴瞳孔散大颅脑损伤病人的治疗经验，归纳出行之有效的治疗方法。方法 对33例伴瞳孔散大颅脑损伤病人的临床资料进行回顾性分析。结果 33例颅脑损伤病人中存活16例(良好和中残11例，重残5例)，死亡17例。结论 尽早行血肿清除、去大骨瓣减压、气管切开及呼吸机辅助呼吸、早期亚低温治疗、维持血氧饱和度超过95％及内环境稳定，有效防治并发症等方法能显改善伴瞳孔散大颅脑损伤的病人的预后。     

重型颅脑损伤死亡原因分析及预防

目的 探讨重型颅脑损伤的死亡因素和防治对策。方法 回顾我院1998-11～2003-11收治116例重型颅脑损伤病人的临床资料。结果 116例重型颅脑损伤病人中GCS6～8分73例，死亡12例，死亡率16．44％：3～5分43例，死亡21例，死亡率48．84％；GCS3～8分116例，死亡33例，死亡率28．45％。结论 重型颅脑损伤应尽早确立主要临床诊断、及早解除脑受压、积极防治并发症，是降低死亡率的关键。     

386例重型颅脑损伤病人的救治

目的总结386例重型颅脑损伤病人的救治经验。方法对386例GCS≤8分重型颅脑损伤病人进行回顾性分析。结果出院时按COS评定386例病人中恢复良好168例(43．5％)，中残62例(16．1％)，重残25例(6．5％)，植物生存10例(2、6％)，死亡121例(31．3％)。结论重型颅脑损伤病人早期有效治疗是降低死亡率。提高生存质量的关键。     

急性颅脑损伤死亡与相关血液指标的关系

目的 探讨急性颅脑损伤死亡与相关血液指标的关系。方法 回顾性分析2016 年1月至2018 年12月收治的227例急性颅脑损伤的临床资料。结果 伤后半年，死亡85例（死亡组），生存142例（生存组）。与生存组相比，死亡组血同型半胱氨酸（Hcy）、血糖、血尿酸以及血小板、中性粒细胞计数/淋巴细胞计数比值（NLR）、血小板计数/淋巴细胞计数比值（PLR）均明显增高（P<0.05）。结论 颅脑损伤病人血Hcy、血糖、血尿酸、血小板、PLR、NLR越高，可能预示病人发生死亡的风险也越大。     

"轻型颅脑损伤"早期突然死亡原因分析

目的 分析3例颅脑损伤后有中间好转期的病人，入院时神志清楚，头颅CT未见颅内血肿，住院数小时内突然死亡的原因。方法 对3例病人的伤情、治疗及死亡经过进行总结。结果 3例死亡原因可能是颅脑剪应力损伤引起的血管舒缩运动中枢损伤，多为脑底动脉环受刺激，血管舒缩麻痹出现的特急性全脑缺血，或颅颈交界处损伤引起的上颈髓和延脑损伤。结论 在有旋转性损伤的轻型病例中，应特别注意很少发生的突发性猝死情况。为了挽救病人生命和防范医疗纠纷，要重视全面体检和辅助检查，特别是颅颈交界处损伤的检出。做好颅脑损伤患低血压的升压治疗及呼吸的复苏。降低死亡率。     

重型颅脑损伤伴休克患者的救治

目的 总结重型颅脑损伤并休克患者的救治经验，分析其休克发生的原因及机理。方法 对我院1997年1月～2003年1月收治的68例重型颅脑损伤伴休克患者进行回顾性分析。对病人严密监护，及时进行手术，抗休克及其他综合治疗。结果 本组68例病人31例存活，37例死亡，死亡率为54．41％。结论 早期迅速查明休克原因，正确早期治疗尤为重要。绝不能把重度休克病人的意识障碍简单地归结于颅脑损伤，更不能把血压下降归结于高颅内压危象、继发性脑干损伤，而延误治疗。     

颅脑损伤与胰岛素抵抗的相关性研究

目的分析颅脑损伤的严重性、血糖与胰岛素水平三者之间的关系。方法92例颅脑损伤患者按入院时GCS评分分为轻度、中度及重度颅脑损伤三组，分别于伤后24h、48h、72h测定空腹血糖、血清胰岛素值，并计算稳态模式中的胰岛素抵抗指数（HOMA—IR）。患者出院时按GOS标准评估预后。采用SPSS11．5统计软件对数据进行处理，分析GCS、空腹血糖、胰岛素水平的关系。结果出院时按GOS标准．良好72例，差12例，死亡8例．死亡率8．7％。92例颅脑损伤患者伤后连续3d空腹血糖及胰岛素水平在轻度、中度、重度颅脑损伤三组患者中有显著差异（P〈0．01或P〈0．05）。颅脑损伤程度越重．血糖和HOMA—IR越高。结论空腹血糖值和HOMA—IR值可作为评估颅脑损伤严重程度的参考指标。     

3000 head injuries: a prospective study of patients admitted to Brisbane neurosurgical units

A prospective epidemiological study of 3095 patients with head injury admitted to Brisbane neurosurgical units is presented. Falls were the commonest cause of injury overall (42%) but traffic accidents were the leading cause of severe head injury Glasgow Coma Scale ([GCS] 8 or less) and had a higher mortality (5.6%). Outcome was closely related to GCS, presence or absence and type of skull fracture, computed tomography (CT) scan findings and age. Overall mortality was 4.4%. Mortality for mild head injury (GCS 13-15) was 0.4%, moderately severe head injury (GCS 9-12) 10.5% and severe head injury (GCS 3-8) 34.5%. The poor outcome in old patients who fall and sustain a mild head injury is highlighted. Low risk criteria are identified and recommendations regarding admission and management policies are made.     

Head injury in early adulthood and the lifetime risk of depression.

BACKGROUND: Depressive symptoms are common and can be debilitating in the months after head injury. Head injury can also have long-term cognitive effects, but little is known about the long-term risk of depression associated with head injury. We investigated the lifetime rates of depressive illness 50 years after closed head injury. METHODS: Participants were male World War II veterans who served during 1944-1945 and were hospitalized at that time for a head injury, pneumonia, or laceration, puncture, or incision wounds. We used military medical records to establish the presence and severity of closed head injuries. Veterans with (n = 520) and without (n = 1198) head injuries were interviewed in 1996-1997 for their lifetime history of depressive illness. Men with dementia were excluded. RESULTS: Veterans with head injury were more likely to report major depression in subsequent years and were more often currently depressed. Using logistic regression and controlling for age and education, the lifetime prevalence of major depression in the head injured group was 18.5% vs 13.4% in those with no head injury (odds ratio = 1.54, 95% confidence interval = 1.17-2.04). Current major depression was detected in 11.2% of the veterans with head injuries vs 8.5% of those without head injury (odds ratio = 1.63, 95% confidence interval = 1.07-2.50). This increase in depression could not be explained by a history of myocardial infarction, a history of cerebrovascular accident, or history of alcohol abuse. The lifetime risk of depression increased with severity of the head injury. CONCLUSION: The risk of depression remains elevated for decades following head injury and seems to be highest in those who have had a severe head injury.     

Impairment of facial recognition after closed head injuries of varying severity

Perceptual matching of photographs of unfamiliar faces was studied in 46 patients with closed head injury. The severity of head injury as indexed by duration of coma and neurological deficits was inversely related to accuracy of performance. Impairment of facial recognition was specifically associated with signs of concomitant hemispheric and brain stem injury. The presence of neurologic deficits suggesting less pervasive injury essentially confined to the cerebral hemispheres, skull fracture, and EEG abnormality was not related to this visuoperceptive deficit. The findings are discussed in relation to hypotheses concerning neurological dysfunction in head injury.     

Features of pediatric head injury in Hong Kong

Head injury in children causes special concern in most communities. From 1989 to 1994, 2,785 children younger than 16 years old were admitted to our neurosurgical service because of head injury. Fall from a height was the major cause of head injury leading to admission in infants and children in preschool age groups, whereas traffic-related or bicycle-related accidents were more likely to be the cause of head injury for those aged 11–15 years. In all age groups there was a male preponderance. The overall mortality was 0.6%. Traffic-ralated accidents caused more severe injury and accounted for 67% of all fatalities. For patients under 6 years old, about 40% of head injuries occurred at home. Preventive measures for pediatric head injury in Hong Kong are suggested.     

Motivation and Neuropsychological Test Performance Following Mild Head Injury

Effect of motivation on neuropsychological test performance in mild head injury was assessed. Motivation was measured using the Portland Digit Recognition Test. Three groups were compared: (a) mild head injury, financial incentives, good motivation; (b) mild head injury, financial incentives, poor motivation; (c) moderate/severe head injury, good motivation. The neuropsychological battery included measures of sensory function, motor function, attention, intelligence, reasoning, and memory. Mild head injury well motivated patients performed significantly better than the other two groups on some tests. Mild head injury poorly motivated individuals and moderate-severe head injury patients were indistinguishable on many tests. Consistent with previous reports, tactile sensory (finger recognition and Fingertip Number Writing Perception) and recognition memory (Rey Auditory Verbal Learning) tasks were identified as clinically useful measures of poor motivation. On these measures mild head injury well motivated examinees performed no better than moderate-severe patients, with both groups superior to mild head injury poorly motivated examinees. Sensitivity and specificity data are reported. Our measures of tactile sensation and verbal recognition memory were more affected by motivation than by the severity of head injury.     

Use of the ICECI and ICD-10 E-Coding structures to evaluate causes of head injury and concussion from sport and recreation participation in a school population

The purpose of this study was to identify the most common causes of head injury and associated symptoms of concussion in a population of school children (n=1,372,979). Using standardized injury report forms, we identified the mechanisms of head injury associated with various sports/recreation activities and assessed each injury for the presence of concussion symptoms. Head injury reports (n=7,765) were coded using the WHO's ICECI and ICD-10 E-codes. 1,338 Cases reported symptoms of concussion. The majority of head injuries occurred during School Free-Play/Recess (59.8%). Combative Sports and Wheeled Non-Motored Sports were the activities most often associated with concussion symptoms (rate of concussion (RC): 48.3% and 44.4%, respectively, p<0.001). School Free-Play/Recess and Physical Education Classes were significantly less likely to have head injuries associated with concussion (RC: 16.0%, p<0.001, and 12.4%, p=0.034, respectively). The most common causes of head injury were (1) Struck by an Object (24.9%) and (2) Falling on the Same Level (22.8%). Falling from a Transport was the only etiological code significantly associated with concussion symptoms after head injury (RC: 28.7%, p<.001). Results were similar when using the two coding structures in combination. Prevention efforts should focus on activities where children are moving at high speeds since these are more likely to cause a concussion when a head injury occurs.     

Posttraumatic visual agnosia and epilepsy as a consequence of gunshot injury to the head. Case report

Half million people in the world, each year have a gunshot injury to the head and eighty thousand of them are hospitalized. Gunshot injuries to the head have became in Poland second most frequent cause of death from head trauma, and in some countries during peace became the most frequent cause of death among patient with head injury. Glasgow Coma Scale (GCS) is a useful prognostic factor for patients with gunshot injury to the head. Injury to the eloquent regions of the brain, commotion and contusion of the brain, intracranial hematomas, subarachnoid hemorrhage, cerebro-vascular spasm, injuries to the major vessels, liquorrhea, infections, coagulopathies and epilepsy are the most important and influential factors in the clinical status of the patient with gunshot injury to the head. The operation is the preferred treatment to all patient, no matter of their clinical status at the moment of the admission. The report presents the history of treatment of a patient with gunshot injury to the head. During the treatment extremely infrequently occurring posttraumatic visual agnosia and posttraumatic epilepsy were observed. Twenty-two months after operation the patient is independent and professionally active.     

Impairment of memory functions after acute head injury

When memory functions are evaluated after head injury, two trends are apparent. Acute head injury patients with approximately normal intelligence demonstrate a reduced capacity to utilize structure in delayed recall relative to a control group. Furthermore, head injury patients with low intelligence demonstrate a wider memory deficit than the previous group, affecting perception and immediate recall as well. No relationship was found between severity of injury, recovery, and performance on the memory scale.     

Diffuse axonal injury due to nonmissile head injury in humans: An analysis of 45 cases

Forty-five cases of diffuse axonal injury (DAI) brought about by nonmissile head injury in humans are analyzed and compared with 132 cases of fatal head injury without DAI. All cases were subjected to a comprehensive neuropathological study. In the patients with DAI a statistically significant lower incidence of lucid interval, fracture of the skull, cerebral contusions, intracranial hematoma, and evidence of high intracranial pressure were found, with a higher incidence of head injury due to road traffic accident. Brain swelling and hypoxic brain damage were not statistically different in the two groups. The features of DAI in humans are compared with the DAI that has been produced in subhuman primates by pure inertial loading brought about by angular acceleration of the head. The available evidence indicates that DAI in human beings occurs at the time of head injury and is not due to complicating factors such as hypoxia, brain swelling, or raised intracranial pressure.