PROGNOSIS OF SEVERE BRAIN INJURY

The data concerning the mortality in severe brain injury and the disability caused by it were analysed. We classified as severe those head injuries which caused unconsciousness for more than 24 hours. The series presented consists of 204 patients. The follow-up time was from three to five years. The total mortality was 50 per cent, but increased steeply in older age groups. The mortality in patients over 60 years of age was 78 per cent, but among those under 20 years it was 38 per cent. Three years after the injury 43 per cent of the survivors were totally disabled. Less than 30 per cent of patients over 50 years of age were able to return to their former work, whereas more than 70 per cent of patients under 20 years were able to return to work or to school. It is concluded that in patients over 60 no special or heroic methods of treatment are indicated but that in children and adolescents every effort should be made as long as there has not been respiratory arrest and cerebral death.     

IMPACT OF BRAIN INJURY SEVERITY ON PERSONALITY DYSFUNCTION

Although the cognitive effects of traumatic brain injury (TBI) have been well investigated, emotional problems are less well understood. The purpose of this study was to explore the relationship of the length of loss of consciousness (LOC) and the severity of cognitive impairment (HRNB) to personality changes after head trauma. The subjects included 320 chronic TBI patients. A multivariate analysis was conducted using HRNB (three levels), as measured by a modified Halstead-Reitan Impairment Index and LOC (four levels), as the independent variables, and 30 scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as the dependent variables. Multivariate Fs were significant for both HRNB and LOC. Follow-up ANOVAs and t-tests revealed a consistent pattern of findings across both variables. The data indicated that the reported emotional problems increased with the severity of both LOC and HRNB, except in the most severe groups. The severe subjects when defined by either variable displayed high levels of denial and a lack of awareness of their problems. LOC and HRNB contributed independently to the degree of personality problems, however, LOC was found to be a stronger predictor of personality change than was HRNB at milder levels of severity. The implications of these findings for both treatment and understanding of the mechanisms of head injury are discussed.     

PRIMARY RETICULUM CELL SARCOMA OF THE BRAIN

This is a report of five cases of primary intracerebral reticulum cell sarcoma, three with cerebral and two with cerebellar localization. The one case studied anatomically (the other four were diagnosed by biopsy) was a frontal recurrence after an interval of seven years quiescence following surgery for a temporal tumour, treated post-operatively by radiotherapy. Postmortem examination of the viscera revealed no pathological changes. In all five cases the microscopic examination showed the tumour to be formed of a perivascular proliferation of cells having clear nuclei and one or more nucleoli, and associated with the formation of reticulin fibres. Electron microscopical examination revealed the multiplication of undifferentiated cells apparently starting the neoplastic transformation of the periadventitial elements. Both the microscopic and ultrastructural features corresponded to those of primary reticulum cell sarcoma of the brain.     

凝血酶对脑出血后脑损伤的作用机制

凝血酶在对脑出血后脑组织的损伤中起着重要作用。本文通过介绍凝血酶的化学结构及其受体的分布,从脑水肿,炎症反应,脑缺血损伤,神经元损伤四个方面,对凝血酶在脑出血后脑损伤的作用机制进行综述。最后对小剂量凝血酶 预处理在脑组织中的保护作用进行了展望。     

RESPONSE OF FETAL AND NEONATAL RAT BRAIN TO INJURY

Previous observations have suggested that a reactive astrocytic response to damage does not occur in fetal brain. In this study the time course of the astrocytic response to injury in fetal and neonatal rat brains has been assessed using the immunoperoxidase technique for glial fibrillary acidic protein (GFAP). Cold lesions were induced in utero to the forebrain and brain stem of rat fetuses at 16-18 days of gestation. The inflammatory response and the presence of GFAP in the processes of reactive astrocytes were studied in the brains of animals killed from 4 days (20-22 days of fetal life) to 12 days (9 days of post natal life) after the injury. Reactive astrocytes containing GFAP were present at the site of injury in all fetal and neonatal rat brains. Astrocyte processes were thin and short but stained strongly for GFAP. There was a greater amount of astrocytic scar tissue in animals killed 12 days after injury than in those killed after 4 days. In contrast to adults, little mesenchymal component was observed in newly formed scar tissue on the meningeal surfaces of the fetal and newborn rat brain.     

HYPOXIC-ISCHAEMIC CEREBRAL INJURY IN THE TERM NEWBORN: CORRÉLATION OF CT FINDINGS WITH NEUROLOGICAL OUTCOME

For asphyxiated term infants, prediction of neurological outcome based on clinical criteria alone is not always reliable. We have used changes in tissue density on CT scan (known to represent hypoxic-ischaemic injury) as an adjunct to clinical examination to assess the severity of cerebral injury. The study population comprised 56 term newborns with hypoxic-ischaemic encephalopathy. Scans were performed with a General Electric 8800 scanner and classified as Normal, Patchy, Diffuse or Global according to the extent of areas of decreased density (DD). These were correlated with neurological outcome (i.e. Normal, Minor handicap, Major handicap, Indefinite or Death). Death or major handicap occurred in only two of 14 infants in the combined Normal or Patchy DD groups but in 26 of 29 in the combined Diffuse or Global groups. This correlation was highly significant (p less than 0.0005). 13 classified as Indefinite were normal at age three to 10 months but were excluded from analysis because of the short follow-up. The data demonstrate that CT scanning is a valuable adjunct to neurological examination for assessment of cerebral injury in the asphyxiated term infant.