Main description:

Posttraumatic cerebral contusions, lacerations and hematomas in the past could often only be suspected by clinical symptomatology and be visualized by angiography in a restricted manner, but they are now diag- nosed with precision through CT and MRI; they remain in the limelight in our daily management of severe head injuries. Stalhammar's longlasting research in biomechanics is he re condensed in a concise review of the current knowledge in this field, thus providing the basis for our understanding of the parenchymal cerebral posttraumatic lesions. The neuropathological investigations and findings remain fundamental to the clinical features, and in this text there is the advantage that they were carried out and interpreted by a very experienced neurasurgeon, Ion Oprescu, who most regretfully died before the completion of this volume. The special morphological and clinical investigations by Nakamura, concerning diffuse brain injury, contribute to our necessary diagnosis and treatment of this phenomenon where, without grass visible lesions of cerebral tissue, a high mortality occurs.
The clinical features, the princip1es of therapy and the outcome are described by Vigouroux and Guillermain, whose clinical study clearly demonstrates the limitations of all our efforts in severe brain injuries, in spite of decades of clinical experience and research.

Contents:

Biomechanics of Brain Injuries.- Basic Injury Mechanics.- Force, Strain, Duration of Load.- Injurious Parameters.- Specific Brain Injury Mechanisms.- Anatomical Features.- Characteristics of Loading.- Cranial Effects of Loading.- Skull Deformation - Angular Acceleration Theory.- Pressure Gradient - Translational Acceleration Theory.- Cavitation.- Cranio-spinal Junction Movements.- Primary Injuries.- Fractures.- Focal Injuries.- Diffuse Injuries.- Aspects of Injury Reduction.- References.- Cerebral Hemispheric Contusions and Lacerations.- Contusions.- Immediate Cerebral Effects.- Types of Brain Contusions.- Macroscopic Pathology.- Microscopic Pathology.- Vascular Alterations.- Neuronal Lesions.- Glial Lesions.- Fiber Lesions.- Late Cerebral Effects.- General Remarks.- Posttraumatic Encephalopathies.- Macroscopic Pathology.- Microscopic Pathology.- Punch-drunk Encephalopathy.- Macroscopic Pathology.- Microscopic Pathology.- Lacerations.- Immediate Cerebral Effects.- Types of Brain Lacerations.- Macroscopic Pathology.- Microscopic Pathology.- Lacerations as Component of Cranio-cerebral Wounds.- Progressive Continuous Form of Brain Lacerations.- Late Lesionai Effects of Brain Lacerations.- Meningo-cerebral Scars.- Macroscopic Pathology.- Microscopic Pathology.- Summary.- References.- Diffuse Brain Injury and Brainstem Dysfunction.- Experimental Confirmation of Diffuse Brain Injury.- Types of Diffuse Brain Injury.- Diffuse Brain Swelling.- Diffuse Degeneration.- Gliding Contusion.- Clinical Aspects of Diffuse Brain Injury.- Diagnostic Criteria.- Cerebral Concussion.- Cerebral Shearing Injury.- Diffuse Axonal Shearing Injury.- Primary Brainstem Injury.- References.- Cerebral Contusions and Lacerations. A Clinical Study.- Symptomatology.- Disturbances of Consciousness.- Signs of Localization.- Diffuse Neurological Signs.- Clinical Synthesis.- Anatomo-clinical Forms.- Cerebral Contusion.- Cerebral Laceration.- Hematoma Contusions.- Evolutive Forms.- Extremely Serious Forms.- Serious Forms.- Less Serious Forms.- Benign Forms.- References.- Traumatic Brain Swelling and Brain Edema.- Diagnosis and Pathogenesis.- 1. Traumatic Brain Swelling.- 1.1. Diagnosis.- 1.2. Pathogenesis.- 2. Traumatic Brain Edema.- 2.1. Diagnosis.- 2.2. Pathogenesis.- 2.2.1. Vasogenic Brain Edema.- 2.2.2. Cytotoxic Brain Edema.- 3. Mediators.- Frequency and Temporal Development.- 1. Frequency.- 2. Temporal Development.- Intracranial Pressure.- Management.- 1. Brain Swelling.- 1.1. Basic Principles.- 1.2. Hyperventilation.- 1.3. Buffering of Brain Tissue Acidosis.- 2. Brain Edema.- 2.1. Removal of Mass Lesion.- 2.2. Repair of the Defective BBB.- 2.3. Improvement of Microcirculation.- 2.4. Control of Mediators.- 2.5. Support of Edema Clearance Rate.- 3. Intracranial Hypertension.- 3.1. Hyperosmotic Solutions.- 3.2. Loop Diuretics.- 3.3. Barbiturates.- Outcome.- 1. Early Outcome.- 2. Follow-up.- References.- Posttraumatic Intracerebral Hematomas.- Definition.- Incidence.- Etiology and Pathogenetic Mechanism.- Biomechanics.- Location.- Clinical Manifestations.- Localizing Signs.- Differential Diagnosis.- Intracerebral Hematomas Concerning Their Appearance in Time.- Intracerebral Bleeding in Children.- Paraclinical Investigations.- Radiography of the Skull.- Pneumoencephalography, Ventriculography.- Cerebral Angiography.- Isotope Scintigraphy.- Echoencephalography.- CT and MRI.- Clinicopathological Correlation.- Predicting Outcome with CT and MRI.- Treatment.- How to Do It.- References.- Posttraumatic Cerebellar Contusions and Hematomas.- Cerebellar Contusions.- Incidence, Distribution of Age and Sex.- Clinical Signs and Symptoms.- Diagnosis.- Differential Diagnosis.- Posterior Fossa Hematomas.- Epidural Hematomas.- Age and Sex Distribution; Location.- Etiology.- Pathological Effect.- Acute Epidural Hematoma.- Subacute and Chronic Hematomas.- Accompanying Lesions.- Clivus Extradural Hematoma.- Diagnosis.- Treatment.- Mortality.- Subdural Hematomas.- Incidence.- Pathology.- Diagnosis.- Treatment.- Mortality.- Intracerebellar Hematomas.- Incidence.- Signs, Symptoms, Diagnosis.- Surgical Treatment.- Results.- Conservative Treatment.- Subtentorial Subdural Hygroma.- Incidence.- Signs, Symptoms, Diagnosis.- Treatment.- Results.- Depressed Fractures.- How to Do It.- References.- Early Dynamic Evolution of Cerebral Contusions and Lacerations. Clinical and Radiological Findings.- Definition.- Radiological Findings.- Correlation of Clinical Manifestation and CT-findings.- Type of Lesions.- Time of Investigation.- Size of Contusions.- Location of Contusions.- Multiple Contusions, Accompanying Lesions.- State of Consciousness.- Enlargement of Contusions on Repeat Scan.- Dynamics of Cerebral Contusions.- Early CT scans.- Temporal Course.- Intracerebral Hematoma.- Frequency.- Secondary Delayed Intracerebral Hematoma.- Treatment.- Prognosis.- Mortality.- Manifestations.- Probability.- Overall Mortality.- Summary.- References.- Evoked Potentials in Head Injury.- Anatomical and Neurophysiological Considerations.- Somatosensory Evoked Potentials.- Visual Evoked Response.- Auditory Evoked Responses.- Prognostic Value of Evoked Potentials in Severe Head Injury.- Patients and Methods.- Results.- Discussion.- Conclusion.- Auditory Evoked Responses in Non-severe Head Injury.- Brain Death.- Patients and Methods.- Supratentorial Lesions.- Infratentorial Lesions.- Discussion.- Reliability of Evoked Potentials.- Conclusion.- How to Do It.- References.