By Georg E. Cold
During the decade a mess of stories about the dynamic adjustments in cerebral blood stream (CBF), cerebral metabolic price of oxygen (CMRO2), and intracranial strain (ICP) within the acute part after head harm were released. those stories were supplemented with stories of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. different investigations comprise reviews of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. during this booklet experimental and medical experiences of the dynamic alterations in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's personal scientific reviews of the dynamic adjustments in CBF and cerebral metabolism are summarized and mentioned, and the therapeutical implication as regards using man made hyperventilation, sedation with barbiturate and mannitol therapy are discussed.
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Additional resources for Cerebral Blood Flow in Acute Head Injury: The Regulation of Cerebral Blood Flow and Metabolism During the Acute Phase of Head Injury, and Its Significance for Therapy
These patients suffered from lesions of the cerebral hemispheres. Nine of the patients had lesions of the brain-stem. The ages of the patients ranged from 14 to 45 years, and in eight of the patients the ages were below 25 years. Five of the patients recovered (group I); five victims did poorly (group II) (Fig. 4, central figure). Material: 14 patients (9 males and 5 females); median age 23 (range 7-67) were studied. Throughout the study all patients were unconscious Glasgow coma score < 7. In accordance with study 1 the patients were divided into two groups.
These observations suggest that ischaemic damages, owing either to ICP-hypertension or a decrease in CPP, are of major importance. The early studies of CBF in HI revealed an inhomogeneous pattern. During the first days after the trauma CBF differed considerably. High and low CBF values were found, unrelated to the level of PaC02 and MABP (Fieschi et a!. 1974, Overgaard et al. 1974, Enevoldsen et al. 1976). However, repeated CBF studies in 21 comatose patients showed some characteristic patterns.
Repeated studies of the average hemispheric CBF (initial slope), measured over the most severely injured hemisphere in 21 unsconcious patients with head injury. CBF was corrected for changes from PaC0 2 30 mm Hg by simultaneous studies of CO 2 reactivity. The ages of the patients are indicated on the figures. Unbroken lines and closed circles indicate good clinical recovery (complete recovery or slight mental impairment). Broken lines and open circles indicate a poor clinical outcome (dementia, vegetative survival and death).