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Biomedical subjects

R A Frowein

Publications and source records attributed to R A Frowein.

At least 19 recordsLinked to original sources
PubMed1992

Rehabilitation after severe head injury.

123 survivors of severely head injured patients presenting with coma grade III show a decreasing mean duration of coma with increasing age. The numbers and frequency of good recovery decrease, whereas poor recovery increases with age. Increase of the duration of coma grade III produces an increase of the mean latency and time of recovery and of the frequency of poor recovery, regardless of the age of the patients. Increasing age does not increase the mean latency and time of recovery systematically. The important conclusion of this analysis is, that the clinical feature of coma grade III, corresponding to GCS score of 4 and RLS of 6 and 7, indicates a different kind of brain damage at various age groups. It represents a lesser degree of brain damage for younger patients under 20, than for those over 20. In our opinion our observations do not demonstrate a better capacity of recovery of the young patients: but the young patients show a more severe clinical picture than the older patients do, if only the clinical syndrome of coma grade III with extensor rigidity, is considered as a yardstick for comparison.

Activities of Daily Living↗
PubMed1992

Brain death: practicability of evoked potentials.

Multimodally evoked potentials were registered in 85 patients who fulfilled the criteria for brain death. While somatosensory and visual evoked potentials have been found to be of limited value for the diagnosis of brain death, the stepwise abolition of brain stem auditory evoked potentials (BAEP) confirmed brain death in 26 out of 85 patients, i.e. 31%. Registration of the abolition of BAEP is concluded to be a safe and acceptable confirmatory test. It is, however, more feasible for institutions, in which BAEP are analysed routinely. In spite of all efforts sequential BAEP could not be used for the diagnosis of brain death in the majority of cases either because of absence of reproducible responses at the initial registration or because the patient was already apnoic at the time of the initial BAEP. Assuming that bilateral preservation of wave I has the same significance as the stepwise abolition of BAEP, since it also proves the integrity of the peripheral receptor, BAEP are relevant for the declaration of brain death in approximately 30% of patients.

Brain Death↗
PubMed1992

Cerebral reperfusion in brain death of a newborn. Case report.

A case of "sudden infant death" after 15 minutes of successful resuscitation of cardiovascular function is presented. While apnoic cranial nerve areflexia and electrocerebral silence persisted, angiography and transcranial Doppler sonography demonstrated nearly normal cerebral perfusion, which even increased day by day inspite of the persistence of other signs of brain death. The phenomenon "cerebral reperfusion" is concluded to be compatible with the diagnosis of brain death.

Blood Flow Velocity↗
PubMed1991

Cerebellar haemorrhage: management and prognosis.

Of 26 patients with CT confirmed intracerebellar haematoma, 17 had ventricular drainage performed and 7 patients had the haematoma evacuated. Eleven patients died. Mortality was clearly related to state of consciousness. Seven out of 8 non-comatose patients survived but 10 out of 18 comatose patients died. As there was no incidence of deterioration immediately following placement of a ventricular drainage, the actual risk of upward transtentorial herniation seemed low. Absence of evoked potentials in 6 patients accurately predicted a fatal outcome but normal SEP and BAEP were of lesser value for predicting survival.

Aged↗
PubMed1990

Multimodality evoked potentials and early prognosis in comatose patients.

In 112 comatose patients somatosensory, visual and auditory evoked potentials were registered within 36 hours after the onset of coma or admission. Main causes of coma were head injury, and intracerebral and subarachnoid haemorrhage. The initial bilateral loss of any evoked potential was associated with a mortality of 98%. Normal somatosensory evoked potentials were associated with a survival rate of 74%, while normal visual and normal auditory evoked potentials had a survival rate of 60% and 66%, respectively. It is concluded that SEPs can be valuable for the prognosis of coma after primary brain lesions.

Brain Injuries↗
PubMed1990

[Cerebral blood flow velocity. A prognostic factor following severe craniocerebral trauma?].

Head injuries lead to changes in cerebral blood flow velocity (BFV)--measured with the transcranial Doppler ultrasonography--in 19 out of 31 patients, i.e. 61%. In 12 cases there was an immediate increase of BFV following the injury or within the first 7 days, often parallel with an increase of the intracranial pressure. On the other hand in 2 out of 4 cases with chronic subdural haemorrhage there was a decrease of the BFV. With routine use of transcranial doppler ultrasound in neurosurgical intensive care, acute changes in BFV along with clinical deterioration may indicate the need for a repeat CT and eventually a surgical intervention.

Adolescent↗
PubMed1989

Repeated early CT examinations in traumatic intracranial hematomas and in closed head injuries.

Within the first three hours after an accident with closed head injuries, we found a continuous increase in size of 30 extracerebral hematomas investigated repeatedly by CT. In the course of this early phase 72 intracerebral lesion in repeated CT investigations showed no similar appearance, neither in evolution nor in the dynamics of the developing contusional hemorrhage or as regards the clinical symptoms.

Adult↗
PubMed1989

Early post-traumatic intracranial hematoma.

To summarise, it is apparent that operable acute hematomas are found particularly in the second and third hours after a CCI. Therefore, it is during the first hour after a CCI that the control of the vital functions of respiration and circulation are the most important. When a hematoma is suspected, the diagnostic procedure must be organized promptly, particularly in the second and third hour. Later, the chances of recovery for a patient with an epidural hematoma are greatly reduced.

Brain Injuries↗
PubMed1989

Encapsulated subdural hematoma.

In 45 out of 103 cases with chronic subdural hematoma a definite membrane was found. Membranectomy was performed in 37 cases, mostly as a secondary procedure after burr-hole evacuation and closed system drainage. The mortality rate was 6.6% and in the survivors a complete recovery was achieved in 90%. CT monitoring of the diameter of the hematoma and midline shift did not reveal any correlation of size of the hematoma with neurological findings. The indication for membranectomy can, therefore, not be based on radiological findings alone, but on the clinical course of events and with due regard to the CT findings.

Adult↗
PubMed1989

Brain death criteria: third generation.

Hence, in the third generation of brain death criteria, the disappearance of evoked potentials is, in our opinion, the best of the new tests. There are, therefore, three tests alternatively available: ECS, EP-abolition and CCA, which permit a shortening of the observation time, before the determination of brain death. This is not valid for newborns. In these tests the difference between supratentorial and infratentorial primary brain lesions has to be considered carefully. In infratentorial lesions the apnea can precede the ECS by several hours.

Brain Death↗