Responses to monoamines perfused over the cortical surface through modified pial windows were monitored in 106 cats. Norepinephrine (NE) and serotonin (5-HT) were diluted in mock CSF to concentrations of 50 and 500 ng/ml respectively, levels at or near the maximum concentrations to which the cortical surface might be exposed in subarachnoid hemorrhage or damage to nearby neurons. Each cat had simultaneous one-hour perfusions of monoamine solution over one hemisphere and a control solution over the other hemisphere thus serving as its own control. The perfusion solutions were observed to be restricted to the area of the pial window, and minimal histological damage was seen with the perfusion technique. The 5-HT perfusions were associated with an almost 20% narrowing of small pial arteries and arterioles but no significant effect on regional cerebral blood flow (rCBF), cortical water content or cortical function as monitored by EEG and somatosensory evoked potentials (SEP). In contrast, NE caused cortical edema and changes in the EEG and SEP's without significant vascular effect. These results suggest a non-ischemic toxicity of NE released by subarachnoid hemorrhage or cerebral damage.

Administration, Topical↗

PubMedDate not supplied

Limitations of neurological assessment in mild head injury.

The authors have investigated two commonly used methods of assessing neurological status in patients with mild head injury to determine whether they can predict intracranial damage. Of 686 such patients with cranial computed tomography (CT) scans, scan results were recorded, along with total and motor components of the Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85). Despite relatively normal admission neurological examinations, 127 of the 689 patients (18.4%) had intracranial lesions, and 38 (5.5%) required surgery. There was no significant difference in distribution of the GCS in patients with and without intracranial lesions. The RLS85 was superior to the GCS in predicting intracranial pathology, and a significant association between RLS85 and lesions on CT scanning was noted. However, even this test was normal in 19 patients found to have intracranial pathology, including nine who required surgery. The authors conclude that a normal or near-normal mental status examination in a head-injured patient on arrival at the emergency room is inadequate to exclude a potentially serious intracranial lesion. It is unlikely that further refinements in the clinical evaluation will result in diagnostic accuracy comparable with that of CT scanning. Accordingly, we recommend that any patient who has suffered a loss of consciousness or amnesia following head injury have an urgent cranial CT scan.

Adult↗