[Neurologic services in cerebral concussion with insignificant clinical findings].
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The results of determinations of lysosomal enzymes: mannosidase, b-galactosidase and b-glucosidase, in the cerebrospinal fluid and blood are presented in 72 patients with severe brain trauma. The determinations were carried out at different times after the trauma. The study demonstrated a significantly lower level and in a smaller degree expressed variability of enzymes in the cerebrospinal fluid in relation to blood. It seems that the level of b-glucosidase in the cerebrospinal fluid depends on the level of this enzyme in the blood, while no such evident correlation was found for the remaining enzymes.
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We report on a 69-year-old woman who had suffered a serious closed brain injury with 3rd degree contusion and who had again suffered, after a heavily prolonged course with an initial clinical improvement, from excessive neuropsychological deterioration. Contrary to slight signs of internal hydrocephalus in CT fluid scintigraphy showed distinct signs of fluid passage disturbances according to occlusive hydrocephalus. Despite serious neurosurgical doubts (age, distance to trauma, slight extension of CT-findings) a Holter-Hausner-valve was finally applied, which resulted in a good motor and neuropsychological improvement. The case may be used as an example of the fact that elderly patients, especially, cannot be judged by general experience, but each patient's case should be discussed individually. From the point of view of rehabilitation, neuropsychological symptoms, especially the course of the vigilance level, should be significant in making decisions.
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The reported patient with contusion of the cerebellum complained also about diplopia on looking to the left and upwards. The latter complaint suggested the possibility of a blow-out fracture of the orbital floor with wedging-in of muscles. The patient had no signs of a direct orbital trauma, tomograms of the orbits demonstrated uneven floor of the left orbit. The test of passive movements of the eyeball confirmed this supposition. Surgical treatment was successful.
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Changes of local cerebral blood flow, vascular reactivity, and intracranial pressure in the first hours after brain contusion in its different areas (hemispheres, brain stem) were studied in experiment. The dynamics of changes of these values and their interrelationship in the first 2 hour after trauma were revealed.
The purpose of the study was a trial of using the calorie pendulum test and the test of reversal of the direction of caloric nystagmus with an optokinetic stimulus for assessment of the oculovestibular response in children after brain commotion. The investigations were carried out in 30 children aged from 6 to 10 years. In both tests the movements of the eyeballs were recorded with an electronystagmograph. It was found that in this type of craniocerebral trauma a transient disturbance occurs in the functions integrating the visual and vestibular stimuli in the central nervous system. It is suggested that these tests might be useful for determination of the otoneurological status of children after brain commotion.
Averaged cortical evoked responses were used to evaluate brain function in anaesthetised sheep. Effects on both evoked somatosensory responses (SERs) and visual evoked responses (VERs) were examined. Following capitive bolt stunning, SERs and VERs were abolished instantaneously and did not reappear for the duration of the experiment. Similar results were found when animals were shot while conscious. It was concluded that captive bolt stunning in sheep produces an immediate, profound and long lasting brain failure and is therefore an effective preslaughter stunning method.