Sharon A. Bowers

Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis.

In January 1978 the Central Nervous System Injury Investigative Group at the University of California, San Diego, in concert with the San Diego Academy of Neurological Surgeons, began collecting data on the epidemiology, pattern, and severity of central nervous system injury in San Diego County. As

Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients.

A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.

Prospective study of patients hospitalized with head injury in San Diego County, 1978

The characteristics of 1311 head-injured patients admitted to 10 selected San Diego hospitals are detailed. Fifty patients who subsequently died are included. Glasgow coma scale scores were strongly related to survival. After adjustment for the Glasgow coma scale score, there was an independent association between age and survival, but not between sex and survival. The four characteristics associated with head injury that bore the highest case fatality ratios (all greater than 30%) in descending order were spinal cord injury, obstructed airway, difficulty breathing, and shock. Previous unconsciousness and transport by private vehicle were predictive of survival. None of the four adverse predictors or multiple injury showed an independent association with mortality when the Glasgow coma scale score was taken into account.

Phase II DMSO Trial for Uncontrollable Intracranial Hypertension

Dimethyl-sulfoxide (DMSO) has received considerable attention for the treatment of a number of diseases of the Central Nervous System, including stroke, experimental head injury and spinal cord injury3,4,5,6. investigations into the intracranial pressure (ICP) reducing properties of this drug, and its effects on the injured brain, have been carried out over the last decade. De la Torre and his colleagues demonstrated in a primate brain injury model that ICP fell over a few minutes following the infusion of a 40 percent solution of DMSO4. Brown et al, showed in a missile model of penetrating head injury that DMSO improved cerebral perfusion pressure, cerebral blood flow and oxidative metabolism when compared to controls1. In a more recent abstract, Waller et al, reported that DMSO improved the control of ICP and potentially improved outcome in a series of patients suffering coma from acute severe head injury or from subarachnoid hemorrhage9. in a more recent publication, de la Torre et al, showed that doses of up to 4 g/kg/ day were well tolerated in primates with no evidence of long term toxicity7. This confirmed his previous observation that doses of up to 8 g/kg/day could be used without difficulty.