tailieunhanh - PRINCIPLES OF NEUROLOGY - PART 7

Vấn đề là chủ yếu là phẫu thuật, và tình trạng lâm sàng của bệnh nhân xác định thời gian của kế hoạch can thiệp phẫu thuật. Ngay lập tức loại bỏ các viên đạn hoặc cắt bỏ các mô não bị vỡ thường không có lợi thế. | 330 PART IV THE MAJOR CATEGORIES OF NEUROLOGIC DISEASE ment or an expanding intracranial hemorrhage is an immediate threat to survival. The problem is mainly surgical and the clinical status of the patient determines the timing of planned operative intervention. Immediate removal of the bullet or excision of shattered brain tissue is usually of no advantage. SEQUELAE OF HEAD INJURY Concussion invariably leaves the patient with a permanent gap in memory extending from a point before the injury occurred until the time he was able to form consecutive memories. The duration of the retrograde and anterograde amnesia particularly the latter is the most reliable index of the severity of the concussive injury. Concussion and even more trivial injuries in which there is no concussion may also leave the patient with persistent headache fatigue irritability dizziness lightheadedness difficulty in concentration disturbed sleep anxiety and depression. This syndrome is common and has been given many names postconcussion syndrome traumatic neurasthenia and posttraumatic nervous instability which is the one we prefer. These symptoms may persist for weeks months or a year or more. The syndrome is more frequent and prolonged when compensation or litigation is an issue. Settlement of the legal problem reassurance and appropriate use of antianxiety and antidepression medication are essential steps in the rehabilitation program. Concussive head injury is thought on dubious grounds to increase the patient s vulnerability to subsequent concussions. In respect to patients with contusional injury all gradations in the severity of neurologic sequelae can be observed. There are widespread hemorrhagic shearing and ischemic injuries that can be seen by MRI and to a lesser extent by CT scan. Death in the first few hours or days after the injury or the vegetative state is frequent. Some patients following a protracted period of coma maintain normal vital signs open their eyes and appear to be .