Oculographic research by caloric stimulation in severe head-injured patients
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77 EPILEPSY AND DEPRESSED FRACTURE OF THE SKULL (NON-MISSILE) R. BRAAKMAN,Rotterdam The results of a study by B. JenneR, J. D. Miller and the author on the relation between epilepsy and 1000 non-missile depressed skull-fractures are reported. 10~ had early epilepsy (first week) and 15 developed late epilepsy. The risk of late epilepsy varies widely, but could be predicted on clinical data available one week after the injury. In more than a third of depressed fractures the risk of late epilepsy is less than 4%; in others it is over 60%. This risk depends on a variety of factors which interrelate. The risk is increased if posttraumatic amnesia exceeds 24 hours, if the dura is thorn and if there has been early epilepsy. The significance of these facts in the decision whether or not to prescribe prophylactic anticonvulsants is emphasized. These facts are also important for patients requiring advice about the future, particularly children and teen-agers planning their carreers. It is also worth-wile for lawyers concerned to assess damages in which they have to take account of later development of complications which might effect the settlement. A calculation can be made one week after injury of the probability that late epilepsy will develop in any individual case. OCULOGRAPHIC RESEARCH BY CALORIC STIMULATION 1N SEVERE HEAD-INJURED PATIENTS T. W. VAN WEERDENand TH. C. A. M. VAN WOERKOM, Groningen In 42 head-injured patients registration of the eye movements after caloric stimulation was done (caloric oculogram - C.O.G.). After stimulation the recording with open and closed eyes was per- formed. In the majority of these patients a decrease of the nystagmus was found after closing of the eyes - paradoxal response. In these patients the nystagmus improved by painfull stimuly. It seems prob- able that a decreasing of the arousal effect with eyes shut caused this paradoxal response. A scoring of the nystagmogram was made on the shape of the curve and the paradoxal response. During the first 20 days after the trauma a correlation was found between the state of consciousness and the C.O.G. scoring. Later only a significant difference was found between all patients with a disturbed consciousness and those with a clear consciousness. In the patients who were still unconscious after the 20th day, the ¢.O.G. gradually improved independent of the clinical condition. Patients still unconscious (20 days) with a good C.O.G. without paradoxal response had a bad prognosis. Eight severe head-injured patients were treated with L-DOPA. Five improved very well, clinically as well as on the C.O.G. Five patients with an akinetic mutism were also treated with physostigmine 1 mg i.v. Three showed an immediate improvement of the state of consciousness (started to talk and to answer questions) during injection. The C.O.G. improved after injection with physostigmine in all the patients treated; also in the patients with no improvement on physostigmine. HOMOVANILLIC ACID AND 5-HYDROXYINDOLEACETIC ACID CONCENTRATIONS IN THE CSF OF CONSCIOUS AND COMATOSE BRAIN DAMAGED PATIENTS CH. J. VECHT, TH. C. A. M. VAN WOERKOM, A. W. TEELKEN and J. M. MINDERHOUD The dopamine and serotonin metabolism in head-injured patients was studied by determination of their metabolites. Respectively the concentration of homovanillic acid (nvg) and 5-hydroxyindoleacetic acid (5-HIAA) was measured with or without probenecid (Olsson and Roos 1968, Van Praag et al 1970, Korf 1971). Probenecid impedes the egress of HVA and 5-HIAA OUt Off the CSF to the blood, what results in increase of these acids, giving an impression of cerebral the turnover of the original amines dopamine and serotonin. 91 Adult patients were studied; 33 received probenecid in the 8 hours before the lumbar puncture and 58 were not treated. The patients were divided into groups based on 4 critiera: slight or severe brain damage, conscious or unconscious, with or without probenecid and measured in the first 5 days or later.
Transcript of Oculographic research by caloric stimulation in severe head-injured patients
77
EPILEPSY AND DEPRESSED FRACTURE OF THE SKULL (NON-MISSILE) R. BRAAKMAN, Rotterdam
The results of a study by B. JenneR, J. D. Miller and the author on the relation between epilepsy and 1000 non-missile depressed skull-fractures are reported. 10~ had early epilepsy (first week) and 15 developed late epilepsy. The risk of late epilepsy varies widely, but could be predicted on clinical data available one week after the injury. In more than a third of depressed fractures the risk of late epilepsy is less than 4%; in others it is over 60%.
This risk depends on a variety of factors which interrelate. The risk is increased if posttraumatic amnesia exceeds 24 hours, if the dura is thorn and if there has been early epilepsy. The significance of these facts in the decision whether or not to prescribe prophylactic anticonvulsants is emphasized. These facts are also important for patients requiring advice about the future, particularly children and teen-agers planning their carreers. It is also worth-wile for lawyers concerned to assess damages in which they have to take account of later development of complications which might effect the settlement. A calculation can be made one week after injury of the probability that late epilepsy will develop in any individual case.
OCULOGRAPHIC RESEARCH BY CALORIC STIMULATION 1N SEVERE HEAD-INJURED PATIENTS T. W. VAN WEERDEN and TH. C. A. M. VAN WOERKOM, Groningen
In 42 head-injured patients registration of the eye movements after caloric stimulation was done (caloric oculogram - C.O.G.). After stimulation the recording with open and closed eyes was per- formed.
In the majority of these patients a decrease of the nystagmus was found after closing of the eyes - paradoxal response. In these patients the nystagmus improved by painfull stimuly. It seems prob- able that a decreasing of the arousal effect with eyes shut caused this paradoxal response. A scoring of the nystagmogram was made on the shape of the curve and the paradoxal response. During the first 20 days after the trauma a correlation was found between the state of consciousness and the C.O.G. scoring. Later only a significant difference was found between all patients with a disturbed consciousness and those with a clear consciousness. In the patients who were still unconscious after the 20th day, the ¢.O.G. gradually improved independent of the clinical condition.
Patients still unconscious (20 days) with a good C.O.G. without paradoxal response had a bad prognosis.
Eight severe head-injured patients were treated with L-DOPA. Five improved very well, clinically as well as on the C.O.G.
Five patients with an akinetic mutism were also treated with physostigmine 1 mg i.v. Three showed an immediate improvement of the state of consciousness (started to talk and to answer questions) during injection.
The C.O.G. improved after injection with physostigmine in all the patients treated; also in the patients with no improvement on physostigmine.
HOMOVANILLIC ACID AND 5-HYDROXYINDOLEACETIC ACID CONCENTRATIONS IN THE CSF OF CONSCIOUS AND COMATOSE BRAIN DAMAGED PATIENTS CH. J. VECHT, TH. C. A. M. VAN WOERKOM, A. W. TEELKEN and J. M. MINDERHOUD
The dopamine and serotonin metabolism in head-injured patients was studied by determination of their metabolites.
Respectively the concentration of homovanillic acid (nvg) and 5-hydroxyindoleacetic acid (5-HIAA) was measured with or without probenecid (Olsson and Roos 1968, Van Praag et al 1970, Korf 1971).
Probenecid impedes the egress of HVA and 5-HIAA OUt Off the CSF to the blood, what results in increase of these acids, giving an impression of cerebral the turnover of the original amines dopamine and serotonin.
91 Adult patients were studied; 33 received probenecid in the 8 hours before the lumbar puncture and 58 were not treated. The patients were divided into groups based on 4 critiera: slight or severe brain damage, conscious or unconscious, with or without probenecid and measured in the first 5 days or later.
