Severe Head Injury. Evaluation of Acute Treatment and Rehabilitation

University dissertation from Christer Eker Department of Neurosurgery Lund University Hospital Lund Sweden

Abstract: Mortality after severe head injury can be considerably reduce with a therapy using physiological principles for brain volume regulation and preserved microcirculation, with the main purpose of restricting the rise in ICP to reasonable levels simultaneously with preservation of adequate blood supply. This study shows that the ?Lund Concept? can reduce mortality in patients with severe traumatic brain lesions from 47% to 8%. This improvement in neurointensive care did not result in an increase in patients remaining in a vegetative state or severe disability. However, the number of patients classified as ?moderate disability? increased. This increase was not caused by an increase in focal neurological deficits but more pronounced deficits in higher functions resulting in increased difficulties in social adjustment. Thus, although improvements in neurointensive care will reduce mortality it will also increase the demands for qualified rehabilitation. The present study also shows that mean CBF values are within normal range already in the early post-acute phase and remains virtually unchanged during the first year of rehabilitation. A correlation was found between the individual CBF level and neuropsychological outcome one year after injury, particularly with regard to verbal memory capacity, reasoning capacity, cognitive flexibility, and information processing speed. AMPS gives a different view of the patient's restitution than neuropsychological tests and may be a better indicator of the patient's ability to resume independent living. The deterioration of Process Skills post rehabilitation suggests that lasting contact in an outpatient setting might facilitate return to social life.

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