RESUMEN. Debido a su creciente incidencia, el traumatismo cra- neoencefálico severo es un grave problema de salud pública, por lo que las unidades de. Download. Citations (1). References (10) Los traumatismos en general, y el traumatismo craneoencefálico en particular, constituyen la emocionales posteriores a traumatismo encefalocraneano moderado y grave en pacientes entre 20 y. El traumatismo craneoencefálico (TCE) es la primera causa de discapacidad en gente Disabil Rehabil Downloaded from freemindakebe.ga by Universitat .. patient perspective using focus groups. Disabil Rehabil [ Epub.
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Introducción: El trauma craneoencefálico (TCE) es un problema de salud mundial que Palabras clave: Trauma craneoencefálico; Lesión primaria; Lesión. [F.R.E.E D.O.W.N.L.O.A.D]] Traumatismo craneoencefalico / Traumatic brain injury (Spanish Patologia del antepie (Spanish Edition) by A Viladot Perice EPUB. You can Free download it COM in easy step and you can Free PDF it now. Epidemiologia del traumatismo encefalocraneano en el hospital abel gilbert.
One month after the traumatic injury, the patient was transferred to our hospital to undergo neurorehabilitation. Upon admission, he was disoriented and showed bradypsychia and psychomotor restlessness.
Four months after head trauma, it was possible to conduct a formal neuropsychological examination, according to which the patient was oriented in time, space, and person and displayed preserved language skills. During the examination, the patient was observed not paying attention to stimuli in the contralesional hemifield; homonymous hemianopsia had not been observed in the neurological examination.
He was subsequently administered a specific neuropsychological testing protocol for assessing visuospatial attention Bells Test, Ogden Figure Copying Task, Line Bisection Test, Baking Tray Task, and Reading Task ; results confirmed presence of left hemispatial neglect.
Ten days later, visuospatial tests were administered again; the patient showed slight improvements in task performance Fig.
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Figure 2. Performance on one of the tests included in the protocol for assessing visuospatial attention Baking Tray Task. The dividing line shown in the picture was added intentionally to this figure; it is not visible during the test. The image shows a marked tendency to place the cubes on the right side of the board. Although hemispatial neglect commonly presents in patients with lesions in the right hemisphere, recurrence after head trauma is infrequent.
Left hemispatial neglect has traditionally been associated with vascular lesions in the right parietal lobe. According to these authors, a focal lesion in the inferior parietal or right superior region is not very likely to cause this condition by itself. Mesulam proposes that contralateral neglect is caused by dysfunctions in the neurocognitive network whose cortical epicentres are located in the frontal cortex involved in the intentional component of neglect and parietal cortex involved in the attentional component.
Those lesions include structural changes in the splenium of the corpus callosum Fig. S beta-protein S beta-protein SB is the most widely studied brain damage biomarker. In this respect, a number of studies have documented persistently elevated serum levels in patients who do not survive, while the plasma levels have been seen to decrease after 36h among survivors.
In addition, we defined a cutoff point in urine samples, though of lesser significance than in the case of blood samples.
Despite its high sensitivity and negative predictive value, S beta-protein is not a specific marker of the central nervous system. In this regard, it must be mentioned that polytraumatized patients without TBI can present S beta-protein elevations in blood, though the concentrations return to normal within 6h after trauma.
Therefore, early determination of this protein is to be avoided in patients with extracranial injuries associated to TBI. It is implicated in the elimination of degraded and denaturalized proteins following oxidative phenomena.
At present, some studies point to it as a promising brain damage biomarker, since there are data indicating that it is able to predict the presence of lesions on the computed tomography scan, the need for neurosurgery, and the outcome of patients with TBI.
The marker can be determined during approximately h, though in cases of increased severity or the development of secondary lesions the levels remain elevated for longer periods of time. Spectrin degradation products Spectrin is a structural protein and a principal component of the cortical cytoskeleton of red blood cells. Spectrin can undergo proteolysis mediated by calpain and caspase-3, which trigger necrotic and apoptotic processes, respectively. Different authors have demonstrated an increase in spectrin degradation products determined in CSF in the context of TBI—underscoring its role as a predictor of severity and mortality in patients of this kind.
In the case of axon damage, these proteins are released into both CSF and the bloodstream.
A number of investigational studies have underscored the role of neurofilaments as biomarkers of axon damage and neurological disability in neurodegenerative and neuroinflammatory diseases. Some markers, such as NSE and S beta-protein, have shown good correlations to clinical severity, the extent of brain damage, response to treatment, and patient outcome.
However, the limitations associated to clinical yield of the molecule or invasiveness of the technique required to obtain the sample have not allowed their generalized use in this patient population.
On the other hand, further studies are needed to understand the role of these proteins in the physiology of the central nervous system and in the physiopathology of severe TBI, as well as to clarify the usefulness of those biomarkers that appear to be promising in this field.
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In this respect, mention must be made of nervous tissue-specific glial fibrillary acidic protein, as well as of other biomarkers that are currently the focus of interest, such as ubiquitin carboxy-terminal hydrolase L1, the light neurofilaments and spectrin degradation products. Since these molecules offer isolated information on some of the many elements implicated in the physiopathology of TBI, we believe that the best strategy is to analyze them in combination.High concentrations of this protein are therefore found at neuronal synaptic junction level.
Figure 1. The levels then gradually decrease, except in individuals with potentially serious injuries, where the marker remains high for days.
These recommendations usually comprise high-dose midazolam, remifentanil and propofol — i. Most Only in this way can we hope to complement the traditional methods with a tool that is simple, noninvasive, reproducible and extraordinarily useful for addressing and managing severe TBI.
However, the existing publications in this respect are few and old, with small sample sizes, and with results that reflect high specificity but limited sensitivity. We found no midline shift, and the ventricular system was symmetrical and of normal size.
A peak in serum cerebral creatine kinase concentration is observed in the first few hours after severe TBI. Pain control is monitored on the basis of clinical parameters, and starts with nonsteroidal antiinflammatory drugs diclofenac, ketorolac administered via the intravenous i.
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