Search

Galvos smegenųtrauma (GST) yra vienas dažniausių neurologiniųsutrikimų. Iš visųGST 90 % yra lengvos, jųdažnis siekia 100-300/100 000 kasmet. Intrakranijinės lengvos galvos smegenųtraumos (LGST) komplikacijos nėra dažnos (10 %). Labai retai prireikia neurochirurginės intervencijos (1 %), tačiau tai gali būti pavojinga gyvybei (mirtingumas -0,1 %). Taigi, tikroji gydymo problema kyla dėl poreikio išsiaiškinti nedidelę gyvybei grėsmingos komplikacijos galimybę dideliam pacientųskaičiui. 2002 m. EFNS nuorodose taikytas geriausio ąrodymo požiūris, remiantis literatūra iki 2001 m. nurodant pradiną gydymą, KT indikacijas, hospitalizavimą ir pacientų, patyrusių LGST, stebėjimą. šios atnaujintos EFNS nuorodos siūlo selektyvesnę KT atlikimo taktiką, esant didiesiems (pavojingas traumos mechanizmas, GKS < 15 balų, GKS vertės sumažėjimas 2 balais, klinikiniai kaukolės (pamato) l ūžio požymiai, vėmimas, gydymas antikoaguliantais, potrauminiai traukuliai) ar mažiesiems (amžius, sąmonės netekimas, išliekanti anterogradinė amnezija, židininiai simptomai, galvos sumušimas, GKS balųblogėjimas) rizikos veiksniams. Nuorodos paremtos publikuotais sprendimais, esant aukštam ąrodymųlygiui. Be to, dabar egzistuoja rekomendacijos dėl KT atlikimo vaikams. Nors ir su žemesniu ąrodymųlygiu, pateikiamos nuorodos dėl klinikinio stebėjimo ligoninėje, siekiant išvengti galimųpavojingųkomplikacijų, ąskaitant elgesio sutrikimus (amnezija, sumišimas ir neramumas) ir infekciją. [ABSTRACT FROM AUTHOR]

Background and purpose: The demographical evolution and the technological revolution seen in the last decades, in developed countries, have dramatically changed the practice of Neurology. However, the academic curriculum in many medical schools has not been updated accordingly over many of the European Countries. The Education Committee of the European Federation of Neurological Societies (EFNS) implemented in 2000 a Task Force on pre-graduate education trying to give guidelines to adequate pre-graduate education to the present status. Methods and discussion: Based on the results of two questionnaires, the first sent to the delegates of the EFNS and to the delegates of the European Board of Neurology, and the second answered by the Task Force members themselves, this paper describes the Task Force recommendations aimed to improve Neurology Education in the Medical Schools. These recommendations are also discussed with the analyses of the current bibliography available. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiology in Europe shows constantly increasing figures for the apallic syndrome (AS)/vegetative state (VS) as a consequence of advanced rescue, emergency services, intensive care treatment after acute brain damage and high-standard activating home nursing for completely dependent end-stage cases secondary to progressive neurological disease. Management of patients in irreversible permanent AS/VS has been the subject of sustained scientific and moral-legal debate over the past decade., Methods: A task force on guidelines for quality management of AS/VS was set up under the auspices of the Scientific Panel Neurotraumatology of the European Federation of Neurological Societies to address key issues relating to AS/VS prevalence and quality management. Collection and analysis of scientific data on class II (III) evidence from the literature and recommendations based on the best practice as resulting from the task force members' expertise are in accordance with EFNS Guidance regulations., Findings: The overall incidence of new AS/VS full stage cases all etiology is 0.5-2/100.000 population per year. About one third are traumatic and two thirds non traumatic cases. Increasing figures for hypoxic brain damage and progressive neurological disease have been noticed. The main conceptual criticism is based on the assessment and diagnosis of all different AS/VS stages based solely on behavioural findings without knowing the exact or uniform pathogenesis or neuropathological findings and the uncertainty of clinical assessment due to varying inclusion criteria. No special diagnostics, no specific medical management can be recommended for class II or III AS treatment and rehabilitation. This is why sine qua non diagnostics of the clinical features and appropriate treatment of AS/VS patients of "AS full, remission, defect and end stages" require further professional training and expertise for doctors and rehabilitation personnel., Interpretation: Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.