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Abstract: Objects: Two children were admitted to hospital for treatment of craniocerebral injury with transorbital penetration. Methods: One child aged 6 years and 6 months had poked a chopstick in his orbit. There was no report of either a palpebral or an ocular wound. He had subsequently developed a meningeal syndrome with a cerebral abscess managed by needle aspiration biopsy and intravenous antibiotics. The other child, aged 4, had fallen onto a metal rod. He presented with a palpebral wound, motor disorders and coma, all due to a frontal intracerebral hematoma. There was an improvement in outcome without complications of an infectious nature or motor sequelae. Conclusions: Such head injuries are rare. Clinical, radiological and ophthalmological investigations must be performed, including computed tomography (CT) scan or cerebral magnetic resonance imaging (MRI) with antibiotic treatment for suspected microorganisms.

Basilar artery thrombosis should be diagnosed immediately, as intra-arterial thrombolysis might improve the outcome. Diffusion-weighted (DWI)-MRI and three-dimensional time-of-flight MR angiography (3D TOF Turbo MRA) may provide additional insight into the extent of ischemia and the level of the occlusion. These methods could be helpful in the early classification of vertebrobasilar stroke, thus reserving the use of conventional angiography and possible intra-arterial thrombolysis for patients who had a severe clinical picture explained by preliminary assessments. We report the case of a 74-year-old woman who experienced a basilar artery occlusion; DWI-MRI and 3D TOF Turbo MRA provided noninvasive information concerning the level of arterial occlusion and its parenchymal ischemic impact, this leading to an intra-arterial thrombolytic therapy. These data suggest the feasibility of a noninvasive urgent diagnostic and prognostic approach with DWI-MRI and 3D TOF Turbo MRA in basilar occlusion.

A controlled double-blind evaluation of the effects of Dextran 40 at different concentrations on cerebral blood flow (CBF), cerebral oxygen consumption (CMRO2) and cerebral lactate production (CMRLact) was carried out. We studied 40 patients in coma due to recent head injury. Concentrations of Dextran solution were not significantly related to variations in CBF and metabolic rate over the period of infusion. The lack of effect of the Dextran infusion may be explained by the absence of global brain ischemia in these patients at the time of the study. The very low initital CBF values were a consequence of brain metabolic depression and not a sign of global ischaemia. The rheological benefits of treatment with Dextran 40 in head injured patients should preferably be investigated using techniques which permit detection of local changes in CBF and metabolism.

Les auteurs ont fait une revue de l'effet des anesthésiques sur les potentiels évoqués (PE) auditifs précoces et de latence moyenne, sur les potentiels somesthésiques et sur les potentiels visuels. Les effets des anesthésiques intraveineux et des anesthésiques volatiles ont été successivement étudiés. La surveillance neurophysiologique sous anesthésie générale sera d'autant plus efficace qu'elle prendra en compte les notions suivantes : 1) les anesthésiques volatiles halogénés exercent une action plus puissante sur les PE que les anesthésiques intraveineux, ceci quelle que soit la modalité sensorielle considérée ; 2) les réponses corticales sont plus sensibles à l'action des anesthésiques que les réponses sous-corticales ; 3) la réponse corticale primaire est plus résistante que les composantes plus tardives ; 4) l'administration continue des anesthésiques doit être préférée à l'administration discontinue en bolus. Les PE peuvent également être utilisés en tant que mesure de la profondeur anesthésique ; pour cela, les réponses auditives de latence moyenne semblent actuellement les mieux adaptées. Enfin certains problèmes posés par l'administration des anesthésiques intraveineux en réanimation ont été abordés.

Combined infusion of high doses of lidocaine and thiopental in a comatose patient induced major latency and amplitude BAEP changes, which progressed to complete BAEP abolition. Responses returned to normal after drugs were discontinued. EEGs during the episodes showed long-lasting periods of activity suppression, but were never isoelectric. BAEPs are resistant to hypothermia and barbiturates, but must be interpreted cautiously in patients treated with a combination of anesthetic drugs that includes lidocaine.