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Consolation
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
The “rules” of the Consolatio were followed by Lincoln in the Gettysburg Address, which has been analyzed by American Civil War scholars.7,8 Lincoln’s speech, like Pericles’: Begins with an acknowledgement of revered predecessors: “Four score and seven years ago, our fathers brought forth upon this continent …”Praises the uniqueness of the State’s commitment to democracy: “a new nation, conceived in liberty and dedicated to the proposition that all men are created equal … government of the people, by the people, and for the people …”Addresses the difficulties faced by a speaker on such an occasion, “we cannot dedicate, we cannot consecrate, we cannot hallow this ground.”Exhorts the survivors to emulate the deeds of the dead, “It is for us the living, rather, to be dedicated here to the great task remaining before us.”Contrasts words and deeds, “The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract … The world will little note, nor long remember what we say here, but it can never forget what they did here.”
Neurologic care
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Maria Chiara Casadio, Paola Cristina Volpi, Giuseppe Citerio
The first and most fundamental component of patient evaluation is the clinical neurologic examination. It should include assessing the level of consciousness by using the GCS1 or the Full Outline of UnResponsiveness (FOUR) score,12 which provides additional information on brainstem reflexes and respiratory drive. Pupil size and pupillary light reflex should be assessed with an automated pupilometer, which provides greater accuracy than a clinical pupil examination.13
A new hybrid classification system for traumatic brain injury which helps predict long-term consciousness: a single-center retrospective study
Published in Brain Injury, 2018
Yan Yan, Jian Song, Shun Yao, Yusong Gao, Guibao Peng, Chenglong Cao, Wei Liao, Wan Yang, Zhixian Lan, Haiyang Xie, He Huang, Hao Du, Guozheng Xu
Previously, a workshop held by National Institute of Neurological Disorders and Stroke (NINDS) and the US National Institutes of Health (NIH) in 2007 called for the development of a reliable, efficient and valid classification system for TBI with the use of multivariate prognostic modeling (13). In recent years, CT has been widely used and is considered helpful for predicting short-term mortality (14,15). An extended Glasgow Coma Scale (GCS-E) was developed with enhanced sensitivity to mild TBI (16), and the FOUR score was also proposed for predicting outcomes (17,18). Nevertheless, both the GCS-E and the Four score focused on overcoming the insensitivity of GCS-score to mild TBI, but did not improve the overall accuracy of TBI classification for predicting long-term consciousness.
Evaluation of the GCS-Pupils Score for PrOgnosis in trauMatic brAin injury- The COMA Study
Published in Brain Injury, 2023
Charu Mahajan, Deep Sengupta, Indu Kapoor, Hemanshu Prabhakar, Vijay Kumar, Shobha Purohit, Vansh Priya, Shashi Srivastava, Deepali Thakur, Hemangi Karnik, Hem Chandra Sati, Mani Kalaivani
The Glasgow Coma Scale (GCS) score and pupillary reactions are the two very important features that have been used in head-injured patients for prognostication (1,2). The GCS score is a simple, easy to execute and widely used index of overall brain damage. It helps to distinguish between the severities of brain injury and, thereby, prognosis of the head-injured patients. The score assesses the eye, verbal and motor response of the patients. However, the score was criticized by some as it did not include features related to the brain stem, which were intended to be assessed separately. It was felt that inclusion of brain stem features would be more useful than assessing the GCS alone. Thus, newer and more detailed assessment methods such as Full Outline of Unresponsiveness (FOUR) score came into use and gained popularity (3). Authors of the GCS scale investigated ways of combining information from the above key features, that is, GCS and pupillary reactions, into an index of prognosis that could cover either mortality or unfavorable outcome (vegetative state or severe disability) in acute brain-injured patients (4). They found that combining these two features yielded more informative data than using either alone, and that the simple arithmetical score, the Glasgow Coma Scale-Pupils (GCS-P) score, performs almost as well as more complex methods of integration. However, their results were based on data obtained from two large head-injury trials, Corticosteroid Randomisation After Significant Head Injury (CRASH) and International Mission for Prognosis and Clinical Trials in TBI (IMPACT) (5,6). Thereafter, many authors have retrospectively assessed and found GCS-P to be more strongly related to in-hospital mortality (7,8).
Evacuation assisted by endoscopy has better efficacy for supratentorial intracerebral hematoma than CT-guided minimally invasive aspiration: a retrospective observational cohort study
Published in British Journal of Neurosurgery, 2019
Jun Dong, Zirong Jiang, Jin Chen, Ning Huang, Junjie Chen, Guodong Liu
The limitations of this study are its retrospective nature and limited patient numbers. Moreover, the patients were highly selected with a GCS score of 3 and 4, and their age were limited to younger than 70 years old. Therefore, the good outcomes and functional results may be due to patient selection. Recent studies reported that several factors such as younger age, lower Full Outline of UnResponsiveness (FOUR) score or Glasgow Coma Scale (GCS) score and larger ICH volume are associated with poor outcomes of supratentorial ICH.16,17, consistent with our results.