title: The significance of a midbrain syndrome in unconscious patients with severe head injury.
abstract: Recent advances in neurosurgical techniques and the development of specialized intensive care units have resulted in an increase in the numbers of patients surviving extensive brain damage. Renfrew (1971) and Symons (1961, 1967) have recently reviewed some aspects of the role of the physiotherapist in the management of patients falling within the category of "severe head injury", which encompasses a wide variety of patients with many different clinical and neurological problems. In the neurosurgical unit at the Royal Melbourne Hospital, we have treated a group of patients with severe head injury who have presented with signs which are predominantly characteristic of midbrain involvement. The dominance of these signs over other neurological signs which are indicative of brain damage, enables these patients to be classified as a separate clinical entity. This is of significance because the patients in this group follow a similar course in the unconscious state which presents difficulties in management for the physiotherapist. These difficulties require modification of the current techniques used in the treatment of head injuries. The scope of this paper is to describe the clinical features of this midbrain syndrome during the unconscious stage, highlighting the problems that these patients present and the techniques used in treating them.
authors.affiliation: Neurosurgical and Neurology Unit, Royal Melbourne Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Howsam