Brain Changes in Patients With Extensive Body Burns

Abstract

THERE are approximately 8,000 deaths of burns each year in the United States.1 With the newer concepts of treatment for burns, an increasing number of patients are kept alive who formerly may have succumbed. Although it is not possible to determine the incidence of brain changes in people with body burns, several cases have been reported. There are, however, so few neuropathological studies that, in order to describe the cerebral changes and their possible clinical implications, we are reporting two cases of patients who suffered extensive burns. REPORT OF CASESCase 1.\p=m-\A 14-year-old boy suffered third-degree burns of 40% of his body surface in an airplane accident and lived 16 days. He was treated with plasma, whole blood, antibiotics, corticotropin (ACTH), and intravenous fluids. He became irrational on the seventh day, then anuric, and went into stupor; his temperature rose to 104 F., and he died. His brain showed toxic ganglion cell changes, small fresh hemorrhages in the white matter, and focal areas of demyelination.W. E., NH17453. A 14-year-old white boy was in an airplane accident May 13, 1951, in which he suffered third-degree burns of 40% of his body surface. He was treated at a local hospital with 1,500 cc. of plasma. His blood count at that time was 65% hemoglobin, 4,520.000 red cells, and 8,600 white cells. The next day he was nauseated and vomited, and he was given 2,000 cc. of 5% dextrose in saline. Four days later the white cell count had risen to 14,900, and the hemoglobin had dropped to 54%, with 3,000,000 red cells. On each of the two following days he was given 2 pints (950 cc.) of whole blood. He became slightly irrational, and this state persisted through his hospitalization. The next day jaundice of the skin and sclerae was noticed. At this time the blood urea nitrogen was 10 mg. per 100 cc, the plasma chlorides 500 mg. per 100 cc, and the icteric index 35. The urine was dark amber and was positive for bile. Urinary intake and output were reported as good.Ten days after his accident the patient was transferred to the Jefferson Medical College Hospital, where he was found to have multiple third-degree burns of the face, hands, and legs. The burns of the face were covered with crusts. The arms and hands were bandaged, and the legs were in plaster casts. The past history was not significant.Examination revealed an irrational, pale boy, who was constantly nauseated and retching. Examination was greatly limited because of the bandages and casts. The blood pressure on admission was 160/80, temperature (axilla), 100 F., and pulse rate 100. The scalp over the frontal area was lacerated where he had struck his head in the crash. He had conjunctivitis, and the eyelids were lacerated. The sclerae were jaundiced, and there was clotted blood in the nostrils.The pupils were oval in shape and reacted slowly to light and in accommodation. Nystagmoid movements were seen when the eyes were fixed, but there was no true nystagmus and there was a full range of movement of the eyes. He had good strength in h...