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Synoptic Problem Website: Two-Source Hypothesis

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Logtime: Logarithmic Time Perception With Aging

Discussion Trauma is an important cause of death in many countries, particularly in children and young adults, and head injury is the main cause of death in about 50% of trauma patients (3). Several epidemiological studies point to automobile accidents as the leading cause of head trauma and motor vehicle accidents as the most important mechanism of severe brain injury (4, 6, 7, 15). In Brazil, penetrating cranioencephalic injuries usually results from civilian gunshot wounds and are accompanied by a high morbidity and mortality rate, with poor neurologic outcomes (10, 11). Low-energy objects (foreign bodies) producing penetrating brain injuries are an uncommon situation on neurosurgical practice (1, 14). In our case, the patient presented with a deep penetrating lesion in the occipital region by a harpoon, a location that frequently raises concern and attention by the attending neurosurgeon due to the close proximity of important vascular and visual anatomical structures. Although some little continuous bleeding was noted on the accident site, it seemed that no significant vascular lesion occurred, which was confirmed during surgery. The pathophysiology of missile injuries involved on death and brain lesion of patients suffering gunshot wounds to the head are complex, however it is believed that, beyond the direct effect of the projectile destroying the parenchyma and vascular structures, a propagated energy and pressure wave through the surrounding brain tissue of missile track would be responsible for many neuron and glial cells deaths (13, 15). In the case of low-energy penetrating brain injury, the main mechanism seems to be restricted to the direct parenchymal lesion. This may explain why many patients present at the emergency departments with relatively good neurological function and outcome, although the large dimensions of foreign body lesions. In the present report, despite the deep penetrating cranioencephalic injury observed, the patient presented to us walking and talking normal and fluently with no apparent neurological deficits. Many therapeutic approaches have been proposed to the management of patients with penetrating brain injuries, varying from a conservative treatment with clinical support and control of the risk factors to a decompressive craniotomy (2, 12, 17). The surgical approach of patients usually depends on many aspects, such as clinical presentation, location and dimension of the trauma, support of intensive care unit and neurosurgeon experience. In the present report, the harpoon proximity to the occipital midline and venous sinuses made the neurosurgical procedure particularly challenging and required careful surgical access and dissection to avoid any additional vascular injury. We believe that, in such cases, the operative management must be performed by an experienced neurosurgeon with great anatomical knowledge of the region. In conclusion, the present report highlights that the early and appropriate neurosurgical management, on experience hands, may improve considerably the outcomes of patients presenting with low-energy penetrating cranioencephalic injuries.

The Logarithmic Time Perception Hypothesis by James Main Kenney Time scarcer

"Mixing" is very different from"expanding to fill!" The rule about gases does not involve mixing;instead it involves compressibility and instant expansion into a vacuum.

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