Neurocritical care
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Management of severe traumatic brain injury (TBI) focuses on mitigating secondary insults. There are a number of biomarkers that are thought to play a part in secondary injury following severe TBI. Two of these, S100β and neuron-specific enolase (NSE), have been extensively studied in the setting of neurological injury. This pilot study was undertaken to investigate the relationship of S100β and NSE to clinical markers of severity and poor outcome: intracranial hypertension (ICH), and cerebral hypoperfusion (CH). ⋯ In this preliminary analysis, S100β levels were associated with ICH and CH over a full week of ICP monitoring. We also found associations between CH and NSE levels in CSF of patients with severe TBI. Our results suggest that there is an association between levels of ICH and CH and these biomarkers when measured before episodes of clinically significant secondary insults. These markers of neuronal cell death demonstrate promise as both indicators of impending clinical deterioration and targets of future therapeutic interventions.
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The prototypical intracranial pressure (ICP) pulse morphology has been well known to be triphasic. Several studies suggest that the morphology of ICP pulse reflects the physiological and pathophysiological conditions of the intracranial dynamics. Recently, there has been a renaissance of studying ICP pulse using new ICP signal processing technologies in various clinical contexts. Cerebral blood flow velocity (CBFV) pulse is another important pulsatile signal originated from the complex circulatory systems of cerebral blood flow. However, CBFV pulse morphology has not been well studied mainly due to the noise level and lack of signal processing techniques. ⋯ Our results suggest that characterizing CBFV pulse morphology is clinically important because it may offer a potential noninvasive alternative to assess various aspects of ICP such as mean ICP.
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Clinical Trial
Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus.
We investigated the feasibility and accuracy of intracranial pressure (ICP)-measurement by lumbar drainage (LD) catheter in patients with post-hemorrhagic communicating hydrocephalus (PHCH). ⋯ ICP measured via LD highly and reliably correlated to ICP measured via EVD in patients with PHCH.
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Infection is common following stroke and is independently associated with worse outcome. Clinical studies suggest that infections occur more frequently in those individuals with stroke-induced immunologic dysfunction. This study sought to explore the contribution of immunomodulatory cytokines and hormones to lymphocyte function and infection risk. ⋯ In this study cohort, increased plasma IL-1ra was independently associated with the risk of post-stroke infection. Further studies are needed to validate this finding, which could have important implications for stroke therapy.
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Transcranial Doppler-derived indices of cerebral autoregulation are related to outcome after TBI. We analyzed our retrospective material to identify thresholds discriminative of outcome for these indices. ⋯ We propose that Mx greater than 0.3 indicates definitely disturbed autoregulation and lower than 0.05 good autoregulation. For values between 0.05 and 0.3 the state of autoregulation is uncertain.