Neurocritical care
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Clinical Trial
Prediction of intracranial pressure from noninvasive transocular venous and arterial hemodynamic measurements: a pilot study.
Continuous measurement of intracranial pressure (ICP) requires the invasive placement of epidural, parenchymal, or intraventricular devices. For critical single-point assessments, lumbar puncture may not always be practical. An accurate, reliable, portable and noninvasive method to estimate absolute ICP remains an elusive goal. The arteries that perfuse and the vein that drains the orbit are exposed to the ambient ICP while coursing through the cerebrospinal fluid or optic nerve. ⋯ The feasibility to estimate ICP from transocular sonographic and dynamometric data is suggested by these preliminary data. Retinal arterial properties are important in modeling the effect of ICP on the venous outflow pressure. Our pilot results serve as a basis on which to conduct a larger prospective and blinded study.
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It is controversial whether a low cerebral blood flow (CBF) simply reflects the severity of injury or whether ischemia contributes to the brain's injury. It is also not clear whether posttraumatic cerebral hypoperfusion results from intracranial hypertension or from pathologic changes of the cerebral vasculature. The answers to these questions have important implications for whether and how to treat a low CBF. ⋯ In patients with CBF<18 mL/100 g/minutes, intracranial hypertension plays a major causative role in the reduction in CBF. Treatment would most likely be directed at controlling intracranial pressure, but the early, severe intracranial hypertension also probably indicates a severe brain injury. For levels of CBF between 18 and 40 mL/100 g/minutes, the presence of regional hypoperfusion was a more important factor in reducing the average CBF.
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Guillain-Barré Syndrome is the leading cause of nontraumatic acute paralysis in industrialized countries. About 30% of patients have respiratory failure requiring intensive care unit (ICU) admission and invasive mechanical ventilation. Progressive weakness of both the inspiratory and the expiratory muscles is the mechanism leading to respiratory failure. ⋯ They include rapidly progressive motor weakness, involvement of both the peripheral limb and the axial muscles, ineffective cough, bulbar muscle weakness, and a rapid decrease in vital capacity. Specific treatments (plasma exchange and intravenous immunoglobulins) have decreased both the number of patients requiring ventilation and the duration of ventilation. The need for mechanical ventilation is associated with residual functional impairments, although all patients eventually recover normal respiratory muscle function.
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The ICH score is a clinical grading scale that is composed of five components related to outcome after nontraumatic intracerebral hemorrhage (ICH): Glasgow Coma Scale score, ICH volume, presence of intraventricular hemorrhage, infratentorial origin, and age. The ICH score accurately risk-stratifies patients in the cohort from which it was developed, but it has not yet been fully externally validated. The purpose of this study was to determine whether the ICH score accurately risk-stratifies patients in an independent cohort. ⋯ The ICH score accurately stratifies outcome in an external patient cohort. Thus, the ICH score is a validated clinical grading scale that can be easily and rapidly applied at ICH presentation. Ascale such as the ICH score could be used to standardize clinical treatment protocols or clinical studies.