Acta neurochirurgica
-
Acta neurochirurgica · Jan 1988
Diagnosis of brain death. Transcranial Doppler sonography as an additional method.
Ever since transplant surgery became a common procedure, the early diagnosis of irreversible cessation of cerebral function has become an important need. We made a comparative study of EEG, angiography and transcranial Doppler imaging in patients who fulfilled the clinical criteria for brain death. ⋯ Intracranial reverberating flow patterns with counterbalancing forward and backward components of the blood column indicate flow arrest. Transcranial Doppler Sonography was found to be a practical, non invasive, early and reliable method for the diagnosis of arrest of the cerebral circulation.
-
Acta neurochirurgica · Jan 1988
Rebleeding, ischaemia and hydrocephalus following anti-fibrinolytic treatment for ruptured cerebral aneurysms: a retrospective clinical study.
350 patients with subarachnoid haemorrhage from aneurysmal rupture--admitted in the years 1966-1983--were selected for a retrospective controlled study on the efficacy of antifibrinolytic therapy (AFT). Patients treated with antifibrinolytics were divided into two groups, according to the day of hospital admission and onset of therapy, respectively between 0 and 3 days (SG 1) and between 4 and 7 days from SAH (SG 2); treated patients (260 cases) received i.v. tranexamic acid (6 gr/day) for at least two weeks. Patients admitted before 1974, not receiving antifibrinolytics (90 cases), were selected as controls and divided into two groups (CG 1 and CG 2), according to the day of admission. ⋯ Final outcome was similar in the 4 groups. In conclusion--according to our data--AFT modifies the behaviour of rebleeding and the patients' course, although it does not modify the outcome after SAH. Clinical use of antifibrinolytic therapy appears still justified in those patients who cannot be operated on in the acute stage after SAH, provided that an associated anti-ischaemic therapy is undertaken.
-
The results of the treatment of 15 cases of ventriculitis related to the use of external ventricular drainage are presented. A review of the literature on the treatment of cerebrospinal fluid shunt infections combined with our data suggest the following treatment of ventriculostomy-related ventriculitis: 1. ⋯ Removal or replacement of the ventricular drain. 3. One should wait for bacteriological cure before implanting a permanent internal drainage system.