Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2000
Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters.
Sixty-two patients with a spontaneous supratentorial haemorrhage had continuous Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP) monitoring. In addition to the recordings of physiological data their past medical history, presenting neurological state, Computed Tomograph (CT) findings, daily Glasgow Coma Score (GCS) and outcome were noted. The mean age was 57.6 years (sd 13.3). ⋯ Again no relationship existed with these parameters and outcome at six months. Surgical evacuation of haematoma acted to significantly reduce ICP and improve CPP. Given that these factors seem to be related to deterioration, death and early outcome, it would seem that surgery could play a role in reducing mortality and improving outcome following Intra cerebral Haemorrhage (ICH).
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Acta Neurochir. Suppl. · Jan 2000
Thrombin preconditioning, heat shock proteins and thrombin-induced brain edema.
Intracerebral injections of high concentrations of thrombin cause brain edema but, in vitro, low concentrations of thrombin may be neuroprotective. This study investigated whether a low dose of thrombin might induce tolerance to subsequent large doses of thrombin (thrombin preconditioning; TPC) in a manner analogous to ischemic preconditioning. The study involved five parts. ⋯ TPC also induced HSP32, but this effect occurred earlier than the effect on edema formation. TPC had no effect on HSP70. These results suggest that thrombin-induced brain tolerance may be related to HSP27 induction.
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Acta Neurochir. Suppl. · Jan 2000
Effects of hypothermia on intracranial hemodynamics and ischemic brain damage-studies in the rat acute subdural hematoma model.
Brain ischemia is the leading pathophysiological mechanism in the development of secondary brain damage after subdural hematoma (SDH). Hypothermia has been used as the effective neuroprotective treatment in clinical and laboratory studies of ischemic brain injury. In this study, we have examined the rat acute SDH model to assess the effect of hypothermia upon intracranial hemodynamics and also upon ischemic brain injury 4 hours after the induction of hematoma. ⋯ This reduction in brain edema formation was comparable to the result of MK-801 (2 mg/kg) treatment (80.95 +/- 0.35%; p < 0.01). Ischemic brain damage detected by H-E staining was also significantly reduced in the hypothermia and MK-801 treated groups (59.1 +/- 12.3 mm3 and 66.4 +/- 13.8 mm3; p < 0.01 and p < 0.05) compared with the normothermic control group (86.6 +/- 20.7 mm3). In conclusion, the present study demonstrates that hypothermia is a potent neuroprotective method and an inhibition of the glutamate excitotoxic process may contribute the protective mechanisms of hypothermia in this rat acute SDH model.
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Acta Neurochir. Suppl. · Jan 2000
Low extracellular (ECF) glucose affects the neurochemical profile in severe head-injured patients.
Glucose (Gluc) is the main energy source for the brain. After severe head-injury energy demand is massively increased and supply is often decreased. In pilot microdialysis studies, many patients with severe head-injury had undetectable glucose concentrations, probably reflecting changes in metabolism and/or reduced supply. ⋯ There was also no correlation between outcome and the dialysate glucose. The results indicate that low ECF glucose is almost always present in severe head-injury. Moreover, the lack of correlation between low glucose and outcome, however, suggests that other energy substrates, such as lactate, are important after TBI.
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Acta Neurochir. Suppl. · Jan 2000
Comparative StudyClinical experiences with the dual-switch valve in patients with normal pressure hydrocephalus.
In patients with normal pressure hydrocephalus (NPH) we compared the postoperative results reference to the implanted valve type. In 117 patients diagnosed with normal pressure hydrocephalus there was placement of 47 Cordis Standard valves (CSV), 20 Cordis Orbis Sigma valves type I (OSV) and 50 Miethke Dual-switch valves (DSV). Ninety-five patients (36/19/40) were re-evaluated. ⋯ The course of disease in patients with NPH is influenced by the stage of disease--degree of cerebral atrophy--and also by the implanted valve type. The great amount of overdrainage complications and subdural hematomas in the Cordis Orbis Sigma valve group may be an argument against this valve. Our clinical experiences with the Miethke Dual-switch valve show that this hydrostatic valve may be advantageous for patients with NPH.