Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Intracranial compliance as a bed-side monitoring technique in severely head-injured patients.
A recently developed monitoring technology makes an on-line assessment of intracranial compliance (ICC) possible. Aims of our research: 1. Course and values of ICC (critical threshold: < 0.5 ml/mmHg) in episodes of pathological intracranial pressure (ICP) (> 20 mmHg) and reduced cerebral oxygenation (brain tissue PO2 (PtiO2) < 10 mmHg). 2. ⋯ In predicting adverse outcome, ICP was equal to ICC. The different ICC in each age class points to the need of age-adjusted thresholds. Further refinements of ICC technology are needed to improve ICC data quality and therefore become a useful tool in neuromonitoring.
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Acta Neurochir. Suppl. · Jan 2002
Metabolic suppressive therapy as a treatment for intracranial hypertension--why it works and when it fails.
Thirty years after its first description metabolic suppressive therapy is still controversial in patients with intractable intracranial hypertension. In this study high dose propofol was used to induce metabolic suppression. The effects on intracranial pressure (ICP) and the cerebral metabolic rates for oxygen and glucose (CMRO2 and CMRGlc) are reported. ⋯ In studies with normal metabolic ratio, ICP reduction was associated with a reduction in CMRO2. In studies with hyperglycolysis, ICP reduction was poor but CMRGlc decreased significantly. In conclusion, intact CO2R, normal or only moderately elevated ICP and normal MR are predictive of ICP reduction with high dose propofol after head injury.
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Acta Neurochir. Suppl. · Jan 2002
Can hyperventilation improve cerebral microcirculation in patients with high ICP?
Gosling's pulsatility index (PI) is generally thought to reflect cerebrovascular resistance. Hyperventilation and increased intracranial pressure (ICP) usually increase PI. In this study, the effect of hyperventilation on PI was assessed in head injured patients with and without elevated ICP. ⋯ High baseline ICP, low initial GCS and impaired hCO2R were associated with the decrease of PI. Hyperventilation unexpectedly reduced PI in patients with high ICP. Because decreased PI suggests decreased CVR, it is postulated that hyperventilation in the setting of raised ICP improves cerebral microcirculation.
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Acta Neurochir. Suppl. · Jan 2002
Natural history of unruptured intracranial aneurysms: risks for aneurysm formation, growth, and rupture.
Several studies concerning risk factors for SAH and for subsequent rupture of an unruptured aneurysm have been published, but not risk factor studies for formation and growth rate of aneurysms. Because less than half of all aneurysms ever rupture, it is essential to know risk factors separately both for aneurysm formation and for its growth. Before 1979, unruptured aneurysms were not operated on in Helsinki. ⋯ Female gender (adjusted odds ratio, 4.73; 95% CI, 1.16-19.38) and current smoking (4.07, 1.09-15.15) were the only significant (p < 0.05) independent risk factors for de novo aneurysm formation. Cessation of smoking is very important for these patients. It is recommended that unruptured aneurysms be operated on irrespective of their size and of patients' smoking status, in people aged < 50 to 60 years.
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Acta Neurochir. Suppl. · Jan 2002
Early rehabilitative concepts in therapy of the comatose brain injured patients.
To evaluate the changes of vegetative parameters and behavioural assessment in comatose patients after severe brain injury during the Multimodal-Early-Onset-Stimulation (MEOS) in early rehabilitation. ⋯ The present results indicate that stimulation therapy should be based on a close observation of patterns of behaviour, and, at least in deep coma stages, involve the registration of vegetative parameters. It may be sensitive to identify parameters predicting a favourable or unfavourable outcome. Preliminary data seem to support the hypothesis that the absence of any response to external stimuli is indicative of an unfavourable outcome.