Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2003
Importance of hemodynamics management in patients with severe head injury and during hypothermia.
To evaluate the hemodynamics in patients with traumatic brain injury (TBI) during therapeutic hypothermia. ⋯ These results suggest that patients run the risk of impairing hemodynamics during therapeutic hypothermia. Hemodynamic management is essential during hypothermia. If dehydration occurs during hypothermia. MAP may be reduced due to inadequate sedation, analgesia, and excess use of diuretic agents.
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Acta Neurochir. Suppl. · Jan 2003
ReviewDeep brain and motor cortex stimulation for post-stroke movement disorders and post-stroke pain.
Our experience of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in patients with post-stroke movement disorders and post-stroke pain is reviewed. DBS of the thalamic nuclei ventralis oralis posterior et intermedius proved to be useful in more than 70% of patients with post-stroke involuntary movements (hemiballismus, hemichoreo-athetosis, distal resting and/or action tremor, and proximal postural tremor). The effect of DBS of the thalamic nucleus ventralis caudalis or internal capsule on post-stroke pain was usually disappointing. ⋯ Subjective improvement of voluntary motor performance, which had been impaired in association with mild or moderate hemiparesis, was reported during MCS by approximately 20% of patients with post-stroke pain. Such an effect on voluntary motor performance appears to be caused by an inhibition of their rigidity. The reversibility of DBS and MCS makes them an important option for the control of post-stroke movement disorders and post-stroke pain.
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Intrathecal drug delivery has been used clinically since the 1970's. Significant clinical advances have been made combining new technology with pharmacology and surgery. Continuous infusion of medication for both analgesia and spasticity has become a part of the armamentarium for specialists in these areas. Significant recent advances in technology promise further enhancements and improvements for intrathecal therapy. ⋯ Intrathecal therapy has established a role in the treatment of malignant pain, benign pain and severe spasticity. Significant literature and the current state of practice in the United States are reviewed. Recent therapeutic enhancements are discussed, and a wish list of future technological enhancements presented.
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Acta Neurochir. Suppl. · Jan 2003
ReviewVolume-targeted therapy of increased intracranial pressure.
Fluid exchange across the intact blood-brain barrier (BBB) is counteracted by the low permeability to crystalloids (mainly Na+ and Cl-) combined with the high osmotic pressure (5,700 mm Hg) on both sides of the BBB. If the BBB is disrupted transcapillary water transport will be determined by the differences in hydrostatic and colloid osmotic pressure between the intra- and extracapillary compartments. Under these pathological conditions pressure autoregulation of cerebral blood flow is likely to be impaired and intracapillary hydrostatic pressure will depend on variations in systemic blood pressure. ⋯ Maintenance of colloid osmotic pressure and control of fluid balance: D. Reduction of cerebral blood volume. The efficacy of the protocol has been evaluated in experimental and clinical studies regarding the physiological and biochemical (utilizing intracerebral microdialysis) effects and the clinical experiences have been favourable.