Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Multicenter Study Clinical TrialWhich paediatric head injured patients might benefit from decompression? Thresholds of ICP and CPP in the first six hours.
Severe head injury in childhood continues to be associated with considerable mortality and morbidity. Early surgical decompression may be beneficial and the objective of this study was to examine the relationship between age-related thresholds of mean intracranial pressure (ICP) and cerebral perfusion pressure (CPP) over the first 6 hours and age outcome in paediatric head injury patients. A total of 209 head injured children admitted to five UK hospitals were studied. ⋯ At a CPP of 50 mmHg the specificity varied between the age groups (2 to 6 years: 0.47, 7 to 10 years: 0.28 and 11 to 16 years: 0.10) and similarly for an ICP of 25 mmHg (2 to 6 years: 0.53, 7 to 10 years: 0.44 and 11 to 16 years: 0.38). Younger children may be able to tolerate lower perfusion pressures and still have an independent outcome. Our threshold values for young children are likely to be important in the identification of patients who might benefit from new treatments such as surgical decompression.
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Acta Neurochir. Suppl. · Jan 2005
ReviewPhenomenological aspects of consciousness--its disturbance in acute and chronic stages.
The meaning of a disturbance of consciousness is completely different in an acute as opposed to a chronic stage. In the acute stage, the grade of arousal is the most essential component in order to assess the changes of the level of intracranial pressure in neurosurgical emergency room. ⋯ We propose the difference in conception between consciousness and mind; that is, consciousness consists of psycho-sensory afferent system, mind of psycho-motor efferent and afferent system, and memory and language as liaison officers between them. This proposal would play a role to understand mental change in the natural aging processes, when memory and cognition are deteriorating gradually, but is still in evolution in the field of culture.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialCerebral blood flow augmentation in patients with severe subarachnoid haemorrhage.
Following aneurysmal subarachnoid haemorrhage (SAH), cerebral blood flow (CBF) may be reduced, resulting in poor outcome due to cerebral ischaemia and subsequent stroke. Hypertonic saline (HS) is known to be effective in reducing intracranial pressure (ICP). We have previously shown a 20-50% increase in CBF in ischaemic regions after intravenous infusion of HS. ⋯ Nine patients showed a decrease in lactate-pyruvate ratio at 60 minutes following HS infusion. These results show that HS safely and effectively augments CBF in patients with poor grade SAH and significantly improves cerebral oxygenation. An improvement in cerebral metabolic status in terms of lactate-pyruvate ratio is also associated with HS infusion.
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Acta Neurochir. Suppl. · Jan 2005
Randomized Controlled TrialMagnesium sulfate for brain protection during temporary cerebral artery occlusion.
We evaluated the effects of magnesium sulfate on brain tissue oxygen (PtO2) tension, carbon dioxide (PtCO2) tension and pH (pHt) in patients undergoing temporary artery occlusion for clipping of cerebral aneurysm. We studied 18 patients with aneurysmal subarachnoid hemorrhage. All patients received standard anesthetics using target controlled infusion of propofol (3 microg/ml) and remifentanil (10 ng/ml). ⋯ Following temporary artery occlusion, PtO2 and pHt decreased and PtCO2 increased in both groups. However, tissue hypoxia was less severe and the rate of PtO2 decline was slower in the magnesium group. Our data suggested that magnesium enhances tissue oxygenation and attenuates hypoxia during temporary artery occlusion.
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Acta Neurochir. Suppl. · Jan 2005
Controlled Clinical TrialBalance of risk of therapeutic hypothermia.
The complications of therapeutic hypothermia sometimes undermine its clinical effects. In this study we investigated the efficacy and safety of therapeutic hypothermia based on analysis of 20 severe head injury cases from 6 institutions treated with therapeutic hypothermia in 1999. The twenty patients with severe head injury were enrolled prospectively based on the following indications; Glasgow Coma Scale of 7 or less on admission, age 60 or younger, and systric BP over 100 mmHg. ⋯ In the hypothermia group, severe pneumonia was seen in three patients, all in the mild hypothermia group with a hypothermic duration of over 120 hours. Mild hypothermia should be ended within 120 hours to avoid severe complication. When long-lasting therapeutic hypothermia of more than 120 hours is planned, very mild hypothermia is the treatment of choice.