Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2006
Delayed profound local brain hypothermia markedly reduces interleukin-1beta gene expression and vasogenic edema development in a porcine model of intracerebral hemorrhage.
White matter (lobar) intracerebral hemorrhage (ICH) can cause edema-related deaths and life-long morbidity. In our porcine model, ICH induces oxidative stress, acute interstitial and delayed vasogenic edema, and up-regulates interleukin-1beta (IL-1beta), a proinflammatory cytokine-linked to blood-brain barrier (BBB) opening. In brain injury models, hypothermia reduces inflammatory cytokine production and protects the BBB. ⋯ We froze brains in situ at 16 hours after ICH induction, sampled perihematomal white matter, extracted RNA, and performed real-time RT-PCR. Local brain cooling markedly reduced both IL-1beta RNA levels and vasogenic edema. These robust results support the potential for local brain cooling to protect the BBB and reduce injury after ICH.
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Acta Neurochir. Suppl. · Jan 2006
Monitoring and interpretation of intracranial pressure after head injury.
To investigate the relationships between long-term computer-assisted monitoring of intracranial pressure (ICP) and indices derived from its waveform versus outcome, age, and sex. ⋯ High ICP and low PRx are strongly associated with fatal outcome. There is a considerable heterogeneity amongst patients; optimization of care depends upon observing the time-trends for the individual patient.
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Acta Neurochir. Suppl. · Jan 2006
Case ReportsPositive selective brain cooling method: a novel, simple, and selective nasopharyngeal brain cooling method.
Brain damage is worsened by hyperthermia and prevented by hypothermia. Conventional hypothermia is a non-selective brain cooling method that employs cooling blankets to achieve surface cooling. This complicated method sometimes induces unfavorable systemic complications. ⋯ The chilled air was exhaled through the oral cavity. In most patients, PSBC maintained normal brain temperature. This new technique provides quick induction of brain temperature control and does not require special facilities.
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Acta Neurochir. Suppl. · Jan 2006
Case ReportsRewarming following accidental hypothermia in patients with acute subdural hematoma: case report.
A 57-year-old man was admitted to the Emergency and Critical Care Department with accidental hypothermia (31.5 degrees C) after resuscitation from cardiopulmonary arrest (CPA). Brain CT revealed an acute subdural hematoma. Active core rewarming to 33 degrees C was performed using an intravenous infusion of warm crystalloid. ⋯ No suitable strategies have been clearly established for the rewarming performed following accidental hypothermia in patients with TBI. Our experience with this patient suggests that therapeutic hypothermia might improve the outcome in some patients with severe brain injury. It also appears that the method used for rewarming might play an important role in the therapy for TBI with accidental hypothermia.
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Acta Neurochir. Suppl. · Jan 2006
Clinical TrialImportance of cerebral perfusion pressure management using cerebrospinal drainage in severe traumatic brain injury.
To evaluate hemodynamics in patients with severe traumatic brain injury (TBI) after cerebral perfusion pressure (CPP) management using cerebrospinal fluid (CSF) drainage. ⋯ CPP management using CSF drainage decreases the total infusion volume of crystalloid and may reduce the risk of aggravated brain edema after excess fluid resuscitation.