Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Low frequency pressure waves of possible autonomic origin in severely head-injured children.
Useful information (both clinical and pathophysiological) which may be extracted from intracranial pressure (ICP) recordings include: (1) the mean level of ICP (and CPP), (2) cerebrovascular autoregulation status, (3) the intracranial pulse pressure (the pulse wave index, ICPpp/ICPm) or the pressure-volume compensatory reserve index (RAP) and (4) the presence of any abnormal ICP waveform. This paper describes a slow frequency ICP waveform in children with TBI and postulates the pathophysiological basis and whether it contains clinically useful detail. ⋯ We postulate that these previously unreported slow waveforms may reflect the very low frequency (VLF) and ultra low frequency (ULF; < or = 1 per 5 min) components of heart rate and arterial blood pressure variability.
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Acta Neurochir. Suppl. · Jan 2008
Biomechanical modeling of decompressive craniectomy in traumatic brain injury.
Decompressive craniectomy is the final phase in the graded scheme of critical care management of refractory raised intracranial pressure following severe traumatic brain injury. We aim to define the optimal size for decompressive craniectomy so that a good balance is achieved between reduction of raised ICP and the extent of trans-calvarial herniation. Provision of such quantitative data will also allow for improved data comparison in clinical trials addressing the surgical management of severe head injury. ⋯ Finite element mesh modeling in the scenario of reafractory raised intracranial pressure following severe head injury may be able to guide the optimal conduct of decompressive surgery so as to effect a reduction in intracranial pressure whilst minimizing trans-calvarial brain herniation.
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Acta Neurochir. Suppl. · Jan 2008
Effect of increased intracranial pressure on cerebral vasospasm in SAH.
Increased ICP is common and might precipitate cerebral vasospasm (VSP)-induced ischemic events in aneurysmal SAH (ASAH).Our objective was to determine if there is an association between increased ICP and transcranial colour coded Doppler-angiographic VSP (TCCD-A VSP) in relation to delayed neurological deficit (DND) and poor outcome. ⋯ Increased ICP, not decreased CPP, was related to VSP. The combination of TCCD-A VSP and increased ICP was predictive of poor outcome. Management of acute ASAH should include reduction of increased ICP especially when there is concomitant TCCD-A VSP.
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Acta Neurochir. Suppl. · Jan 2008
Neurological deficits and brain edema after intracerebral hemorrhage in Mongolian gerbils.
We examined the time course of neurological deficits in gerbils after an intracerebral hemorrhage (ICH) induced by autologous blood infusion and examined its correlation with the severity of perihematomal edema. Mongolian gerbils (n = 15) were subjected to stereotaxic autologous blood infusion (30 or 60 microL) into the left caudate nucleus. Corner-turn and forelimb-placing tests were performed before, and 1 and 3 days after ICH. ⋯ Both neurological deficits and perihematomal edema were significantly greater in animals with 60 microL blood infusion compared to the 30 microL infusion group, and both neurological deficits and edema were also greater at 3 days compared to 1 day after ICH. The severity of neurological deficits paralleled the degree of perihematomal edema. We conclude that the Mongolian gerbil is a suitable model for studies on the behavioral effects of ICH.
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Approximately 15% of all strokes are due to intracerebral hemorrhage (ICH) and of these, 5-10% occur in the cerebellum. The resultant mortality is around 20-30%. However, there is no well-established animal model to address this important clinical problem. ⋯ Females had mortality of 16%, while there was no mortality in male rats. Neurological deficits assessed by both beam walking and inclined plane were significantly increased at 0.4 and 0.6 U in females, but only at 0.6 for males. This new cerebellar hemorrhage rat model demonstrated dosage- and sex-dependent changes in hemorrhagic volume, brain edema, and neurological deficits, and could be used to test treatment strategies for ICH.