Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Changes in brain biochemistry and oxygenation in the zone surrounding primary intracerebral hemorrhage.
While the management of primary intracerebral hemorrhage (ICH) remains controversial, there remains a subset of patients that undergo clot evacuation. This study aims to characterize brain physiology and biochemistry after surgery for this condition. ⋯ In spontaneous ICH, derangements in the perilesional tissue demonstrated by local techniques of PbO2 monitoring and CMD are not seen in global indices such as the PRx.
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In sepsis the brain is frequently affected although there is no infection of the CNS (septic encephalopathy). One possible cause of septic encephalopathy is failure of the blood-brain barrier. Brain edema has been documented in animal models of sepsis. Aggressive fluid resuscitation in the early course of sepsis improves survival and is standard practice. We hypothesized that aggressive fluid administration will increase intracranial pressure (ICP) and may cause critical reductions in cerebral perfusion pressure (CPP). ⋯ Further research is needed to determine the role of ICP/CPP monitoring in patients with sepsis.
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Acta Neurochir. Suppl. · Jan 2008
Metabolic disturbance without brain ischemia in traumatic brain injury: a positron emission tomography study.
Cerebral ischemia is believed to be an important mechanism of secondary neuronal injury in traumatic brain injury (TBI). ⋯ We conclude that impaired cerebral blood flow and metabolism in the pericontusional region is observed even in the subacute stage after TBI and is unlikely to cause severe further neuronal damage.
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Acta Neurochir. Suppl. · Jan 2008
Patient and aneurysm characteristics in multiple intracranial aneurysms.
Multiple aneurysms occur in up to one-third of people with intracranial aneurysms. Of such patients, epidemiological data, clinical information, and aneurysm characteristics (of both unruptured and ruptured aneurysms in the same patients) were gathered in this retrospective review. ⋯ Ruptured aneurysms were significantly larger than unruptured ones. Although discussed controversially, most of our population's ruptured aneurysms were 10mm or smaller in size. Considering this, our study may contribute to improve the management of patients with intracranial aneurysms.
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Acta Neurochir. Suppl. · Jan 2008
Modulation of AQP4 expression by the selective V1a receptor antagonist, SR49059, decreases trauma-induced brain edema.
Currently, there are no pharmacological treatments available for traumatically induced brain edema and the subsequent rise of ICP. Evidence indicates that Aquaporin-4 (AQP4) plays a significant role in the pathophysiology of brain edema. Previously we have reported that SR49059 reduced brain edema secondary to ischemia. We, therefore, examined whether the selective V1a receptor antagonist, SR49059, reduces brain edema by modulating AQP4 expression following cortical contusion injury (CCI). ⋯ SR49059 significantly reduced trauma-induced AQP4 up-regulation in the contused hemisphere. Moreover, brain water content was also significantly reduced paralleling the AQP4 suppression. These data provide further support that vasopressin (AVP) and V1a receptors can control water flux through astrocytic plasma membranes by regulating AQP4 expression. Taken in concert, these results affirm our laboratories contention that AQP4 can be effectively modulated pharmacologically.