Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
ReviewNeuromodulation with pleiotropic and multimodal drugs -- future approaches to treatment of neurological disorders.
Neurologists are confronted with an ever-growing amount of new information regarding the intimate processes taking place in both normal and pathological brains. Concepts like neuroprotection, neurotrophicity, or anoikis and their clinical utility may be of dazzling complexity. ⋯ Since it is becoming more and more clear that using neuroprotective molecule with only one mechanism of action in disease treatment is a utopist idea, the research and use of multimodal drugs should be encouraged. It is not easy to find good therapeutic approaches to neurological disorders, especially if we do not have a deep understanding of all the basic endogenous biological processes, pathophysiological processes, and the links between them.
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled TrialEffects of magnesium sulfate infusion on cerebral perfusion in patients after aneurysmal SAH.
A meta-analysis of current data suggests that magnesium sulfate infusion improves the outcome after aneurysmal subarachnoid hemorrhage through a reduction in delayed ischemic neurological deficit. Two multi-center randomized controlled trials are currently underway to investigate this hypothesis. The possible pharmacological basis of this hypothesis includes neuroprotection and vasodilatation. We aim to investigate the cerebral hemodynamic effects of magnesium sulfate infusion in aneurysmal subarachnoid hemorrhage patients. ⋯ Magnesium sulfate infusion, in the dosage of current clinical trials, did not increase cerebral blood volume and cerebral blood flow, as postulated by dilation of small vessels and/or collateral pathways.
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Acta Neurochir. Suppl. · Jan 2010
Assessing the neurological outcome of traumatic acute subdural hematoma patients with and without primary decompressive craniectomies.
We have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables. ⋯ Primary decompressive craniectomy failed to show benefit in terms of neurological outcomes and should be reserved for cases with uncontrolled intra-operative brain swelling.
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Acta Neurochir. Suppl. · Jan 2010
Prognosis for severe traumatic brain injury patients treated with bilateral decompressive craniectomy.
Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy. ⋯ Head injury patients with either bilateral or contralateral lesions have poor prognosis. However, bilateral decompressive craniectomy may be a favorable treatment in certain younger patients with reactive pupils, whose ICP and CPP values are stabilized 24 h post-surgery.
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Acta Neurochir. Suppl. · Jan 2010
Following brain trauma, copeptin, a stable peptide derived from the AVP precusor, does not reflect osmoregulation but correlates with injury severity.
The incidence of water and electrolyte disturbances following traumatic brain injury (TBI) is considerable and has been attributed to a dysregulation of the hypothalamic peptide arginine-vasopressin (AVP). Copeptin, the C-terminal part of the AVP prohormone, reflects AVP activity. In 71 TBI patients we measured copeptin in serum by a sandwich immunoassay. ⋯ Copeptin was significantly decreased following skullbase fracture (p = 0.016). Our data reveal a loss of hypothalamic osmoregulation following TBI. The measurement of Copeptin/AVP release reveals a significant predictive function for the severity of TBI.