Acta neurochirurgica. Supplement
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Chronic subdural hematoma (CSDH) is a common neurosurgical condition that has a high incidence in the increasing elderly population of many countries. Pathologically, it is defined as a persistent liquefied hematoma in the subdural space more than 3 weeks old that is generally encased by a membraneous capsule. CSDHs likely originate after minor head trauma, with a key factor in its development being the potential for a subdural cavity to permit its expansion within, which is usually due to craniocerebral disproportion. ⋯ Current belief is that CSDH arises from recurrent bleeding in the subdural space, caused by a cycle of local angiogenesis, inflammation, coagulation and ongoing fibrinolysis. However, because of a lack of detailed knowledge about the precise mechanisms, treatment is often limited to surgical interventions that are invasive and often prone to recurrence. Thus, it is possible that an easily reproducible and representative animal model of CSDH would facilitate research in the pathogenesis of CSDH and aid with development of treatment options.
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Acta Neurochir. Suppl. · Jan 2011
ReviewHypoperfusion in the acute phase of subarachnoid hemorrhage.
Acute disruption of cerebral perfusion and metabolism is a well-established hallmark of the immediate phase after subarachnoid hemorrhage (SAH). It is thought to contribute significantly to acute brain injury, but despite its prognostic importance, the exact mechanism and time course is largely unknown and remains to be characterized. ⋯ Acute vasospasm, cytotoxic edema and a general metabolic stress response occur immediately after experimental SAH. Prophylactic treatment with hypothermia or ET-A antagonists can correct these disturbances in the experimental setting. Clinically, prolonged and ICP-independent hypoperfusion was also confirmed. As the initial phase is of particular importance regarding the neurological outcome and is amenable to beneficial intervention, the acute stage after SAH demands further investigation and warrants the exploration of measures to improve the immediate management of SAH patients.
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Acta Neurochir. Suppl. · Jan 2011
Delayed intracranial hemorrhage associated with antiplatelet therapy in stent-assisted coil embolized cerebral aneurysms.
Administration of oral clopidogrel plus aspirin is the most important regimen to reduce thromboembolic complications in stent-assisted coil embolization of cerebral aneurysm. However, such therapy may increase the risk of hemorrhage. The purpose of this study is to analyze the effect of two different antiplatelet regimens on hemorrhagic and thromboembolic complication rates around the stent-assisted coil embolization period. ⋯ The thromboembolic complication rates were not significantly different between the two groups. Oral administration of routine antiplatelet drugs for 3 days before stent-assisted coil embolization possibly increases the risk of delayed intracranial hemorrhage, compared to loading group. Symptomatic thromboembolic complications have no significant difference in the two different regimens.
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Acta Neurochir. Suppl. · Jan 2011
Clinical TrialRole of controlled lumbar CSF drainage for ICP control in aneurysmal SAH.
a prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There has been increasing data that this may be a effective and safe intervention for reduction of ICP. ⋯ we have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP which refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols.
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Acta Neurochir. Suppl. · Jan 2011
The new MRI modalities "BPAS and VISTA" for the diagnosis of VA dissection.
Recently VA dissection has drawn attention as a relatively common cause of stroke because of the introduction of MRI as a diagnostic technique. Basiparallel anatomic scanning (BPAS) was designed to visualize the surface appearance of the vertebrobasilar artery within the cistern. Volumetric isotropic TSE acquisition (VISTA) is a sort of black blood imaging method to evaluate the arterial wall and lumen. In this study, we aimed to evaluate the efficacy of the new MRI modalities "BPAS and VISTA," and to present a retrospective analysis of our experience with the diagnosis. ⋯ Dilatation of the external diameter was shown highly frequently in VA dissections. In addition, a discrepancy between BPAS and MRA as well as the intramural hematoma on VISTA was found comparatively frequently. BPAS and VISTA are minimally invasive and useful methods as screening tests.