Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Monitoring of the association between cerebral blood flow velocity and intracranial pressure.
Slow waves in intracranial pressure (ICP) are believed to originate from changes in cerebral blood volume secondary to adjustments in arteriolar diameter. Blood flow velocity (FV) signals recorded with transcranial Doppler ultrasound show similar oscillations. We investigated a continuous measure of FV/ICP association and its relationship to cerebral perfusion pressure (CPP), ICP, cerebral autoregulation (CA) and outcome after severe traumatic brain injury (TBI). ⋯ FIx correlated with ICP (Spearman's R = -0.40, p < 0.01), Mx (R = -0.54, p < 0.00005) and CPP (R = 0.34, p < 0.01), but not with PRx (p = 0.84). FIx was significantly associated with outcome after grouping into Glasgow Outcome Score (GOS) 1-3 or GOS 4-5 (Mann-Whitney p = 0.009). FIx may provide unique insights into the behaviour of the cerebral circulation during intracranial hypertension.
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Acta Neurochir. Suppl. · Jan 2012
Case ReportsAn uncommon case of Idiopathic Intracranial Hypertension with diagnostic pitfalls.
We report on an unusual case of Idiopathic Intracranial Hypertension (IIH) in a woman of normal weight. Papilledema and increased intracranial pressure are symptoms of cerebral venous sinus thrombosis or idiopathic intrancranial hypertension. Because of the different treatment strategies, it is important to keep these two diseases separate. We show that the use of different imaging methods is an important tool in obtaining an effective diagnosis.
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Acta Neurochir. Suppl. · Jan 2012
Correlation of clinical outcome and angiographic vasospasm with the dynamic autoregulatory response after aneurysmal subarachnoid hemorrhage.
A certain correlation between unfavorable clinical outcome, incidence of vasospasm, and impaired pressure autoregulation in patients following aneurysmal subarachnoid hemorrhage (aSAH) has been suggested. However, determination of vasospasm is inaccurate and the measurement technique of cerebral vasoreactivity seems not to have been sufficiently validated. Therefore, a correlation of clinical outcome and the extent of angiographic VS was performed using an established autoregulation test. ⋯ Incidence of angiographic vasospasm and impaired clinical outcome seems to be related to impaired pressure autoregulation following aSAH.
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Acta Neurochir. Suppl. · Jan 2012
Bioinformatics analysis of mortality associated with elevated intracranial pressure in children.
Multivariate data analyses have the potential to enrich the use of the complex plethora of data gathered in the care of critically ill patients. We sought to apply hierarchical cluster analysis to investigate factors affecting outcome in children with acute brain injury requiring ICP monitoring. ⋯ The dose of abnormal ICP may contribute to outcome in insults that involve increased ICP. These results are proof of principle of the potential application of hierarchical clustering to the clinical practice of pediatric neurocritical care.
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Acta Neurochir. Suppl. · Jan 2012
Cerebrospinal fluid lactate concentration after withdrawal of metabolic suppressive therapy in subarachnoid hemorrhage.
Hyperglycolysis is a known phenomenon after severe subarachnoid hemorrhage (SAH) and after brain injury. It is characterized by decreased oxidative metabolism and relatively increased anaerobic glycolysis. Metabolic suppressive therapy reduces the cerebral metabolic rate of oxygen (CMRO(2)) and the cerebral metabolic rate of glucose (CMRGluc). ⋯ In 56% of patients an increase in CSF lactate (mean: 3.2 ± 0.9 mmol/L) after withdrawal of metabolic suppressive therapy was observed. Mean Glasgow Outcome Score (GOS) was lower in patients with an increase in CSF lactate concentration (>0.5 mmol/L) after withdrawal of metabolic suppressive therapy (p = 0.095). In 88% of patients who died during the first 30 days after SAH, a CSF lactate elevation of more than 0.5 mmol/L after withdrawal of metabolic suppressive therapy was found (p = 0.071).