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
Late decompressive craniectomy as rescue treatment for refractory high intracranial pressure in children and adults.
The purpose of this study was to determine the prognosis of children and adults in whom decompressive craniectomy (DC) was used as a rescue treatment to lower refractory high intracranial pressures if maximal conservative therapies failed. Data of DC patients were retrospectively reviewed. Three-month and 1-year outcomes were evaluated (modified Rankin Score). ⋯ Eleven suffered from traumatic brain swelling, in 10 the primary pathological condition was intracranial hemorrhage, arteriovenous malformation bleeding or subarachnoid hemorrhage. All 13 survivors (62%) had a favorable outcome after 1 year (mRS≤3), 8 (38%) lacked any disabilities at all. Therefore, decompressive craniectomy offers a chance for a favorable outcome in uncontrollable ICP.
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Acta Neurochir. Suppl. · Jan 2012
Fixed, dilated pupils following traumatic brain injury: historical perspectives, causes and ophthalmological sequelae.
Pupillary abnormalities are commonly seen in patients presenting with severe traumatic brain injury (TBI). The objectives of this study were to determine the underlying condition responsible, the natural history of recovery of third nerve palsy and the ultimate clinical outcome in 60 patients admitted to a regional neurosurgical centre with a diagnosis of TBI and unilateral or bilateral fixed, dilated pupils (FDP). In approximately three-quarters of cases, some form of road traffic incident was the mechanism of injury. ⋯ Of those patients who survived an FDP, 72% were left with some form of ophthalmological deficit. Most patients with bilateral FDP did not survive (88%); however, of those who did survive, none was left in a persistent vegetative state or with any ophthalmological sequelae. A FDP is a grave prognostic sign following TBI commonly resulting in long term ophthalmological sequelae; however, a favourable outcome is still attainable.
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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
The linear relationship between transcranial Doppler pulsatility indices and intracranial pressure is influenced by traumatic brain injury and vasospasm.
The pulsatility index (PI) and the intracranial -pressure (ICP) may or may not be correlated; the evidence to date differs widely. A study of multiple measures of PI and the corresponding ICP in patients with severe traumatic brain injury (TBI) showed that some of the relationships were moderately strong when calculated as conventional Pearson correlation coefficients. ⋯ With the TBI patients demonstrating a large fraction of skewed measurements, a set of robust correlations were calculated that demonstrated that the apparent relationships between PI and ICP were entirely attributable to the statistical outliers. We conclude that the fundamental relationship of PI to ICP is weakly positive at best.