Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2016
Effects of Low-Dose Unfractionated Heparin Pretreatment on Early Brain Injury after Subarachnoid Hemorrhage in Mice.
Heparin is a pleiotropic drug that antagonizes many pathophysiological mechanisms. In this study, we evaluated whether heparin prevents early brain injury (EBI) after subarachnoid hemorrhage (SAH) in mice. SAH was induced by endovascular perforation in mice randomly assigned to sham-operated (n = 8), SAH + vehicle (n = 12), SAH + 10 U heparin pretreatment (n = 11), and SAH + 30 U heparin pretreatment (n = 14) groups. ⋯ Low-dose heparin pretreatment improved neurobehavioral function, and decreased brain edema in the ipsilateral cerebral hemisphere to the perforation side. High-dose heparin had a tendency for increased SAH, which obscured the neuroprotective effects by heparin. Low-dose heparin pretreatment may decrease the development of post-SAH EBI.
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Acta Neurochir. Suppl. · Jan 2016
Comparative StudyAccuracy, Precision, Sensitivity, and Specificity of Noninvasive ICP Absolute Value Measurements.
An innovative absolute intracranial pressure (ICP) value measurement method has been validated by multicenter comparative clinical studies. The method is based on two-depth transcranial Doppler (TCD) technology and uses intracranial and extracranial segments of the ophthalmic artery as pressure sensors. ⋯ To balance the scales, ICP = Pe a special two-depth TCD device was used as a pressure balance indicator. The proposed method is the only noninvasive ICP measurement method that does not need patient-specific calibration.
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Acta Neurochir. Suppl. · Jan 2016
State of Cerebrovascular Autoregulation Correlates with Outcome in Severe Infant/Pediatric Traumatic Brain Injury.
It could be shown in adults with severe traumatic brain injury (TBI) that the functional status of cerebrovascular autoregulation (AR), determined by the pressure reactivity index (PRx), correlates with and even predicts outcome. We investigated PRx and its correlation with outcome in infant and pediatric TBI. Methods Ten patients (median age 2.8 years, range 1 day to 14 years) with severe TBI (Glasgow Coma Scale score <9 at presentation) underwent long-term computerized intracranial pressure (ICP) and mean arterial pressure (MAP) monitoring using dedicated software for continuous determination of cerebral perfusion pressure (CPP) and PRx. Outcome was determined at discharge and at follow-up at 6 months using the Glasgow Outcome Scale (GOS) score. ⋯ The integrity of AR seems to play the same fundamental role after TBI in the pediatric population as in adults and should be determined routinely. It carries an important prognostic value. PRx seems to be an ideal candidate parameter to guide treatment in the sense of optimizing CPP, aiming at improvement of cerebrovascular autoregulation (CPPopt concept).
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Acta Neurochir. Suppl. · Jan 2016
Early Changes in Brain Oxygen Tension May Predict Outcome Following Severe Traumatic Brain Injury.
We report on the change in brain oxygen tension (PbtO2) over the first 24 h of monitoring in a series of 25 patients with severe traumatic brain injury (TBI) and relate this to outcome. The trend in PbtO2 for the whole group was to increase with time (mean PbtO2 17.4 [1.75] vs 24.7 [1.60] mmHg, first- vs last-hour data, respectively; p = 0.002). However, a significant increase in PbtO2 occurred in only 17 patients (68 %), all surviving to intensive care unit discharge (p = 0.006). ⋯ The cumulative length of time that PbtO2 was <20 mmHg was not significantly different among these three groups. In conclusion, although for the cohort as a whole PbtO2 increased over the first 24 h, the individual trends of PbtO2 were related to outcome. There was a significant association between improving PbtO2 and survival, despite these patients having cumulative durations of hypoxia similar to those of non-survivors.
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Acta Neurochir. Suppl. · Jan 2016
Comparative StudyOutcome, Pressure Reactivity and Optimal Cerebral Perfusion Pressure Calculation in Traumatic Brain Injury: A Comparison of Two Variants.
This study investigates the outcome prediction and calculation of optimal cerebral perfusion pressure (CPPopt) in 307 patients after severe traumatic brain injury (TBI) based on cerebrovascular reactivity calculation of a moving correlation correlation coefficient, named PRx, between mean arterial pressure (ABP) and intracranial pressure (ICP). The correlation coefficient was calculated from simultaneously recorded data using different frequencies. PRx was calculated from oscillations between 0.008 and 0.05Hz and the longPRx (L-PRx) was calculated from oscillations between 0.0008 and 0.016 Hz. ⋯ Severe disability was associated with CPP above CPPopt (PRx). These relationships were not statistically significant for CPPopt (L-PRx). We conclude that PRx and L-PRx cannot be used interchangeably.