Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2013
Early CT signs of hypoxia in patients with subarachnoid hemorrhage presenting with cardiac arrest: early CT signs in SAH patients presenting with CA.
For cardiac arrest (CA) victims, brain computed tomography (CT) may serve as a prognosticator. Loss of gray-white matter discrimination (GWMD) and sulcal edema/effacement are reliable CT signs of hypoxia, and a time window may exist for development of these signs. Most data are derived from CA victims of cardiac etiology, however, and CT signs have rarely been evaluated in victims of CA secondary to subarachnoid hemorrhage (SAH). ⋯ CT signs may develop earlier in patients with SAH-CA than CA of cardiac origin. Because of a poor prognosis, early CT signs are not useful prognosticators in that population.
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Acta Neurochir. Suppl. · Jan 2013
Early cerebral circulation disturbance in patients suffering from different types of severe traumatic brain injury: a xenon CT and perfusion CT study.
Traumatic brain injury (TBI) is widely known to cause dynamic changes in cerebral blood flow (CBF). In particular, secondary brain insults have been reported to decrease CBF. The purpose of this study was to clarify the cerebral circulation in different types of TBI. ⋯ Moderate hypothermia therapy, which decreases CBF, the cerebral metabolic rate oxygen consumption (CMRO2), and intracranial pressure might be effective against the types of TBI accompanied by cerebral circulation disturbance. We have to use all possible measures including hypothermia therapy to treat severe TBI patients according to the type of TBI that they have suffered.
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Acta Neurochir. Suppl. · Jan 2013
The effect of an NK1 receptor antagonist on blood spinal cord barrier permeability following balloon compression-induced spinal cord injury.
The blood spinal cord barrier (BSCB) is disrupted following spinal cord injury (SCI) resulting in vasogenic edema and increased intrathecal pressure (ITP). The neuropeptide substance P (SP) has been implicated in the development of blood-brain barrier (BBB) disruption, edema, and increased intracranial pressure following brain injury, although it has not been investigated in SCI. The balloon compression model of experimental SCI has many advantages in that it replicates the "closed" environment observed clinically. ⋯ There was no significant difference between vehicle and NAT treatment. We conclude that the balloon compression model of SCI produces significant BSCB disruption although NAT treatment did not attenuate BSCB permeability or edema. Further studies are required to fully elucidate the role of SP following SCI.
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Acta Neurochir. Suppl. · Jan 2013
How to control propofol infusion in pediatric patients undergoing gamma knife radiosurgery.
Although Gamma Knife radiosurgery (GKS) is commonly performed under local anesthesia, general anesthesia is sometimes required. The authors previously reported a remote-controlled patient management system consisting of propofol-based general anesthesia with a target-controlled infusion (TCI) that we designed for pediatric GKS. However, a commercially available propofol TCI system has age and weight limitations (<16 years and <30 kg). We examined a manually controlled regimen of propofol appropriate for pediatric GKS. ⋯ Propofol titration is a key issue in GKS. Manual infusion is less accurate than TCI, but the combination of a small bolus and continuous infusion might be a substitute. Considering the characteristics of propofol pharmacokinetics in children, co-administration of opioids is recommended.
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Acta Neurochir. Suppl. · Jan 2013
Low-dose lipopolysaccharide injection prior to subarachnoid hemorrhage modulates Delayed Deterioration associated with vasospasm in subarachnoid hemorrhage.
There is increasing evidence that inflammation plays a role in the development of Delayed Deterioration associated with vasospasm (DDAV) after subarachnoid hemorrhage (SAH). Lipopolysaccharide (LPS) is an activator of the innate inflammatory system that causes DDAV in animal models. The effect of low-dose LPS has been shown to be protective in stroke models but has not been investigated in SAH. ⋯ Brain levels of the inflammatory chemokine KC (keratinocyte-derived chemokine) were decreased in the ldLPS ×1 and increased in the ldLPS ×4 group. Single-injection low-dose LPS preconditioning was protective for delayed deterioration associated with vasospasm (DDAV), whereas the multiple-injection course exacerbated DDAV. This further supports that inflammation plays an important role in the development of DDAV, and that modulating the inflammatory system may be a potential target for future therapies in SAH.