Acta neurochirurgica. Supplement
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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
Case ReportsWhat is the appropriate shunt system for normal pressure hydrocephalus?
Normal pressure hydrocephalus (NPH) represents a common disorder among older people with mild elevation of cerebrospinal fluid pressure and certain clinical manifestations. We present a patient with such a disorder in whom a programmable valve was implanted. ⋯ After evacuating the hematoma and by setting the valve pressure higher, the patient recovered without any symptomatology. We observed that only the higher pressure was the right one, although in two different pressure values the symptoms had subsided.
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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.
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Acta Neurochir. Suppl. · Jan 2012
Biography Historical ArticleModeling of CSF dynamics: legacy of Professor Anthony Marmarou.
The mathematical model of cerebrospinal fluid (CSF) pressure volume compensation, introduced by Anthony Marmarou in 1973 and modified in later studies, provides a theoretical basis for differential diagnosis in hydrocephalus. The Servo-Controlled Constant Pressure Test (Umea, Sweden) and Computerised Infusion Test (Cambridge, UK) are based on this model and are designed to compensate for inadequate accuracy of estimation of both the resistance to CSF outflow and elasticity of CSF pressure volume compensation. Dr. ⋯ Marmarou demonstrated that only around 30% of cases of elevated ICP in patients with TBI could be explained by changes in CSF circulation. The remaining 70% of cases should be attributable to vascular components, which have been proposed as equivalent to raised brain venous pressure. Professor Marmarou's work has had a direct impact in the field of contemporary clinical neurosciences, and many of his ideas are still being investigated actively today.