Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Randomized Controlled TrialA microdialysis study of oral vigabatrin administration in head injury patients: preliminary evaluation of multimodality monitoring.
We assessed the feasibility of administering a neuroprotective drug, vigabatrin (VGB; gamma-vinyl-gamma-aminobutyric acid) with multimodality monitoring, including cerebral microdialysis, in severe head injury patients, to measure surrogate endpoints and blood-brain barrier (BBB) penetration. ⋯ Multimodality monitoring, including cerebral microdialysis, is feasible for studying surrogate endpoints following drug administration. VGB crosses the BBB, leading to modest increases in extracellular GABA. Further analyses are ongoing. Microdialysis may assist the development of neuroprotective agents by determining penetration into extracellular fluid of the brain.
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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
Realization of a comprehensive non-invasive detection of intracranial pressure analyzer based upon FVEP and TCD.
Up to now, several methods, such as flash visual evoked potential (FVEP) and transcranial Doppler (TCD), have been studied with regard to assessing intracranial pressure (ICP) non-invasively. However, there are still no instruments that are readily available for non-invasive measurement of ICP in clinical practice. Based on the advantages of FVEP and TCD for ICP assessment, the two methods are synthesized to develop a specific instrument to non-invasively measure ICP more reliably and applicably, as the integration of FVEP and TCD overcomes the shortcomings of a single method of ICP measurement.
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Acta Neurochir. Suppl. · Jan 2012
Non-invasively estimated ICP pulse amplitude strongly correlates with outcome after TBI.
An existing monitoring database of brain signal recordings in patients with head injury has been re-evaluated with regard to the accuracy of estimation of non-invasive ICP (nICP) and its components, with a particular interest in the implications for outcome after head injury. ⋯ When compared between patients who died and who survived mean nAmp showed the greatest difference, suggesting its potential to predict mortality after TBI.
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Acta Neurochir. Suppl. · Jan 2012
Near infrared spectroscopy as possible non-invasive monitor of slow vasogenic ICP waves.
We aimed to study synchronisation between ICP and near infrared spectroscopy (NIRS) variables induced by vasogenic waves of ICP during an infusion study in hydrocephalic patients and after TBI. Nineteen patients presenting with hydrocephalus underwent a diagnostic intraventricular constant-flow infusion test. The original concept of the methodology, presented in the current paper, was derived from this material. ⋯ Fluctuations of Hb and HbO(2) at baseline negatively correlated with each other, but switched to high positive values during periods of increased ICP slow-wave activity during infusion (p < 0.001). Similar behaviour was observed in TBI patients: baseline negative Hb/HbO(2) correlation changed to positive values during peaks of ICP of vasogenic nature. Correlating changes in Hb and HbO(2) may be of use as a method of non-invasive detection of vasogenic ICP waves.