Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
State-of-the-art management and monitoring of brain edema and intracranial hypertension in fulminant hepatic failure. A proposed algorithm.
Develop an evidence-based clinical algorithm integrating clinical decision making on intracranial pressure (ICP) monitoring and intracranial hypertension (ICH) management in the setting of fulminant hepatic failure (FHF). ⋯ State-of-the-art management of ICH due to brain edema in FHF includes Class I therapies such as mannitol and hypertonic saline. Bioartificial liver, hypothermia and hyperventilation are supported by Class II evidence. Indomethacin and sedation remain Class III. Monitoring ICP is supported by Class II and III evidence. A clinical algorithm was created based on the existing therapeutic armamentarium and corresponding evidence support.
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Acta Neurochir. Suppl. · Jan 2010
The effects of tetrahydrobiopterin on intracerebral hemorrhage-induced brain injury in mice.
Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase (NOS) and is presently used clinically to treat forms of phenylketonuria. BH4 has been reported to restrain superoxide generation of NOS and chemically reduce superoxide. However, there has been no report concerning the effects of BH4 in intracerebral hemorrhage (ICH). ⋯ Our data demonstrates that ICH caused significant neurological deficit that is associated with brain edema. Treatment with BH4 did not reduce brain edema and neurological deficits at 24 h after ICH in mice. Further study is required to investigate the long-term effect of BH4 in ICH-induced brain injury.
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Acta Neurochir. Suppl. · Jan 2010
Endogenous pituitary adenylate cyclase activating polypeptide is involved in suppression of edema in the ischemic brain.
Pituitary adenylate cyclase activating polypeptide is a pleiotropic neuropeptide. We previously showed that heterozygous PACAP gene knockout (PACAP(+/-)) mice had larger infarct volumes and worse neurological scores after middle cerebral artery occlusion (MCAO). However, the relationship between endogenous PACAP levels and edema in the ischemic brain has not yet been evaluated. ⋯ To investigate the effects of endogenous PACAP on blood flow during ischemia, cerebral blood flow in the ipsilateral and the contralateral cortices was compared between PACAP(+/-) and PACAP(+/+) mice for 25 min after ischemia. With a two-dimensional laser Doppler perfusion imaging system, the blood flow in the ipsilateral and contralateral cortices was shown to be similar in PACAP(+/-) and PACAP(+/+) mice during ischemia. These results suggest that endogenous PACAP suppresses the formation of edema in the ischemic brain.
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Acta Neurochir. Suppl. · Jan 2008
The predictive value of ICP as compared to magnetic resonance imaging in comatose patients after head injury.
While highly increased intracranial pressure (ICP) is of high predictive value indicating a fatal outcome, the predictive value of moderately increased ICP early after head injury remains uncertain. We compared the predictive value of ICP to the predictive value of magnetic resonance imaging (MRI) early after head injury. ⋯ Our current MRI findings suggest that the location of the initial brain injury lesion correlates with outcome at 6 months. No such correlation could be identified for intracranial pressure on the first day after head injury (p = 0.766).
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Acta Neurochir. Suppl. · Jan 2008
Noninvasive estimation of intracranial compliance in idiopathic NPH using MRI.
The pathophysiology of idiopathic normal pressure hydrocephalus (I-NPH) is still unclear and the diagnosis is sometimes difficult. The aim of this study was to assess the biophysics of I-NPH by measuring intracranial compliance using cine MRI. ⋯ It is possible to estimate intracranial compliance as CI non-invasively using cine MRI. CI could become a useful method for the diagnosis of I-NPH.