Acta neurochirurgica. Supplement
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Intracerebral hemorrhage (ICH) is a subtype of stroke with very high mortality. Experiments have indicated that clot lysis and iron play an important role in ICH-induced brain injury. Iron overload occurs in the brain after ICH in rats. ⋯ Deferoxamine can rapidly penetrate the blood-brain barrier and accumulate in the brain tissue in significant concentration after systemic administration. We have demonstrated that deferoxamine reduces ICH-induced brain edema, neuronal death, brain atrophy, and neurological deficits. Iron chelation with deferoxamine could be a new therapy for ICH.
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Acta Neurochir. Suppl. · Jan 2008
Randomized Controlled Trial Clinical TrialPreliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial.
Compared to ischemic stroke, intracerebral hemorrhage (ICH) is easily and rapidly identified, occurs in younger patients, and produces relatively small initial injury to cerebral tissues--all factors suggesting that interventional amelioration is possible. Investigations from the last decade established that extent of ICH-mediated brain injury relates directly to blood clot volume and duration of blood exposure to brain tissue. Using minimally-invasive surgery plus recombinant tissue plasminogen activator (rtPA), MISTIE investigators explored aggressive avenues to treat ICH. ⋯ There is tentative indication that minimally-invasive surgery plus rtPA shows greater clot resolution than traditional medical management.
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Acta Neurochir. Suppl. · Jan 2008
Cerebral metabolism monitoring during hypothermia following resuscitation from cardiopulmonary arrest.
The aim of the present study was to evaluate cerebral metabolism monitoring during therapeutic hypothermia for global ischemic brain damage after cardiopulmonary resuscitation (CPR). ⋯ The measurement of cerebral metabolism parameters, especially OEF, might be useful for estimation of hypothermia therapy in patients with unconsciousness after resuscitation after cardiac arrest.
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Acta Neurochir. Suppl. · Jan 2008
Mathematical models of cerebral hemodynamics for detection of vasospasm in major cerebral arteries.
Vasospasm is a common complication of aneurismal subarachnoid hemorrhage (SAH) that may lead to cerebral ischemia and death. The standard method for detection of vasospasm is conventional cerebral angiography, which is invasive and does not allow continuous monitoring of arterial radius. Monitoring of vasospasm is typically performed by measuring Cerebral Blood Flow Velocity (CBFV) in the major cerebral arteries and calculating the Lindegaard ratio. We describe an alternative approach to estimate intracranial arterial radius, which is based on modeling and state-estimation techniques. The objective is to obtain a better estimation than that offered by the Lindegaard ratio, that might allow for continuous monitoring and possibly vasospam prediction without the need for angiography. ⋯ Our results indicate that arterial radius may be estimated using measurements of ABP, ICP and CBFV, allowing the detection of vasospasm.
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialControlled lumbar drainage in medically refractory increased intracranial pressure. A safe and effective treatment.
A prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There have been no controlled trials of its use reported in the literature, to the best of our knowledge. ⋯ We have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols.