Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Intracranial pressure variability and long-term outcome following traumatic brain injury.
Research suggests that intracranial pressure (ICP) dynamics beyond just absolute ICP level provide information reflecting intracranial adaptive capacity. Specifically, evidence indicates that physiologic variability provides information about system functioning that may reflect dimensions of adaptive capacity. The purpose of this study was to examine the association between ICP variability in patients following moderate to severe traumatic brain injury (TBI) and outcome at hospital discharge and 6 months post-injury. ⋯ ICP variability may reflect the degree of intactness of intracranial adaptive ability.
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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
Comparative Study Clinical TrialRegional cerebral blood flow and oxygen metabolism in aneurysmal subarachnoid hemorrhage: positron emission tomography evaluation of clipping versus coiling.
We investigated early postoperative hemodynamic and metabolic values using positron emission tomography (PET) scanning in subarachnoid hemorrhage (SAH) patients treated with clipping or coiling, and evaluated usefulness of PET studies in predicting late ischemic events and neurological outcome in SAH patients. ⋯ A wide range of cerebral perfusion patterns including hyperemia were found in the CLIP group. Surgical manipulation of the brain significantly reduced oxygen metabolism in the operated frontal lobe. PET data alone may not have independent prognostic value for detecting delayed cerebral ischemia or in predicting neurological outcome.
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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
Are head injury guidelines changing the outcome of head injured children? A regional investigation.
Secondary pathophysiological CPP insult is related to outcome after head injury, and improved management would be expected to reduce secondary brain insult. Paediatric head injury management guidelines have been published in recent years, by SIGN (2000), RCPCH (2001), NICE (June 2003), and jointly by Critical/Intensive Care Societies (C/ICS July 2003). We investigated whether outcome of children's head injury (and total burden of secondary CPP insult) has changed (1) annually; (2) before and after the introduction of any HI guidelines, and (3) following other service changes. ⋯ The most recent paediatric HI guidelines appear to have reduced the burden of secondary insult, but more time is required to determine if this will be reflected in improved outcomes.