Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Cerebrovascular reactivity and autonomic drive following traumatic brain injury.
The autonomic nervous system exerts tonic control on cerebral vessels, which in turn determine the autoregulation of cerebral blood flow. We hypothesize that the impairment of cerebral autoregulation following traumatic brain injury might be related to the acute failure of the autonomic system. ⋯ Following traumatic brain injury, autonomic failure and cerebrovascular autoregulation impairment are both associated with fatal outcome. Impairment of cerebrovascular autoregulation and autonomic drive are interdependent phenomena. With some refinements, HRV might become a tool for screening patients at risk for cerebral autoregulation derangement following TBI.
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Acta Neurochir. Suppl. · Jan 2008
Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial.
Brain hemorrhage is the most frequent fatal form of stroke and has the highest level of morbidity of any stroke subtype. For patients with both intracerebral hemorrhage and intraventricular hemorrhage (IVH), expected mortality is 50-80%. No validated, efficacious treatment exists for humans, but animal models demonstrate substantial physiologic and functional benefits associated with rapid, near-complete removal of blood from either the ventricle or intracerebral location (i.e., approximately 80% removal over 48 h). The purpose of the CLEAR-IVH trial (Parts A and B) is to evaluate safety and efficacy of using multiple injections of low-dose rt-PA to accelerate lysis and evacuation of IVH. ⋯ Preliminary analyses show that use of low-dose rt-PA can be safely administered to stable IVH clots and may increase lysis rates.
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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.
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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
Cerebral blood flow thresholds predicting new hypoattenuation areas due to macrovascular ischemia during the acute phase of severe and complicated aneurysmal subarachnoid hemorrhage. A preliminary study.
Focal ischemia may affect patients with aneurysmal subarachnoid hemorrhage (SAH), and the potential evolution of cerebral infarction may greatly influence the patients' outcome. The aim of the study was to assess the values of regional cortical cerebral blood flow (rCBF) thresholds predictive for ischemia during the acute phase of SAH. ⋯ The results suggest that there is no absolute rCBF threshold ofischemia in severe and complicated SAH patients and that the rCBF values are only moderately predictive at levels lower than previously described.