Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Recent studies have demonstrated that the computerized EEG (CEEG) is a reliable indicator for the early detection of brain ischemia during carotid surgery. During intracranial aneurysm surgery, different cerebral monitoring techniques are proposed, and the benefits and limitations of conventional EEG, evoked potentials and transcranial doppler are discussed. The authors also give the results of their experience with the CEEG monitoring during intracranial aneurysm surgery. In conclusion, they insist on the necessity for some type of cerebral monitoring during this type of surgery.
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Case Reports
[A rare and severe complication of meningeal hemorrhage: spinal arachnoiditis with paraplegia].
This observation relates a case of spinal arachnoiditis with paraplegia, for a 56 year old patient hospitalized for a S. A. H. by a ruptured aneurysm of the P. ⋯ A. This patient present some complications, requiring a prolonged ventilatory support with a tracheostomy, a ventricular shunt for hydrocephalus. The treatment is only surgical, and the corticosteroids delay the evolution, but without successful outcome.
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Review Case Reports
[Neurogenic pulmonary edema, complication of meningeal hemorrhage: report of 4 cases].
Neurogenic pulmonary edema (NPE) observed in 4 patients admitted in Neurosurgical Intensive Care au SAH by ruptured a vascular malformation. This complication is unusual (1.9%) and has been observed in comatose patients. For 3 patients, NEP resorption was rapid, from 12 to 72 hours with a treatment by CCPV with a P. ⋯ The drug must be discussed according to eventual deleterous side effects on cardiac output and systemic resistances. The early hemodynamical study argues for an essentially hemodynamical mechanism due to the brutal symphatic discharge created by cerebral lesions and increasing. ICP, more than a toxic lesionnal edema, as the Weidner's study shows it in ultrastructural analysis of sheep lungs.
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Hypovolemia seems a commun state in patients with subarachnoid hemorrhage. It has been further suggested that hypovolemia could cause ischemia if vasospasm is present. Total blood volume and red blood cells volume determined in 84 consecutive patients volume of distribution (of 51Chromium labeled autologous red cells, shows an hypovolemia in 70% of these patients). Associated hypomotremia requires Na restitution with normovolemic hemodilution to facilitate cerebral blood flow.