Current neurology and neuroscience reports
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Patients with cerebral lesions run a high risk of developing cerebral hypoxic and ischemic damage due to secondary insults. To minimize the risk of secondary cerebral hypoxia and ischemia, new monitoring techniques of cerebral oxygenation and metabolism have been developed and may help to understand the pathophysiology of secondary brain damage for a better treatment and outcome in critical patients. ⋯ The technical aspects, the interpretation of the commonly measured parameters, the use of the two commonly used oxygenation parameters (jugular venous oxygen saturation and monitoring of brain tissue PO(2) and the microdialysis technique to monitor cerebral metabolism in patients with head injury), subarachnoid hemorrhage, and ischemic stroke are considered. Pitfalls of the techniques and their future potential are discussed.
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Raised intracranial pressure (ICP) is a major contributor to the mortality of many conditions encountered in a neurologic intensive care unit. Achieving a sustained reduction in ICP in patients with intracranial hypertension remains a challenge. Treatment with hyperosmolar agents is one of the few options that are available, and mannitol is currently the most commonly used agent. However, hypertonic saline solutions have recently emerged as a potentially safer and more efficacious alternative to mannitol.