Articles: brain-injuries.
-
Swiss medical weekly · Oct 2000
ReviewPathophysiology of brain insult. Therapeutic implications with the Lund Concept.
This paper describes some major implications of brain insult following trauma or intracerebral haemorrhage for the development of brain oedema and compromised microcirculation. Secondary insults such as an increase in intracranial pressure and development of contusion and penumbra zone areas, as well as their bearing on outcome, are discussed. A therapeutic protocol is presented which aims at keeping intracranial volume within acceptable limits by counteraction of interstitial brain oedema, reduction in intracerebral blood volume, and improvement of microcirculation around contusions. This ICP-targeted therapy, called the "Lund Concept", for treatment of severe head injury has resulted in marked reduction in mortality following brain trauma.
-
Ann Fr Anesth Reanim · Oct 2000
Case Reports[Prone position and severe pneumopathy in a patient with head injuries and intracranial hypertension].
The treatment of hypoxaemia is one of the main goals of intensive care to patients with severe head injury. In the case reported here, the appearance of early pneumonia was accompanied by a severe deterioration of blood gases with worsening of intracranial hypertension. Prone position allowed rapid improvement of blood gases which contributed to the control of intracranial hypertension.
-
J Neurosurg Anesthesiol · Oct 2000
The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults.
Cerebrospinal fluid drainage is a first line treatment used to manage severely elevated intracranial pressure (> or = 20 mm Hg) and improve outcomes in patients with acute head injury. There is no consensus regarding the optimal method of cerebrospinal fluid removal. The purpose of this investigation was to determine whether cerebrospinal fluid drainage decreases intracranial pressure and improves cerebral perfusion and to identify factors that impact treatment effectiveness. ⋯ One third of patients experienced a decrease in the intracranial pressure below 20 mm Hg; in two patients the intracranial pressure dropped less than 1 mm Hg. The following factors predicted 61.5% of the variance in the responsiveness of intracranial pressure to drainage: vecuronium hypothermia, baseline cerebral perfusion pressure and acuity of illness. Cerebrospinal fluid drainage provides a transient decrease in intracranial pressure without a measurable improvement in other indices of cerebral perfusion.
-
J Neurosurg Anesthesiol · Oct 2000
Comparative StudyComparison between hypertonic saline and mannitol in the reduction of elevated intracranial pressure in a rodent model of acute cerebral injury.
Clinically both mannitol and hypertonic saline (HTS) have been used successfully to treat elevated intracranial pressure (ICP), although which therapy is superior is yet unclear. Most experimental data have been derived from animal models of brain injury using general anesthesia, which may not be applicable under other conditions. Our laboratory compared the efficacy of single, equi-osmolar bolus doses of HTS and mannitol in reducing elevated ICP in a lightly sedated, unrestrained rodent model of acute brain injury. ⋯ The therapeutic action of HTS was also more durable, lasting up to 500 minutes whereas the mannitol treated animals were observed to return to, and overshoot the baseline elevated ICP by 10% to 25% by 120 minutes following dosing (P < .01). Despite these differences, brain water content was similar between groups. We conclude that HTS was more effective in reducing elevated ICP in this awake model of traumatic brain injury.