Articles: brain-injuries.
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Journal of neurosurgery · Oct 1995
Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report.
The effect of indomethacin, a cyclooxygenase inhibitor, was studied in the treatment of 10 patients with head injury and one patient with spontaneous subarachnoid hemorrhage, each of whom presented with high intracranial pressure (ICP) (34.4 +/- 13.1 mm Hg) and cerebral perfusion pressure (CPP) impairment (67.0 +/- 15.4 mm Hg), which did not improve with standard therapy using mannitol, hyperventilation, and barbiturates. The patient had Glasgow Coma Scale scores of 8 or less. Recordings were made of the patients' ICP and mean arterial blood pressure from the nurse's end-hour recording at the bedside, as well as of their CPP, rectal temperature, and standard therapy regimens. ⋯ The effects of standard therapy regimens before and during indomethacin infusion showed no significant changes, except in three patients in whom mannitol reestablished its action on ICP and CPP. Sudden discontinuation of indomethacin treatment was followed by significant ICP rebound. The authors suggest that indomethacin may be considered one of the frontline agents for raised ICP and CPP impairment.
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The current study investigates the effects of sufentanil on cerebral blood flow velocity and intracranial pressure (ICP) in 30 patients with intracranial hypertension after severe brain trauma (Glasgow coma scale < 6). ⋯ The current data show that sufentanil (3 micrograms/kg intravenous) has no significant effect on middle cerebral artery blood flow velocity and ICP in patients with brain injury, intracranial hypertension, and controlled MAP. However, transient increases in ICP without changes in middle cerebral artery blood flow velocity may occur concomitant with decreases in MAP. This suggests that increases in ICP seen with sufentanil may be due to autoregulatory decreases in cerebral vascular resistance secondary to systemic hypotension.
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Six patients with diffuse axonal injury, ranging in age 8 to 29 years, hospitalized in emergency in our Polyclinic with a Glagow coma score under 8, were examined. Patients were intubated and connected to an automatic respirator. They underwent serial cranial CT and transcranial Doppler sonography recordings using the temporal window with insonation of the two middle cerebral arteries. ⋯ In 5 patients over 6 (80%) increased blood flow, variously sensitive to barbiturates, was detected associated to increased resistance index secondary to intracranial hypertension. Based on Doppler findings four patients underwent surgical treatment: ventriculostomy for monitoring of intracranial pressure or decompressive craniectomy. According to this experience, the use of transcranial Doppler US is mandatory for a correct identification of the hemodynamic injury associated to diffuse axonal injury, for planning the medical and/or surgical approach and for assessment of the successful results of therapeutic management.
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Ann. N. Y. Acad. Sci. · Sep 1995
ReviewClinical potential for the use of neuroprotective agents. A brief overview.
"Stroke treatment seems to be entering a golden age ...." Fisher's observation not only applies to ischemic stroke, but to all the conditions described above, and in the future, possibly (and quite speculatively), to other neurologic diseases, such as multiple sclerosis, amyotrophic lateral sclerosis, even radiation therapy and Bell's palsy. Physicians must sharpen their criteria for decisions regarding therapy and must" ... be prepared to accept what is actually known from scientific data ... rather than to rely on instinct, clinical impression, or the need to do something rather than nothing."