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predicting cerebral herniation with ct scan

Won Joo Jeong, Jae Seung Bang, Kyu Sun Yum, Sangkil Lee, Inyoung Chung, O-Ki Kwon, Chang Wan Oh, Beom Joon Kim, Hee-Joon Bae, Moon-Ku Han
Brain herniation is most often the result of severe brain swelling and can rapidly lead to death or brain death. We retrospectively identified radiologic indicators to evaluate the effects of targeted temperature management (TTM) on the extent of cerebral edema and determine the cutoff values that best predict TTM outcomes in patients with large hemispheric infarction. We retrospectively reviewed brain computed tomography (CT) scans of 21 patients with large hemispheric infarctions, who were treated with TTM...
February 15, 2018: Therapeutic Hypothermia and Temperature Management
I C Kiphuth, H B Huttner, T Struffert, S Schwab, M Köhrmann
BACKGROUND AND OBJECTIVE: Intraventricular hemorrhage often leads to obstructive hydrocephalus, necessitating placement of extraventricular drainage to prevent increasing intracranial pressure and subsequent herniation. For clamping and removal of the drainage, repeated CT scans are required to rule out recurrent hydrocephalus. We performed a prospective observational study on the use of transcranial duplex sonography to monitor changes in width of the lateral ventricles during clamping as an alternative to CT...
March 8, 2011: Neurology
Seong-Beom Koh, Byung-Jo Kim, Moon Ho Park, Sung-Wook Yu, Kun-Woo Park, Dae Hie Lee
Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke...
November 2007: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
P M Parizel, J W Van Goethem, O Ozsarlak, M Maes, C D Phillips
Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice...
March 2005: European Radiology
Soo Joo Lee, Kwang Ho Lee, Dong Gyu Na, Hong Sik Byun, Yong Boem Kim, Young-Min Shon, Soo-Jin Cho, Jun Lee, Chin-Sang Chung, Seung-Chyul Hong
OBJECTIVE: To evaluate the use of multiphasic helical computed tomography (CT) in predicting subsequent development of severe brain edema in patients with acute middle cerebral artery (MCA) stroke. DESIGN: Case-control study. SETTING: Tertiary referral hospital. PATIENTS: We studied 31 patients with acute MCA stroke who had a baseline National Institutes of Health Stroke Scale score of 15 or higher within 6 hours of symptom onset...
April 2004: Archives of Neurology
Serap Yücel Gülçek, Aysun Erdoğan, Uğur Toprak, Almila Alp Ortaç, Eşref Paşaoğlu
PURPOSE: We aimed to emphasize the indication for and importance of CT cisternography in the diagnosis of rhinorrhea patients by reviewing the literature with the support of unenhanced cranial CT findings. MATERIALS AND METHODS: Unenhanced cranial CT with axial sections and CT cisternography with coronal sections were performed in 14 patients who had spontaneous (n = 3) and posttraumatic (n = 11), intermittent or continuous CSF rhinorrhea. The slice thickness of infratentorial planes was 5 mm and supratentorial planes 10 mm...
September 2003: Tanısal Ve Girişimsel Radyoloji: Tıbbi Görüntüleme Ve Girişimsel Radyoloji Derneği Yayın Organı
Philip A Barber, Andrew M Demchuk, Jinjin Zhang, Scott E Kasner, Michael D Hill, Jorg Berrouschot, Erich Schmutzhard, Lutz Harms, Piero Verro, Derk Krieger
BACKGROUND: Large middle cerebral artery (MCA) ischaemic stroke when associated with extensive mass effect can result in brain herniation and neurological death. As yet there are few guidelines to aid the selection of patients for aggressive interventional therapies, such as decompression hemicraniectomy and/or hypothermia. METHODS: We studied a cohort of patients from seven centres with large MCA infarction requiring neurocritical care. The purpose of this analysis was to assess the use of early radiological signs on follow-up computed tomographic (CT) signs performed within 48 h of stroke onset for predicting mortality at 30 days...
2003: Cerebrovascular Diseases
Edward M Manno, Douglas A Nichols, Jimmy R Fulgham, Eelco F M Wijdicks
OBJECTIVE: To identify specific radiographic features on computed tomographic (CT) imaging that can predict neurologic deterioration in patients with large middle cerebral artery (MCA) infarctions. PATIENTS AND METHODS: We performed a 10-year retrospective review from January 1, 1991, through December 31, 2001, of medical records and CT scans of patients with large MCA infarctions. Neurologic deterioration was defied as progressive drowsiness or signs of herniation...
February 2003: Mayo Clinic Proceedings
Wendy C Ziai, John D Port, John A Cowan, Ira M Garonzik, Anish Bhardwaj, Daniele Rigamonti
Several case reports and small clinical series have reported benefits of decompressive hemicraniectomy in patients with intractable cerebral edema and early clinical herniation. Specific indications and timing for this intervention remain unclear. We present our experience with this procedure in a subset of 18 patients with massive cerebral edema refractory to medical management, treated with decompressive craniectomy over a 3-year period (1997 to 2000). Computerized tomography (CT) scans were independently analyzed by a neuroradiologist blinded to clinical outcome...
January 2003: Journal of Neurosurgical Anesthesiology
S E Kasner, A M Demchuk, J Berrouschot, E Schmutzhard, L Harms, P Verro, J A Chalela, R Abbur, H McGrade, I Christou, D W Krieger
BACKGROUND AND PURPOSE: Early identification of stroke patients at risk for fatal brain edema may be useful in selecting patients for aggressive interventions. Prior studies suggested that early nausea/vomiting and major hypodensity on baseline computed tomography (CT) were predictive of herniation. METHODS: This study was a retrospective multicenter case-control study of patients with large middle cerebral artery (MCA) strokes admitted within 48 hours of symptom onset...
September 2001: Stroke; a Journal of Cerebral Circulation
T Gerriets, E Stolz, S König, S Babacan, I Fiss, M Jauss, M Kaps
BACKGROUND AND PURPOSE: Transcranial color-coded duplex sonography (TCCS) allows bedside imaging of intracranial hemodynamics and parenchymal structures. It provides reliable information regarding midline shift (MLS) in space-occupying hemispheric stroke. We studied the value of MLS measurement to predict fatal outcome at different time points after stroke onset. METHODS: Forty-two patients with acute, severe hemispheric stroke were enrolled. Cranial computed tomography (CCT) and extracranial duplex sonography were performed on admission...
February 2001: Stroke; a Journal of Cerebral Circulation
P G Meyer, G A Orliaguet, M Zerah, B Charron, M M Jarreau, F Brunelle, A Laurent-Vannier, P A Carli
PURPOSE: To assess the impact of emergency management on mortality and morbidity of acute rupture of cerebral arteriovenous malformations resulting in deep coma in children, and the factors predicting outcome. METHODS: Retrospective chart review of 20 children with a Glasgow Coma Scale < or = 8 with acute hemorrhagic stroke from a cerebral arteriovenous malformation rupture was conducted. Protocol included: early resuscitation with tracheal intubation and ventilation after induction of anesthesia with sufentanil, and benzodiazepine, and mannitol 20% or hypertonic saline 7...
August 2000: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
J Berrouschot, H Barthel, R von Kummer, W H Knapp, S Hesse, D Schneider
BACKGROUND AND PURPOSE: We sought to study the prognostic value of early 99mtechnetium-ethyl-cysteinate-dimer single-photon emission CT (99mTc-ECD SPECT) for fatal ischemic brain edema in patients with middle cerebral artery (MCA) stroke compared with the prognostic value of CT and of clinical findings. METHODS: We prospectively studied 108 patients clinically, with 99mTc-ECD SPECT, and with CT within 6 hours of symptom onset (Scandinavian Stroke Scale <40 points) appropriate to MCA ischemia...
December 1998: Stroke; a Journal of Cerebral Circulation
E K St Louis, E F Wijdicks, H Li
BACKGROUND: Patients with cerebellar hematomas may appear stable but may worsen suddenly. Whether certain clinical or CT scan findings predict worsening is not known. METHODS: We reviewed clinical and neuroimaging data in 72 patients with cerebellar hematomas at the Mayo Clinic from 1973 through 1993 to identify predictive features for neurologic deterioration. Patients presenting in coma and patients with vascular malformations or malignancies were excluded. Data were analyzed using chi-square or Fisher's exact test, with calculation of odds ratios with 95% confidence intervals...
November 1998: Neurology
E F Wijdicks, M N Diringer
OBJECTIVE: To determine the clinical course and outcome in patients with a middle cerebral artery (MCA) occlusion and early computed tomographic (CT) scan findings of infarction, particularly relative to age of the patient. MATERIAL AND METHODS: The clinical and neuroimaging features of 42 consecutive patients with MCA occlusion and early CT signs of swelling (within 24 hours after ictus) were studied. CT scans were graded for displacement of the pineal gland and septum pellucidum as well as compression of the frontal horn of the ventricular system...
September 1998: Mayo Clinic Proceedings
A D Firlik, H Yonas, A M Kaufmann, L R Wechsler, C A Jungreis, M B Fukui, R L Williams
OBJECT: The purpose of this study was to determine whether cerebral blood flow (CBF) measurements in acute stroke could be correlated with the subsequent development of cerebral edema and life-threatening brain herniation. METHODS: Twenty patients with aggressively managed acute middle cerebral artery (MCA) territory strokes who underwent xenon-enhanced computerized tomography (Xe-CT) CBF scanning within 6 hours of onset of symptoms were retrospectively reviewed...
August 1998: Journal of Neurosurgery
T Yoshikai, T Tahara, T Kuroiwa, A Kato, A Uchino, M Abe, K Tabuchi, S Kudo
Computed tomographic (CT) findings of 13 patients manifesting brain death were reviewed. This diagnosis was confirmed by the so-called "hollow skull" pattern observed in brain perfusion single photon emission computed tomography (SPECT), which was performed between 4 hours before and 3 days after the CT scans, and by subsequent corporal death. The brain perfusion SPECT was performed with the intravenous administration of technetium (Tc)-99m-hexamethylpropyleneamine oxime (HMPAO) or iodine (I)-123-N-isopropyl-p-iodoamphetamine (IMP)...
November 1997: Radiation Medicine
H J Pikus, P A Ball
The rural CGW population has not yet undergone the metamorphosis experienced by its urban counterparts. Reminiscent of a past era, suicides far outweight homicides. Although many rural firearm injuries involve hunting accidents, these comprise only a small fraction of CGW at best. Similarly, although many rural firearm injuries involve shotguns or rifles, few CGW result from these weapons. Although the number of patients is small, those with shotgun or rifle injuries manifest lower mortality rates. The authors have confirmed the notion that caliber of civilian weapons is difficult to correlate with outcome...
October 1995: Neurosurgery Clinics of North America
D Pang, J A Horton, J M Herron, J E Wilberger, J K Vries
With the advent of computerized tomography (CT), an increasing number of patients with only minimal neurological symptoms and no signs of brain herniation are found to harbor subacute or chronic extradural hematomas (EH's). The authors present the cases of 11 symptomatic but neurologically normal children with medium to large EH's managed by close observation. These EH's were discovered 4 hours to 6 days after injury; three were in the posterior fossa, seven over the frontoparietal convexity, and one in the temporal fossa...
December 1983: Journal of Neurosurgery
J P Nguyen, M Djindjian, P Brugières, S Badiane, E Melon, J Poirier
The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation...
December 1990: Journal de Radiologie
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