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Intracranial hypertension management

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https://www.readbyqxmd.com/read/28532922/awake-craniotomy-anesthesia-a-comparison-between-the-monitored-anesthesia-care-versus-the-asleep-awake-asleep-technique
#1
Chikezie I Eseonu, Karim ReFaey, Oscar Garcia, Amballur John, Alfredo Quinones-Hinojosa, Punita Tripathi
BACKGROUND: The commonly used sedation techniques for an awake craniotomy includes monitored anesthesia care(MAC), using an unprotected airway, or the asleep-awake-asleep(AAA) technique, using a partially or totally protected airway. We present a comparative analysis between the MAC and AAA technique evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. METHODS: Eighty-one patients underwent an awake craniotomy for an intracranial lesion over a nine-year period by a single-surgeon and a team of anesthesiologists...
May 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28527856/a-bloody-mess
#2
Michael C Brodsky, Valérie Biousse
A 15-year-old girl presented with a unilateral sixth nerve palsy and papilledema following a severe headache. MR imaging showed thrombosis of the superior sagittal sinus and proximal right transverse sinus that were attributed to oral contraceptive use after a coagulation workup was negative. Systemic anticoagulation caused a hemorrhagic papillopathy in both eyes, raising the question as to whether anticoagulation should be discontinued. Diagnostic and management issues regarding cerebral venous sinus thrombosis with secondary intracranial hypertension are discussed...
May 17, 2017: Survey of Ophthalmology
https://www.readbyqxmd.com/read/28516363/posterior-reversible-encephalopathy-syndrome-presenting-in-the-anterior-circulation-with-malignant-intracranial-hypertension-requiring-surgical-decompression-a-case-report-and-literature-review
#3
S Hernández-Durán, A Barrantes-Freer, V Rohde, C von der Brelie
Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood-brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy...
May 17, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28512741/intervention-for-elevated-intracranial-pressure-improves-success-rate-after-repair-of-spontaneous-cerebrospinal-fluid-leaks
#4
William Teachey, Jessica Grayson, Do-Yeon Cho, Kristen O Riley, Bradford A Woodworth
OBJECTIVES/HYPOTHESIS: Spontaneous cerebrospinal fluid (CSF) leaks are associated with increased intracranial pressure (ICP) and considered a manifestation of idiopathic intracranial hypertension. Although postoperative acetazolamide and placement of CSF shunt systems are considered valuable interventions for elevated ICP, the impact on recurrence rate remains unclear. The objective of this study was to systematically review evidence from reported literature to evaluate whether postoperative ICP management reduces recurrence rates after primary endoscopic repair...
May 16, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28511969/the-current-role-of-decompressive-craniectomy-for-severe-traumatic-brain-injury
#5
REVIEW
S Honeybul, K M Ho, C R P Lind, G R Gillett
There is little doubt that decompressive craniectomy can reduce mortality however, the results of a recent study has provided more evidence to inform the debate regarding clinical and ethical concerns that it merely converts death into survival with severe disability or in a vegetative state. The recently published RESCUEicp trial compared last-tier secondary decompressive craniectomy with continued medical management for refractory intracranial hypertension after severe traumatic brain injury. Patients were randomly assigned to decompressive craniectomy with medical therapy or to receive continued medical therapy with the option of adding barbiturates...
May 13, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28492874/peripapillary-retinal-pigment-epithelium-layer-shape-changes-from-acetazolamide-treatment-in-the-idiopathic-intracranial-hypertension-treatment-trial
#6
Jui-Kai Wang, Randy H Kardon, Johannes Ledolter, Patrick A Sibony, Mark J Kupersmith, Mona K Garvin
Purpose: Recent studies indicate that the amount of deformation of the peripapillary retinal pigment epithelium and Bruch's membrane (pRPE/BM) toward or away from the vitreous may reflect acute changes in cerebrospinal fluid pressure. The study purpose is to determine if changes in optic-nerve-head (ONH) shape reflect a treatment effect (acetazolamide/placebo + weight management) using the optical coherence tomography (OCT) substudy of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) at baseline, 3, and 6 months...
May 1, 2017: Investigative Ophthalmology & Visual Science
https://www.readbyqxmd.com/read/28489610/invasive-and-noninvasive-means-of-measuring-intracranial-pressure-a-review
#7
Xuan Zhang, Joshua Medow, Bermans Iskandar, Fa Wang, Mehdi Shokoueinejad, Joyce Koueik, John Webster
Measurement of intracranial pressure (ICP) can be invaluable in the management of critically ill patients. Cerebrospinal fluid (CSF) is produced by the choroid plexus in the brain ventricles (a set of communicating chambers), after which it circulates through the different ventricles and exits into the subarachnoid space (SAS) around the brain, where it is reabsorbed into the venous system. If the fluid does not drain out of the brain or get reabsorbed, the ICP increases, which may lead to brain damage or death...
May 10, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28487359/venous-sinus-stenting-shortens-the-duration-of-medical-therapy-for-increased-intracranial-pressure-secondary-to-venous-sinus-stenosis
#8
Tarek A Shazly, Ashutosh P Jadhav, Amin Aghaebrahim, Andrew F Ducruet, Brian T Jankowitz, Tudor G Jovin, Gabrielle R Bonhomme
INTRODUCTION: Medical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP. METHODS: 12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry...
May 9, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28483156/-bilateral-papilledema
#9
REVIEW
M-B Rougier
This article will review the current standard of care in the diagnosis and management of bilateral optic disc edema. Two emergent conditions must be considered first: secondary intracranial hypertension (cerebral tumor, cerebral thrombophlebitis…) and arteritic ischemic optic neuropathy (or giant cell arteritis). Having ruled out these two diagnoses, the management follows various steps in order to: (i) rule out pseudo-edema, and (ii) determine the underlying cause of the edema: papilledema, non-arteritic ischemic optic neuropathy or papillitis...
May 2017: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/28480112/nontraumatic-posterior-circulation-pseudoaneurysm-of-the-basilar-artery-summit-with-complete-spontaneous-resolution-case-report-and-literature-review
#10
Nefize Turan, Shannon Butler, Theodore C Larson, Alexander Mason
BACKGROUND: Intracranial pseudoaneurysms are rare vascular defects of arterial walls that are classically the result of traumatic injury, iatrogenic causes, or infection. Idiopathic pseudoaneurysms are seen even less frequently and are often related to atherosclerosis. Pseudoaneurysms are most commonly found along the distal wall of the internal carotid artery, however, can occur at any location in the cerebrovascular circulation. Treatment of these arterial defects is often challenging due to their frail nature...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28480107/clinical-features-microsurgical-treatment-and-outcome-of-vestibular-schwannoma-with-brainstem-compression
#11
Ali Harati, Kai-Michael Scheufler, Rolf Schultheiss, Albaraa Tonkal, Kamran Harati, Paul Oni, Thomas Deitmer
BACKGROUND: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. METHODS: Forty-nine patients presented with VS (Hannover grading scale T4a or T4b) in our department. A subgroup analysis was performed among patients without (T4a) and with (T4b) compression and dislocation of the fourth ventricle...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28473606/headaches-complicating-pregnancy-and-the-postpartum-period
#12
REVIEW
Mary Angela O'Neal
Headaches are a common neurological complaint during pregnancy and the postpartum period. Most are primary and benign, but there are also several secondary headaches. This review uses a practical case-based approach to the evaluation and management of the most common headaches referred for neurological consultation: primary headaches such as migraine as well as the presentation and management of some of the secondary headaches complicating pregnancy and the puerperium. These include: idiopathic intracranial hypertension, eclampsia, reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, pituitary apoplexy and postdural puncture headache...
May 4, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28471928/complication-rates-of-3-hypertonic-saline-infusion-through-peripheral-intravenous-access
#13
Claudia Andira Perez, Stephen A Figueroa
INTRODUCTION: Hyperosmolar therapy with hypertonic saline (HTS) is a cornerstone in the management of intracranial hypertension and hyponatremia in the neurological intensive care unit. Theoretical safety concerns remain for infiltration, thrombophlebitis, tissue ischemia, and venous thrombosis associated with continuous 3% HTS administered via peripheral intravenous (pIV) catheters. It is common practice at many institutions to allow only central venous catheter infusion of 3% HTS. METHODS: Hospital policy was changed to allow the administration of 3% HTS via 16- to 20-gauge pIVs to a maximum infusion rate of 50 mL/h in patients without central venous access...
June 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28435117/use-of-intracranial-pressure-monitoring-frequently-refutes-diagnosis-of-idiopathic-intracranial-hypertension
#14
David S Xu, Randall J Hlubek, Celene B Mulholland, Kerry L Knievel, Kris A Smith, Peter Nakaji
OBJECTIVE: The diagnosis and management of patients with idiopathic intracranial hypertension (IIH) frequently relies on lumbar puncture to ascertain intracranial pressures. However, pressures derived this way may be spurious due to patient body habitus and behavior. We recently incorporated direct continuous intracranial pressure (ICP) monitoring into the work-up for IIH and review our experience and outcomes. METHODS: Through billing records, we identified all patients during a 3-year period who had a diagnosis of idiopathic intracranial hypertension and who underwent ICP monitoring prior to shunt placement or revision...
April 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28431144/effect-of-body-mass-index-on-venous-sinus-pressures-in-idiopathic-intracranial-hypertension-patients-before-and-after-endovascular-stenting
#15
Daniel M S Raper, Dale Ding, Thomas J Buell, R Webster Crowley, Robert M Starke, Kenneth C Liu
BACKGROUND: Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes...
April 20, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28398633/intracranial-hemorrhage-in-a-patient-with-sub-massive-pulmonary-embolism-treated-with-ekosonic-endovascular-system-directed-thrombolysis
#16
Sarju Ganatra, Arjun Majithia, Yun-Ting Eric Yeh, Michael S Levy
Ultrasound-assisted catheter-directed thrombolysis therapy has emerged more recently as a management strategy for patients with intermediate risk pulmonary embolism and has shown promising results in clinical trials by early reversal of right ventricle dilation, reduced pulmonary hypertension, and decreased anatomic thrombus burden. This therapeutic strategy requires a small fraction of the systemic fibrinolytic dose and is therefore associated with a reduced bleeding risk. Although intracranial hemorrhage has not been reported in clinical trials, it is a possible complication...
April 11, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28390510/acute-management-of-moderate-severe-traumatic-brain-injury
#17
REVIEW
Wittstatt Alexandra Whitaker-Lea, Alex B Valadka
Traumatic brain injury (TBI) continues to be a major public health problem. Proposed treatments have not withstood testing in clinical trials because of failure to account for different types of TBI and other weaknesses in trial design. Management goals continue to be prevention and prompt treatment of secondary insults (hypotension, hypoxia, and other physiologic derangements). This goal is best accomplished by careful attention to airway, breathing, circulation, and basic principles of intensive care unit management...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28387055/feasibility-of-laparoscopic-cholecystectomy-in-patients-with-cerebrospinal-fluid-shunt
#18
Terukazu Yoshihara, Yoshito Tomimaru, Kozo Noguchi, Hirotsugu Nagase, Atsushi Hamabe, Masashi Hirota, Kazuteru Oshima, Tsukasa Tanida, Shunji Morita, Hiroshi Imamura, Takashi Iwazawa, Kenzo Akagi, Keizo Dono
INTRODUCTION: Previous reports of laparoscopic surgery in patients with cerebrospinal fluid (CSF) shunts for intracranial hypertension described shunt-related complications. Thus, the shunts have been considered a contraindication for laparoscopic procedures. However, with the implementation of recent improvements in surgical techniques, perioperative management, and shunt technology, laparoscopic surgery may now be safe in cases with shunts. The aim of the present study was to examine the safety of such procedures based on our own experiences with laparoscopic surgery in patients with CSF shunts...
April 7, 2017: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/28383859/-ultrasonographic-measurement-of-the-optical-nerve-sheath-for-the-diagnosis-of-intracranial-hypertension-in-the-emergency-room-a-case-report
#19
R Levy, B Kerzmann, V Franssen, A S Schwab, J F Adam, Th Sottiaux
Early diagnosis and treatment of intracranial hypertension (ICHT) are major components of the management of neurological emergencies. The optic nerve sheath diameter is closely dependent on intracranial pressure and can be measured by bedside ultrasound (US). We report the story of a 70-year-old COPD patient initially admitted to the emergency room for a sepsis of pulmonary origin. An unusual confusion prompted us to perform an US of the optic nerve sheath. This exam clearly suggested the presence of an ICHT...
June 2016: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28349763/radiographic-evidence-of-occult-intracranial-hypertension-in-patients-with-m%C3%A3-ni%C3%A3-re-s-disease
#20
Kareem O Tawfik, Shawn M Stevens, David Mihal, Mark S Costello, Rebecca S Cornelius, Ravi N Samy, Myles L Pensak
Objectives (1) Describe the prevalence of radiographic signs of intracranial hypertension (ICH) in Ménière's disease (MD) and (2) compare the prevalence of radiographic signs of ICH in MD patients managed medically to those managed surgically. Study Design Case-control study. Setting Academic neurotologic practice. Subjects and Methods Adult MD patients (aged ≥17 years) treated from 2011 to 2015 were reviewed. Inclusion required magnetic resonance imaging (MRI) of the head and follow-up >6 months. Patients with intracranial tumors, mass effect, trauma, previous intracranial surgery, and glaucoma were excluded...
March 1, 2017: Otolaryngology—Head and Neck Surgery
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