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Intracranial hypertension management

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https://www.readbyqxmd.com/read/29123886/sudden-cerebral-depression-detected-by-bispectral-index-monitoring-in-cryptococcal-meningitis-with-elevated-near-fatal-cerebrospinal-fluid-pressure
#1
Hironori Matsumoto, Suguru Annen, Kensuke Umakoshi, Jun Takeba, Satoshi Kikuchi, Yuki Nakabayashi, Naoki Moriyama, Muneaki Ohshita, Mayuki Aibiki
Case: An increase in cerebrospinal fluid pressure (CSFP) is usually prominent in cryptococcal meningitis, which has a high mortality rate, so aggressive management to control CSFP is crucial. In this case, a 40-year-old-man survived cryptococcal meningitis treated with continuous spinal drainage under bispectral index (BIS) monitoring. He unexpectedly showed hypertension, went into a coma, and even loss his light reflexes due to CSFP elevation. His BIS values had abruptly dropped before developing these symptoms, but dramatically recovered after lumbar puncture drainage, suggesting that BIS monitoring could reflect cerebral function changes due to CSFP alternations...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29118788/mechanical-thrombectomy-for-m2-occlusions-a-single-centre-experience
#2
Pervinder Bhogal, Philipp Bücke, Marta Aguilar Pérez, Oliver Ganslandt, Hansjörg Bäzner, Hans Henkes
Background: The recent success of several mechanical thrombectomy trials has resulted in a significant change in the management of patients presenting with stroke. However, questions still remain as to whether certain groups will benefit from mechanical thrombectomy. In particular, it is still uncertain whether mechanical thrombectomy should be performed in the M2 branches and, more generally, in the distal vasculature. Methods: We retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29095707/long-term-management-and-outcomes-after-repair-of-cerebrospinal-fluid-rhinorrhea-related-to-idiopathic-intracranial-hypertension
#3
Theodore A Schuman, Brent A Senior
PURPOSE OF REVIEW: To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). RECENT FINDINGS: Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder...
October 31, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29094154/racial-differences-in-prevalence-and-risk-for-intracranial-atherosclerosis-in-a-us-community-based-population
#4
Ye Qiao, Fareed K Suri, Yiyi Zhang, Li Liu, Rebecca Gottesman, Alvaro Alonso, Eliseo Guallar, Bruce A Wasserman
Importance: Intracranial atherosclerotic disease (ICAD) is an important cause of stroke; however, little is known about racial differences in ICAD prevalence and its risk factors. Objective: To determine racial differences in ICAD prevalence and the risk factors (both midlife and concurrent) associated with its development in a large, US community-based cohort. Design, Setting, and Participants: Analysis of 1752 black and white participants recruited from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent 3-dimensional intracranial vessel wall magnetic resonance imaging from October 18, 2011 to December 30, 2013; data analysis was performed from October 18, 2011 to May 13, 2015...
November 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29094066/surgical-repair-of-spontaneous-cerebrospinal-fluid-csf-leaks-a-systematic-review
#5
REVIEW
Brian C Lobo, Maraya M Baumanis, Rick F Nelson
Objectives: To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base. Data Sources: A systematic review of English articles using MEDLINE. Review Methods: Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors. Results: Patients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m(2)) and female (72%)...
October 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29088962/complications-of-invasive-intracranial-pressure-monitoring-devices-in-neurocritical-care
#6
Samon Tavakoli, Geoffrey Peitz, William Ares, Shaheryar Hafeez, Ramesh Grandhi
Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement-and misplacement-is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088943/the-role-of-icp-monitoring-in-meningitis
#7
Areej Tariq, Pedro Aguilar-Salinas, Ricardo A Hanel, Neeraj Naval, Mohamad Chmayssani
Intracranial pressure (ICP) monitoring has been widely accepted in the management of traumatic brain injury. However, its use in other pathologies that affect ICP has not been advocated as strongly, especially in CNS infections. Despite the most aggressive and novel antimicrobial therapies for meningitis, the mortality rate associated with this disease is far from satisfactory. Although intracranial hypertension and subsequent death have long been known to complicate meningitis, no specific guidelines targeting ICP monitoring are available...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29081393/cisternostomy-for-refractory-post-traumatic-intracranial-hypertension-a-case-report
#8
L Giammattei, M Messerer, M Oddo, F Borsotti, M Levivier, R T Daniel
BACKGROUND: The current surgical treatment of choice for refractory intracranial hypertension following traumatic brain injury (TBI) is decompressive craniectomy. Despite efficacy in control of intracranial pressure, its contribution towards an improved outcome is debatable. CASE DESCRIPTION: We present here a case of refractory intracranial hypertension successfully managed with cisternostomy. The rationale of this surgical technique is discussed with a focus on the pathophysiological processes underlying elevated intracranial pressure (ICP) and its improvement following surgery...
October 25, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29059119/early-management-of-acute-cerebrovascular-accident
#9
Jody Manners, Alexis Steinberg, Lori Shutter
PURPOSE OF REVIEW: Stroke is common and often presents as a neurologic emergency that requires rapid evaluation and treatment to minimize debilitation. Recent advances in therapy expanded time windows for intra-arterial thrombectomy in ischemic stroke, and surgical interventions for clot evacuation in large intracranial hemorrhage have recently proven feasible. This review discusses recent data regarding new therapeutic options in both ischemic and hemorrhagic stroke, notably in scenarios in which therapy was previously limited to supportive care...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29058090/icp-management-in-patients-suffering-from-traumatic-brain-injury-a-systematic-review-of-randomized-controlled-trials
#10
REVIEW
Peter Abraham, Robert C Rennert, Brandon C Gabel, Jayson A Sack, Navaz Karanjia, Peter Warnke, Clark C Chen
BACKGROUND: Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI. METHODS: A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles...
December 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29044088/management-of-idiopathic-intracranial-hypertension-in-an-infant-with-bilateral-congenital-cataract-and-associated-comitant-sensory-esotropia
#11
Jyoti Himanshu Matalia, Sheetal Shirke, Hemant Anaspure, Pooja Ghalla, Minal Kekatpure
In this report, we describe the management of a child with bilateral cataract, nystagmus, and comitant sensory esotropia. Routine ultrasonography done before cataract surgery revealed bilateral disc edema confirmed as idiopathic intracranial hypertension by a pediatric neurologist. The primary intervention for cataract surgery was followed by nonresolving papilledema, despite maximum medical therapy. To salvage the optic nerve function in a nonverbal child, bilateral optic nerve sheath decompression was planned with simultaneous medial rectus recessions for the persistent esotropia with the satisfactory postoperative outcome...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29030279/posterior-cranial-vault-distraction-osteogenesis-in-craniofacial-surgery-technical-note
#12
Q de Kerangal, A Paré, A Joly, N Travers, D Goga, B Laure
INTRODUCTION: Posterior cranial vault distraction is a treatment for intracranial hypertension in certain cases of craniosynostosis and faciocraniosynostosis. It allows the harmonization of the skull back and prevents turricephaly. This study presents the surgical technique. TECHNICAL NOTE: Posterior cranial vault distraction osteogenesis consists of a circular osteotomy of the skull back. Four distractors are placed on the cranial flap without detachment of the dura mater...
October 10, 2017: Journal of Stomatology, Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28988225/persistent-de-quervain-tenosynovitis-induced-by-somatotropin-treatment
#13
Ozan Volkan Yurdakul, Lütfiye Aytüre, Ebru Yilmaz Yalçinkaya
BACKGROUND: Growth hormone deficiency is a well-known clinical entity that is usually treated with somatotropin (growth hormone). Growth hormone has some frequent side effects such as intracranial hypertension, lymphedema and diabetes mellitus. CASE PRESENTATION: We report the case of a 14-year-old girl with a history of wrist pain and clumsiness. Magnetic resonance imaging revealed de Quervain tenosynovitis. The patient had a history of using growth hormones for 12 months...
October 26, 2017: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://www.readbyqxmd.com/read/28987433/cerebral-venous-thrombosis-a-challenging-neurologic-diagnosis
#14
REVIEW
Brit Long, Alex Koyfman, Michael S Runyon
Headache is a common emergency department chief complaint. Although most are benign, emergency physicians must rapidly identify and manage the uncommon, sometimes subtle, presentation of headache from a life-threatening cause. Cerebral venous thrombosis imparts significant morbidity and mortality, and can be a challenging diagnosis. It most commonly occurs in those under 50 years of age with thrombosis of the cerebral veins/sinuses. Diagnosis is frequently delayed. The disease can present with 1 or more clinical syndromes, including intracranial hypertension with headaches, focal neurologic deficits, seizures, and encephalopathy...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987431/spontaneous-intracerebral-hemorrhage
#15
REVIEW
Stephen Alerhand, Cappi Lay
Although commonly arising from poorly controlled hypertension, spontaneous intracerebral hemorrhage may occur secondary to several other etiologies. Clinical presentation to the emergency department ranges from headache with vomiting to coma. In addition to managing the ABCs, the crux of emergency management lies in stopping hematoma expansion and other complications to prevent clinical deterioration. This may be achieved primarily through anticoagulation reversal, blood pressure, empiric management of intracranial pressure, and early neurosurgical consultation for posterior fossa hemorrhage...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28983441/high-value-care-in-the-evaluation-of-stroke
#16
Prakrity Urja, Eric H Nippoldt, Virginia Barak, Carrie Valenta
Value-based care emphasizes achieving the greatest overall health benefit for every dollar spent. We present an interesting case of stroke, which made us consider how frequently health care providers are utilizing value-based care. A 73-year-old Caucasian, who was initially admitted for a hypertensive emergency, was transferred to our facility for worsening slurring of speech and left-sided weakness. The patient had an extensive chronic cerebrovascular disease, including multiple embolic type strokes, mainly in the distribution of the right temporal-occipital cerebral artery and transient ischemic attacks (TIAs)...
August 1, 2017: Curēus
https://www.readbyqxmd.com/read/28978900/subarachnoid-aneurysmal-hemorrhage-associated-with-coarctation-of-the-aorta-case-report-and-review-of-the-literature
#17
Ryuta Nakae, Yu Fujiki, Shoji Yokobori, Yasutaka Naoe, Hiroyuki Yokota
Intracranial aneurysms (IAs) that undergo rupture causing subarachnoid hemorrhage (SAH), are common in young patients with coarctation of the aorta (CoA), but rarer in middle-aged and elderly patients. The pathogenesis of IAs associated with CoA remains unclear. We report the case of a 50-year-old woman who presented with SAH. On evaluation, six IAs were distributed among the anterior communicating artery (ACoA) (ruptured), distal segments of both anterior cerebral arteries (ACA), the left internal carotid artery (ICA), the bifurcation of the left middle cerebral artery (MCA)/MCA early branch, and the inferior trunk of the left MCA...
2017: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
https://www.readbyqxmd.com/read/28965156/decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-including-patients-with-additional-involvement-of-the-anterior-and-or-posterior-cerebral-artery-territory-outcome-analysis-and-definition-of-prognostic-factors
#18
Sven Kürten, Christopher Munoz, Kerim Beseoglu, Igor Fischer, Jason Perrin, Hans-Jakob Steiger
BACKGROUND: According to current evidence, adding decompressive craniectomy (DC) to best medical therapy reduces case fatality rate of malignant middle cerebral artery infarction by 50-75%. There is currently little information available regarding the outcome of subgroups, in particular of patients with extensive infarctions exceeding the territory of the middle cerebral artery. METHODS: The records of 101 patients with large hemispheric infarctions undergoing DC were retrospectively reviewed...
September 30, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28962805/management-of-traumatic-brain-injury-an-update
#19
REVIEW
Mohamed H Abou El Fadl, Kristine H O'Phelan
The care of patients with traumatic brain injury can be one of the most challenging and rewarding aspects of clinical neurocritical care. This article reviews the approach to unique aspects specific to the care of this patient population. These aspects include appropriate use of sedation and analgesia, and the principles and the clinical use of intracranial monitors. Common clinical challenges encountered in these patients are also discussed, including the treatment of intracranial hypertension, temperature management, and control of sympathetic hyperactivity...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28959487/current-management-of-spontaneous-intracerebral-haemorrhage
#20
REVIEW
Cyrus K Dastur, Wengui Yu
Intracerebral haemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled hypertension (HTN) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organised stroke care, dedicated Neuro-ICUs, medical and surgical management have improved the management of ICH. Early airway protection, control of malignant HTN, urgent reversal of coagulopathy and surgical intervention may increase the chance of survival for patients with severe ICH. Intensive lowering of systolic blood pressure to <140 mm Hg is proven safe by two recent randomised trials...
March 2017: Stroke and Vascular Neurology
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