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Intracranial hypertension management

Kathryn F Kirchoff-Torres, Ekaterina Bakradze
PURPOSE OF REVIEW: Cerebral hyperperfusion syndrome (CHS) is a rare but significant complication after carotid revascularization and is increasingly recognized after acute stroke treatments. In this review, we discuss the epidemiology and pathophysiology of CHS, clinical presentation including ipsilateral headache, seizures, and focal neurological deficits, and radiographic presentation. We propose preventive therapies with emphasis on acute stroke post-thrombectomy hyperperfusion. RECENT FINDINGS: CHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke...
March 19, 2018: Current Pain and Headache Reports
Nehat Baftiu, Islam Krasniqi, Kastriot Haxhirexha, Rudin Domi
BACKGROUND: Tracheal extubations may be performed before or after awakening from anaesthesia. The advantage of extubation during anaesthesia may avoid all the unpleasant effects of fully awake extubation such as severe hypertension and tachycardia, malignant dysrhythmias, myocardial ischemia laryngospasm, and cough induced high intraocular and intracranial pressure. AIM: To show the current practice of performing extubations in Kosovo, as well as the advantage and disadvantage in performing this procedure in an awake patient or inpatient in light anaesthesia...
February 15, 2018: Open Access Macedonian Journal of Medical Sciences
Waleed Brinjikji, Vitor M Pereira, Rujimas Khumtong, Alex Kostensky, Michael Tymianski, Timo Krings, Ivan Radovanovich
BACKGROUND AND PURPOSE: Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a retrospective study examining risk factors for growth of unruptured intracranial aneurysms followed at our institution examining both traditional risk factors and the PHASES score. MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of unruptured intracranial aneurysms followed at our institution for a minimum of six months over a 15-year period...
March 9, 2018: World Neurosurgery
Nakul Katyal, Christopher R Newey
Cerebrovascular autoregulation may be dysfunctional after acute intracerebral hemorrhage (ICH). This disruption in autoregulation can potentially result in secondary neurological damage that may present as an intracranial hemorrhage at locations distant from the primary site of hemorrhage. We discuss a case of 68-year-old female who presented with acute left hemiparesis from a spontaneous right frontal ICH. Magnetic resonance imaging (MRI) was negative for any other blooming artifact. Her weakness was improving, but after 72 hours from admission, she had an acute change in her mental status and was found to have a new left frontal ICH distant from the primary hemorrhage...
December 29, 2017: Curēus
Anas Alrohimi, Rajive Jassal
Headache is an uncommon symptom in Guillain-Barré syndrome (GBS). We review four clinical settings related to GBS in which headache may be present. We focus on pathophysiological explanations, alerting the clinician to further potential investigations and treatment. Most reports of headache in GBS occur in the context of the posterior reversible encephalopathy syndrome, an increasingly recognized dysautonomia-related GBS complication. Less frequent is headache in the setting of increased intracranial pressure and papilledema (secondary intracranial hypertension), Miller Fisher syndrome, and cerebral venous sinus thrombosis...
March 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
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...
April 2018: Neurosurgery Clinics of North America
Daniel Agustín Godoy, Santiago Lubillo, Alejandro A Rabinstein
Monitoring intracranial pressure in comatose patients with severe traumatic brain injury (TBI) is considered necessary by most experts. Acute intracranial hypertension (IHT), when severe and sustained, is a life-threatening complication that demands emergency treatment. Yet, secondary anoxic-ischemic injury after brain trauma can occur in the absence of IHT. In such cases, adding other monitoring modalities can alert clinicians when the patient is in a state of energy failure. This article reviews the mechanisms, diagnosis, and treatment of IHT and brain hypoxia after TBI, emphasizing the need to develop a physiologically integrative approach to the management of these complex situations...
April 2018: Neurosurgery Clinics of North America
Chiara Robba, Danilo Cardim, Tamara Tajsic, Justine Pietersen, Michael Bulman, Frank Rasulo, Rita Bertuetti, Joseph Donnelly, Liu Xiuyun, Zofia Czosnyka, Manuel Cabeleira, Peter Smielewski, Basil Matta, Alessandro Bertuccio, Marek Czosnyka
BACKGROUND: Non-invasive measurement of intracranial pressure (ICP) can be invaluable in the management of critically ill patients. Invasive measurement of ICP remains the "gold standard" and should be performed when clinical indications are met, but it is invasive and brings some risks. In this project, we aim to validate the non-invasive ICP (nICP) assessment models based on arterious and venous transcranial Doppler ultrasonography (TCD) and optic nerve sheath diameter (ONSD)...
2018: Acta Neurochirurgica. Supplement
Malke Asaad, Samita Goyal, Kristen A Klement, Arlen D Denny
Crouzon syndrome (CS) is one of the craniosynostosis syndromes that leads to early fusion of cranial sutures and increased intracranial pressure. Intracranial hypertension is a serious complication that may lead to vision loss and cognitive impairment. Early detection and management are necessary to prevent complications. The authors present a patient with CS who underwent posterior cranial vault reconstruction with internal distraction after multiple episodes of headache and papilledema. The patient was unaware of any loss of color vision before the surgery; however, he noted an improvement in his color vision after the surgery...
February 26, 2018: Journal of Craniofacial Surgery
Jinjin Liu, Yongchun Chen, Li Lan, Boli Lin, Weijian Chen, Meihao Wang, Rui Li, Yunjun Yang, Bing Zhao, Zilong Hu, Yuxia Duan
OBJECTIVES: Anterior communicating artery (ACOM) aneurysms are the most common intracranial aneurysms, and predicting their rupture risk is challenging. We aimed to predict this risk using a two-layer feed-forward artificial neural network (ANN). MATERIALS AND METHOD: 594 ACOM aneurysms, 54 unruptured and 540 ruptured, were reviewed. A two-layer feed-forward ANN was designed for ACOM aneurysm rupture-risk analysis. To improve ANN efficiency, an adaptive synthetic (ADASYN) sampling approach was applied to generate more synthetic data for unruptured aneurysms...
February 23, 2018: European Radiology
Hari Hara Dash, Siddharth Chavali
Traumatic brain injury (TBI) has been called the 'silent epidemic' of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Foundation. The aims and objectives of its management are prophylaxis and prompt management of intracranial hypertension and secondary brain injury, maintenance of cerebral perfusion pressure, and ensuring adequate oxygen delivery to injured brain tissue...
February 2018: Korean Journal of Anesthesiology
Thomas J Cusack, J Ricardo Carhuapoma, Wendy C Ziai
PURPOSE OF REVIEW: Spontaneous intraparenchymal hemorrhage (IPH) is a prominent challenge faced globally by neurosurgeons, neurologists, and intensivists. Over the past few decades, basic and clinical research efforts have been undertaken with the goal of delineating biologically and evidence-based practices aimed at decreasing mortality and optimizing the likelihood of meaningful functional outcome for patients afflicted with this devastating condition. Here, the authors review the medical and surgical approaches available for the treatment of spontaneous intraparenchymal hemorrhage, identifying areas of recent progress and ongoing research to delineate the scope and scale of IPH as it is currently understood and treated...
February 3, 2018: Current Treatment Options in Neurology
Michael Karsy, Hussam Abou-Al-Shaar, Christian A Bowers, Richard H Schmidt
OBJECTIVE Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a complex and difficult-to-manage condition that can lead to permanent vision loss and refractory headaches if untreated. Traditional treatment options, such as unilateral ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt placement, have high complication and failure rates and often require multiple revisions. The use of bilateral proximal catheters has been hypothesized as a method to improve shunt survival. The use of stereotactic technology has improved the accuracy of catheter placement and may improve treatment of IIH, with fewer complications and greater shunt patency time...
February 2, 2018: Journal of Neurosurgery
Francois Okoroafor, Muhammad Ali Karim, Abdulmajid Ali
OBJECTIVE: There is paucity of data concerning the impact of bariatric surgery on idiopathic intracranial hypertension (IIH). We therefore present the clinical course of two cases that were managed at our centre, which is a regional referral centre for bariatric surgery and present a literature review of patients with IIH who underwent bariatric surgery for the treatment of obesity. METHOD: Two patients were referred for bariatric surgery who were both morbidly obese and were diagnosed with IIH...
January 31, 2018: British Journal of Neurosurgery
Luiz Eduardo Wildemberg, Andrea Glezer, Marcello D Bronstein, Mônica R Gadelha
Pituitary apoplexy is an uncommon event, occurring due to the infarction and/or haemorrhage usually of a previously unknown pituitary adenoma. It can occur in all adenoma subtypes but is more common in nonfunctioning pituitary adenomas. The physiopathology is not completely clear, and precipitating factors, such as major surgeries, anticoagulant use or pituitary dynamic tests, can be found in up to 40% of patients. The clinical presentation is characterized by a rapid onset with a headache as the main symptom, but visual disturbances can also be present as well as meningism and intracranial hypertension...
January 31, 2018: Pituitary
Ponraj K Sundaram, Pawan Kumar Jain
Elevation of a depressed skull fracture (DSF) overlying a venous sinus is generally avoided due to risk of sinus injury. Rarely, the sinus may be compressed by the fractured segment, causing intracranial hypertension (IH) or encephalopathy and can only be diagnosed with cerebral angiography or MR imaging techniques. The posterior third of the superior sagittal sinus (SSS) was found involved in all the reported cases. There is no consensus on its management, but most patients did not have any sinus thrombosis and improved after elevation of the compressing DSF alone...
January 24, 2018: British Journal of Neurosurgery
Jose Gavito-Higuera, Rakesh Khatri, Ihtesham A Qureshi, Alberto Maud, Gustavo J Rodriguez
Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones...
December 28, 2017: World Journal of Radiology
Blessing N R Jaja, Gustavo Saposnik, Hester F Lingsma, Erin Macdonald, Kevin E Thorpe, Muhammed Mamdani, Ewout W Steyerberg, Andrew Molyneux, Airton Leonardo de Oliveira Manoel, Bawarjan Schatlo, Daniel Hanggi, David Hasan, George K C Wong, Nima Etminan, Hitoshi Fukuda, James Torner, Karl L Schaller, Jose I Suarez, Martin N Stienen, Mervyn D I Vergouwen, Gabriel J E Rinkel, Julian Spears, Michael D Cusimano, Michael Todd, Peter Le Roux, Peter Kirkpatrick, John Pickard, Walter M van den Bergh, Gordon Murray, S Claiborne Johnston, Sen Yamagata, Stephan Mayer, Tom A Schweizer, R Loch Macdonald
OBJECTIVE: To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). DESIGN: Cohort study with logistic regression analysis to combine predictors and treatment modality. SETTING: Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries...
January 18, 2018: BMJ: British Medical Journal
Andrew J Anzeljc, Patrick Frias, Brent R Hayek, Nancy Canter Weiner, Ted H Wojno, H Joon Kim
PURPOSE: Optic nerve sheath fenestration (ONSF) is a common surgical option for patients with idiopathic intracranial hypertension (IIH) with vision loss refractory to medical management. Little is known about the visual benefit of repeated ONSF. The authors aimed to assess the efficacy of secondary and tertiary ONSF in patients with IIH. METHODS: A retrospective chart review was performed on all patients with repeat ONSF for IIH at Emory University from 1999 to 2016...
January 9, 2018: Orbit
Virender Sachdeva, Caroline Vasseneix, Rabih Hage, Samuel Bidot, Lindsay C Clough, David W Wright, Nancy J Newman, Valérie Biousse, Beau B Bruce
OBJECTIVE: To determine the frequency of and predictive factors for optic nerve head edema (ONHE) among patients with headache, neurologic deficit, visual loss, or elevated blood pressure in the emergency department (ED). METHODS: Cross-sectional analysis was done of patients with ONHE in the prospective Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study. Demographics, neuroimaging results, management, and patient disposition were collected...
January 30, 2018: Neurology
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