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https://www.readbyqxmd.com/read/29770118/neuroinflammation-as-a-target-for-intervention-in-subarachnoid-hemorrhage
#1
REVIEW
Airton Leonardo de Oliveira Manoel, R Loch Macdonald
Aneurysmal subarachnoid hemorrhage (SAH) is a sub-type of hemorrhagic stroke associated with the highest rates of mortality and long-term neurological disabilities. Despite the improvement in the management of SAH patients and the reduction in case fatality in the last decades, disability and mortality remain high in this population. Brain injury can occur immediately and in the first days after SAH. This early brain injury can be due to physical effects on the brain such as increased intracranial pressure, herniations, intracerebral, intraventricular hemorrhage, and hydrocephalus...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29354235/compare-the-intracranial-pressure-trend-after-the-decompressive-craniectomy-between-massive-intracerebral-hemorrhagic-and-major-ischemic-stroke-patients
#2
Joon Huh, Seo-Yeon Yang, Han-Yong Huh, Jae-Kun Ahn, Kwang-Wook Cho, Young-Woo Kim, Sung-Lim Kim, Jong-Tae Kim, Do-Sung Yoo, Hae-Kwan Park, Cheol Ji
Objective: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance. Methods: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively...
January 2018: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29311754/correlation-between-cerebral-hemodynamic-and-perfusion-pressure-changes-in-non-human-primates
#3
A Ruesch, M A Smith, G Wollstein, I A Sigal, S Nelson, J M Kainerstorfer
The mechanism that maintains a stable blood flow in the brain despite changes in cerebral perfusion pressure (CPP), and therefore guaranties a constant supply of oxygen and nutrients to the neurons, is known as cerebral autoregulation (CA). In a certain range of CPP, blood flow is mediated by a vasomotor adjustment in vascular resistance through dilation of blood vessels. CA is known to be impaired in diseases like traumatic brain injury, Parkinson's disease, stroke, hydrocephalus and others. If CA is impaired, blood flow and pressure changes are coupled and the oxygen supply might be unstable...
February 2017: Proceedings of SPIE
https://www.readbyqxmd.com/read/29303450/subcutaneous-bone-flap-storage-after-emergency-craniectomy-cost-effectiveness-and-rate-of-resorption
#4
Griffin Ernst, Fares Qeadan, Andrew P Carlson
OBJECTIVE Decompressive craniectomy is used for uncontrolled intracranial pressure in traumatic brain injury and malignant hemispheric stroke. Subcutaneous preservation of the autologous bone flap in the abdomen is a simple, portable technique but has largely been abandoned due to perceived concerns of resorption. The authors sought to characterize their experience with subcutaneous preservation of the bone flap and cranioplasty. METHODS The authors performed a retrospective single-institution review of subcutaneous preservation of the autologous bone flap after decompressive craniectomy from 2005 to 2015...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29262432/spontaneous-intraventricular-hemorrhage-when-should-intraventricular-tpa-be-considered
#5
Peter A Abdelmalik, Wendy C Ziai
Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29247499/cardiac-output-changes-after-osmotic-therapy-in-neurosurgical-and-neurocritical-care-patients-a-systematic-review-of-the-clinical-literature
#6
Georgia Tsaousi, Elisabetta Stazi, Marco Cinicola, Federico Bilotta
AIM: Osmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHOD: A database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting...
April 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29201841/the-combined-use-of-cardiac-output-and-intracranial-pressure-monitoring-to-maintain-optimal-cerebral-perfusion-pressure-and-minimize-complications-for-severe-traumatic-brain-injury
#7
Jin Shup So, Jung-Ho Yun
Objective: To show the effect of dual monitoring including cardiac output (CO) and intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI) patiens. We hypothesized that meticulous treatment using dual monitoring is effective to sustain maintain minimal intensive care unit (ICU) complications and maintain optimal ICP and cerebral perfusion pressure (CPP) for severe TBI patiens. Methods: We included severe TBI, below Glasgow Coma Scale (GCS) 8 and head abbreviation injury scale (AIS) >4 and performed decompressive craniectomy at trauma ICU of our hospital...
October 2017: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/29151668/bulging-brains
#8
J Weickenmeier, P Saze, C A M Butler, P G Young, A Goriely, E Kuhl
Brain swelling is a serious condition associated with an accumulation of fluid inside the brain that can be caused by trauma, stroke, infection, or tumors. It increases the pressure inside the skull and reduces blood and oxygen supply. To relieve the intracranial pressure, neurosurgeons remove part of the skull and allow the swollen brain to bulge outward, a procedure known as decompressive craniectomy. Decompressive craniectomy has been preformed for more than a century; yet, its effects on the swollen brain remain poorly understood...
December 2017: Journal of Elasticity
https://www.readbyqxmd.com/read/29128928/serum-neuron-specific-enolase-may-be-a-marker-to-predict-the-severity-and-outcome-of-cerebral-venous-thrombosis
#9
Yanyu Hu, Ran Meng, Xuxiang Zhang, Linlin Guo, Sijie Li, Yan Wu, Jiangang Duan, Yuchuan Ding, Xunming Ji
The objective is to explore the effective of baseline serum neuron specific enolase (NSE) on predicting the severity and outcome in patients with cerebral venous thrombosis (CVT). A total of 156 patients confirmed as CVT in Xuanwu Hospital were enrolled in this retrospective study from March 2011 through September 2016. The severity was evaluated with the National Institutes of Health Stroke Score (NIHSS), intracranial pressure (ICP), and CVT-related complications; the outcome was evaluated by modified Rankin Scale (mRS); the relationship between baseline serum NSE and mRS was analyzed with receiver operating characteristic curve (ROC), logistic regression analysis, and Kaplan-Meier curves...
January 2018: Journal of Neurology
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
#10
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...
January 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28934363/sex-related-differences-in-the-risk-factors-for-in-hospital-mortality-and-outcomes-of-ischemic-stroke-patients-in-rural-areas-of-taiwan
#11
Cheung-Ter Ong, Yi-Sin Wong, Sheng-Feng Sung, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung
BACKGROUND AND PURPOSE: Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients. METHODS: A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study...
2017: PloS One
https://www.readbyqxmd.com/read/28817088/the-role-of-neurogenic-inflammation-in-blood-brain-barrier-disruption-and-development-of-cerebral-oedema-following-acute-central-nervous-system-cns-injury
#12
REVIEW
Annabel J Sorby-Adams, Amanda M Marcoionni, Eden R Dempsey, Joshua A Woenig, Renée J Turner
Acute central nervous system (CNS) injury, encompassing traumatic brain injury (TBI) and stroke, accounts for a significant burden of morbidity and mortality worldwide, largely attributable to the development of cerebral oedema and elevated intracranial pressure (ICP). Despite this, clinical treatments are limited and new therapies are urgently required to improve patient outcomes and survival. Originally characterised in peripheral tissues, such as the skin and lungs as a neurally-elicited inflammatory process that contributes to increased microvascular permeability and tissue swelling, neurogenic inflammation has now been described in acute injury to the brain where it may play a key role in the secondary injury cascades that evolve following both TBI and stroke...
August 17, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#13
REVIEW
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
December 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28642178/neurologic-outcome-after-decompressive-craniectomy-predictors-of-outcome-in-different-pathologic-conditions
#14
Taco Goedemans, Dagmar Verbaan, Bert A Coert, Bertjan J Kerklaan, René van den Berg, Jonathan M Coutinho, Tessa van Middelaar, Paul J Nederkoorn, William Peter Vandertop, Pepijn van den Munckhof
OBJECTIVE: Decompressive craniectomy (DC) has been proposed as a lifesaving treatment in patients with elevated intracranial pressure, but its effectiveness on reaching a favorable neurologic outcome remains unclear. We identified predictors of outcome in a large, single-center cohort of patients undergoing DC for different pathologic conditions. METHODS: This retrospective study included all patients undergoing DC from 2006 to 2014. The 1-year outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3) outcome...
September 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#15
REVIEW
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187799/management-of-intracerebral-hemorrhage
#16
REVIEW
A M Thabet, M Kottapally, J Claude Hemphill
Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28130682/therapies-for-hemorrhagic-transformation-in-acute-ischemic-stroke
#17
REVIEW
Joshua A Stone, Joshua Z Willey, Salah Keyrouz, James Butera, Ryan A McTaggart, Shawna Cutting, Brian Silver, Bradford Thompson, Karen L Furie, Shadi Yaghi
Hemorrhagic transformation occurs in about 10-15% of patients with acute ischemic stroke. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure. Future research should be directed on identifying indications to treat and use of appropriate homeostatic regimens to effectively reverse the different anticoagulants and thrombolytic agents in an attempt to improve outcomes of patients with hemorrhagic transformation...
January 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/27998316/decompressive-craniectomy-for-malignant-middle-cerebral-artery-infarction-in-a-16-year-old-boy-a-case-report
#18
Simon Lammy, Paul Fivey, Meharpal Sangra
BACKGROUND: Cryptogenic stroke frequently occurs in younger patients and has a high risk of recurrence. Consequently, secondary prevention is often suboptimal as there is no known risk factor to target. This case demonstrates an unexpected finding of middle cerebral artery infarction and extensive malignant transformation in a 16-year-old boy more than a day post-admission. The lack of a proven culprit lesion makes this case even more intriguing and subsequently raises questions of cryptogenic mechanisms in the context of unrelated trauma...
December 20, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27867477/hyperbaric-oxygen-therapy-in-experimental-and-clinical-stroke
#19
REVIEW
Wei-Wei Zhai, Liang Sun, Zheng-Quan Yu, Gang Chen
Stroke, which is defined as a neurologic deficit caused by sudden impaired blood supply, has been considered as a common cause of death and disability for decades. The World Health Organization has declared that almost every 5 seconds a new stroke occurs, placing immense socioeconomic burdens. However, the effective and available treatment strategies are still limited. Additionally, the most effective therapy, such as thrombolysis and stenting for ischemic stroke, generally requires a narrow therapeutic time window after the event...
April 2016: Medical Gas Research
https://www.readbyqxmd.com/read/27798981/hydrocephalus-associated-with-childhood-nonaccidental-head-trauma
#20
Sudhakar Vadivelu, Harold L Rekate, Debra Esernio-Jenssen, Mark A Mittler, Steven J Schneider
OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period...
November 2016: Neurosurgical Focus
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