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Intracranial hypotension

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https://www.readbyqxmd.com/read/29671295/monitoring-the-injured-brain
#1
Anna T Mazzeo, Deepak K Gupta
Traumatic brain injury can be defined as the most complex disease in the most complex organ. When an acute brain injury occurs, several pathophysiological cascades are triggered, leading to further exacerbation of the primary damage. A number of events potentially occurring after TBI can compromise the availability or utilization of energy substrates in the brain, ultimately leading to brain energy crisis. The frequent occurrence of secondary insults in the acute phase after TBI, such as intracranial hypertension, hypotension, hypoxia, hypercapnia, hyperthermia, seizures, can then increase cerebral damage, and adversely affect outcome...
April 18, 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29665012/wavelet-pressure-reactivity-index-a-validation-study
#2
Xiuyun Liu, Marek Czosnyka, Joseph Donnelly, Danilo Cardim, Manuel Cabeleira, Peter J Hutchinson, Xiao Hu, Peter Smielewski, Ken Brady
KEY POINTS: The brain is vulnerable to damage from too little or too much blood flow. A physiological mechanism called cerebral autoregulation (CA) exists to maintain stable blood flow even if cerebral perfusion pressure (CPP) is changing. A robust method for assessing CA is not yet available. There are still some problems with the traditional measure, the pressure reactivity index (PRx). We introduced a new method, wavelet transform method (wPRx) to assess CA using data from two sets of controlled hypotension experiments in piglets: One set with artificially manipulated ABP oscillations; the other group were spontaneous ABP waves...
April 17, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29629045/iatrogenic-development-of-cerebrospinal-fluid-leakage-in-diagnosing-spontaneous-intracranial-hypotension
#3
Chang-Joon Lee, Sung-Min Shim, Sang-Hyeon Cho, Jae-Ho Park, Young Ki Kim
A 34-year-old woman came to the emergency room complaining of a severe orthostatic headache. Results of a cerebrospinal fluid tap and brain computed tomography were normal. Based on her history and symptoms, she was found to have spontaneous intracranial hypotension. She was hospitalized and her symptoms improved with conservative treatment. On the next day, her headache suddenly worsened. Cisternography was performed to confirm the diagnosis and determine the spinal level of her cerebrospinal fluid leak. It revealed multiple cerebrospinal fluid leaks in the lumbar and upper thoracic regions...
March 2018: Korean Journal of Family Medicine
https://www.readbyqxmd.com/read/29627171/comparison-of-nicardipine-with-clevidipine-in-the-management-of-hypertension-in-acute-cerebrovascular-diseases
#4
Zachary Rosenfeldt, Katelyn Conklen, Breck Jones, Don Ferrill, Maithili Deshpande, Fazeel M Siddiqui
BACKGROUND AND PURPOSE: In acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke. METHODS: This retrospective review compared nicardipine with clevidipine for hypertension in acute stroke patients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour...
April 4, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#5
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29621631/spontaneous-intracranial-hypotension-is-diagnosed-by-a-combination-of-lipocalin-type-prostaglandin-d-synthase-and-brain-type-transferrin-in-cerebrospinal-fluid
#6
Yuta Murakami, Koichi Takahashi, Kyoka Hoshi, Hiromi Ito, Mayumi Kanno, Kiyoshi Saito, Kenneth Nollet, Yoshiki Yamaguchi, Masakazu Miyajima, Hajime Arai, Yasuhiro Hashimoto, Tatsuo Mima
BACKGROUND: Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid (CSF) leakage. Definitive diagnosis can be difficult by clinical examinations and imaging studies. METHODS: SIH was diagnosed with the following criteria: (i) evidence of CSF leakage by cranial magnetic resonance imaging (MRI) findings of intracranial hypotension and/or low CSF opening pressure; (ii) no recent history of dural puncture. We quantified CSF proteins by ELISA or Western blotting...
April 2, 2018: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/29614364/moderate-traumatic-brain-injury-clinical-characteristics-and-a-prognostic-model-of-12-month-outcome
#7
Cathrine Elisabeth Einarsen, Joukje van der Naalt, Bram Jacobs, Turid Follestad, Kent Gøran Moen, Anne Vik, Asta Kristine Haberg, Toril Skandsen
BACKGROUND: Patients with moderate traumatic brain injury (TBI) are often studied together with patients with severe TBI, even though expected outcome is better. Therefore, we aimed to describe patient characteristics and 12-month outcome, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI. METHODS: Patients with Glasgow Coma Scale score of 9-13 and age ≥16 years were prospectively enrolled in two level I trauma centers in Europe...
March 31, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29600909/spontaneous-occult-intracranial-hypotension-precipitating-life-threatening-cerebral-venous-thrombosis-case-report
#8
Avital Perry, Christopher S Graffeo, Waleed Brinjikji, William R Copeland, Alejandro A Rabinstein, Michael J Link
Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia...
March 30, 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29561918/prospective-evaluation-of-nasopharyngeal-intubation-during-radiofrequency-thermocoagulation-of-the-trigeminal-ganglion
#9
Cheng-Fu Wan, Dao-Song Dong, Qi Xi, Yan Liu, Wen-Yao Cui, Qiu-Shi Wang, Tao Song
AIMS: To investigate whether nasopharyngeal airway (NPA) intubation could reduce the risk of complications caused by radiofrequency thermocoagulation (RFT) of the trigeminal ganglion. METHODS: From November 1, 2014 to May 1, 2015, 200 patients treated with sedation (combination of sufentanil and propofol) were randomly divided into two groups, one in which NPA intubation was used (intervention group) and one in which it was not used (control group). The primary outcome was the frequency of hypoxemia, and secondary outcomes were the frequency of hypotension, nasal mucosa damage, corneal numbness, masticatory weakness, palsies of other cranial nerves, and intracranial hemorrhage...
March 21, 2018: Journal of Oral & Facial Pain and Headache
https://www.readbyqxmd.com/read/29534203/behavioral-variant-frontotemporal-dementia-as-a-serious-complication-of-spontaneous-intracranial-hypotension
#10
Wouter I Schievink, M Marcel Maya, Zachary R Barnard, Franklin G Moser, Stacey Jean-Pierre, Alan D Waxman, Miriam Nuño
BACKGROUND: Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported. OBJECTIVE: To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD. METHODS: We identified patients with SIH who met clinical criteria for bvFTD...
March 8, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29530694/repeated-spontaneous-intracranial-epidural-hemorrhage-after-hysterical-crying-a-case-report
#11
Chun-Ting Chen, Hung-Yi Lai, Ting-Wei Chang, Ching-Yi Lee
BACKGROUND: Spontaneous epidural hemorrhage (EDH) is a rare occurrence that may be caused by vascular anomalies, infections, coagulopathies, or tumors. Spontaneous EDH occurring in patients without specific underlying disease has been reported only as intraspinal lesion but has never been demonstrated in the intracranial area. This study presents a 19-year-old patient with repeated spontaneous intracranial EDH caused twice by hysterical crying. CASE DESCRIPTION: The patient had spontaneous left frontal EDH after hysterical crying...
March 9, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29529977/routine-ct-scanning-of-patients-retrieved-to-a-tertiary-centre-on-veno-venous-extracorporeal-membrane-oxygenation-a-retrospective-risk-benefit-analysis
#12
Kate M Richmond, Katharine G Warburton, Simon J Finney, Sachin Shah, Benjamin A J Reddi
INTRODUCTION: Comprehensive clinical examination can be compromised in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Adjunctive diagnostic imaging strategies range from bedside imaging only to routine computed tomography (CT). The risk-benefit of either approach remains to be evaluated. Patients retrieved to the Royal Brompton Hospital (RBH) on VV-ECMO routinely undergo admission CT imaging of head, chest, abdomen and pelvis. This study aimed to identify how frequently changes in therapy or adverse events could be attributed to routine CT scanning...
March 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29524703/neurological-deterioration-due-to-brain-sag-following-bilateral-craniotomy-for-subdural-hematoma-evacuation
#13
James K C Liu
BACKGROUND: Intracranial hypotension from cerebrospinal fluid hypovolemia resulting in cerebral herniation is a rare but known complication that can occur following neurosurgical procedures, usually encountered in correlation with perioperative placement of a lumbar subarachnoid drain. Decrease in CSF volume resulting in loss of buoyancy results in downward herniation of the brain without contributing mass effect, causing a phenomenon known as 'brain sag.' Unreported previously is brain sag occurring without concomitant occult CSF leak or lumbar drainage...
March 7, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29513222/acquired-chiari-i-malformation-secondary-to-spontaneous-intracranial-hypotension-syndrome-and-persistent-hypoglycemia-a-case-report
#14
Hasan Önal, Atilla Ersen, Hakan Gemici, Erdal Adal, Serhat Güler, Serdar Sander, Sait Albayram
Spontaneous intracranial hypotension (SIH) is a rare and potentially serious condition in childhood. Cerebrospinal fluid (CSF) volume depletion is thought to be the main causative feature for intracranial hypotension, results from spontaneous CSF leak, often at the spine level. SIH is increasingly diagnosed in clinical practice, although it manifests into a variegated symptomatology. Indeed, downward displacement of the brain, sometimes mimicking a Chiari I malformation, but concomitant presentation of these syndromes has rarely been reported...
February 27, 2018: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/29495052/-image-findings-in-spontaneous-intracranial-hypotension-sih
#15
Anja Örgel, Benjamin Bender, Maria-Ioanna Stefanou, Helene Hurth, Till-Karsten Hauser, Marius Horger
No abstract text is available yet for this article.
March 2018: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
https://www.readbyqxmd.com/read/29492523/prognosis-of-severe-traumatic-brain-injury-outcomes-in-children
#16
Semen V Meshcheryakov, Zhanna B Semenova, Valery I Lukianov, Elena G Sorokina, Olga V Karaseva
OBJECTIVES: We aimed to determine prognostic factors that can influence the outcome of severe traumatic brain injury (TBI) in children. MATERIALS AND METHODS: One hundred and sixty-nine patients with severe TBI were included. Consciousness was evaluated using the Glasgow Coma Scale (GCS). Severity of concomitant injuries was evaluated using the Injury Severity Score (ISS). Computer tomography (CT) scanning was used on admission and later. Intracranial injuries were classified using the Marshall CT scale...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29492522/pre-hospital-predictors-of-impaired-icp-trends-in-continuous-monitoring-of-paediatric-traumatic-brain-injury-patients
#17
Adam M H Young, Joseph Donnelly, Xiuyun Liu, Mathew R Guilfoyle, Melvin Carew, Manuel Cabeleira, Danilo Cardim, Matthew R Garnett, Helen M Fernandes, Christina Haubrich, Peter Smielewski, Marek Czosnyka, Peter J Hutchinson, Shruti Agrawal
OBJECTIVE:  Although secondary insults such as raised intracranial pressure (ICP) or cardiovascular compromise strongly contribute to morbidity, a growing interest can be noticed in how the pre-hospital management can affect outcomes after traumatic brain injury (TBI). The objective of this study was to determine whether pre-hospital co-morbidity has influence on patterns of continuously measured waveforms of intracranial physiology after paediatric TBI. MATERIALS AND METHODS: Thirty-nine patients (mean age, 10 years; range, 0...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29491335/-cerebrospinal-fluid-leakage-and-abducens-nerve-palsy-caused-by-bowling-activity
#18
Hiroyasu Inoue, Masaya Takemoto, Masahiro Muto, Taro Kitamura, Kentaro Yamada
Cerebrospinal fluid leakage can develop due to traffic trauma or lumbar puncture; however, in many cases, it develops spontaneously without any obvious cause. This report describes a case of cerebrospinal fluid leakage caused by bowling activity. A 57-year-old woman adjusted her bowling form, which led to the development of an orthostatic headache and double vision. Cerebrospinal fluid leakage and right abducens nerve palsy was diagnosed, which was resistant to conservative treatment. An epidural blood patch was performed, leading to an improvement in the headache and abducens nerve palsy...
February 28, 2018: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/29449521/-spontaneous-intracranial-hypotension-presenting-with-de-novo-orthostatic-headache-and-subdural-hematoma-after-meningeal-biopsy
#19
Yasuhiro Takeda, Shohei Nambu, Yoshiaki Goto, Shiko Shimada, Keiichiro Maeda
No abstract text is available yet for this article.
February 2018: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/29437266/noninvasive-assessment-of-intracranial-elastance-and-pressure-in-spontaneous-intracranial-hypotension-by-mri
#20
Yi-Hsin Tsai, Hung-Chieh Chen, Hsin Tung, Yi-Ying Wu, Hsian-Min Chen, Kuan-Jung Pan, Da-Chuan Cheng, Jeon-Hor Chen, Clayton Chi-Chang Chen, Jyh-Wen Chai, Wu-Chung Shen
BACKGROUND: Spontaneous intracranial hypotension (SIH) is often misdiagnosed, and can lead to severe complications. Conventional MR sequences show a limited ability to aid in this diagnosis. MR-based intracranial pressure (MR-ICP) may be able to detect changes of intracranial elastance and pressure. PURPOSE: To determine whether MR-ICP is able to differentiate SIH patients from normal subjects, improve diagnostic sensitivity, and provide an insight into the pathophysiology...
February 13, 2018: Journal of Magnetic Resonance Imaging: JMRI
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