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Intracranial hypotension

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https://www.readbyqxmd.com/read/29229352/the-outcome-of-severe-traumatic-brain-injury-in-latin-america
#1
Robert H Bonow, Jason Barber, Nancy R Temkin, Walter Videtta, Carlos Rondina, Gustavo Petroni, Silvia Lujan, Victor Alanis, Gustavo La Fuente, Arturo Lavadenz, Roberto Merida, Manuel Jibaja, Luis Gonzáles, Antonio Falcao, Ricardo Romero, Sureyya Dikmen, James Pridgeon, Randall M Chesnut
Traumatic brain injury (TBI) disproportionately affects lower and middle income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries (HIC). This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥ 13 years and admitted to study hospitals with GCS ≤ 8...
December 8, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29217497/prevalence-of-hyperdense-paraspinal-vein-sign-in-patients-with-spontaneous-intracranial-hypotension-without-dural-csf-leak-on-standard-ct-myelography
#2
Michael S Clark, Felix E Diehn, Jared T Verdoorn, Vance T Lehman, Greta B Liebo, Jonathan M Morris, Kent R Thielen, John T Wald, Neeraj Kumar, Patrick H Luetmer
PURPOSE: A recently identified and treatable cause of spontaneous intracranial hypotension (SIH) is cerebrospinal fluid (CSF)-venous fistula, and a recently described computed tomography myelogram (CTM) finding highly compatible with but not diagnostic of this entity is the hyperdense paraspinal vein sign. We aimed to retrospectively measure the prevalence of the hyperdense paraspinal vein sign on CTMs in SIH patients without dural CSF leak, in comparison with control groups. METHODS: Three CTM groups were identified: 1) SIH study group, which included dural CSF leak-negative standard CTMs performed for SIH, with early and delayed imaging; 2) Early control CTMs, which were performed for indications other than SIH, with imaging shortly after intrathecal contrast administration; 3) Delayed control CTMs, which included delayed imaging...
December 7, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/29212405/a-description-of-a-new-continuous-physiologic-index-in-tbi-using-the-correlation-between-pulse-amplitude-of-icp-and-cerebral-perfusion-pressure
#3
Frederick Adam Zeiler, Joseph Donnelly, David Menon, Peter Smieleweski, Peter John Hutchinson, Marek Czosnyka
To describe a new continuous index of physiologic measurement in a TBI population, the moving correlation coefficient between intracranial pressure (ICP) pulse amplitude (AMP) and cerebral perfusion pressure (CPP), which we refer to as RAC. We use patient examples of sustained intracranial hypertension, systemic arterial hypotension and plateau waves, as well as the retrospective analysis of 358 non-decompressive craniectomy (DC) traumatic brain injury (TBI) patients with high frequency ICP and ABP data, to explore the relationships of this new index, RAC, with AMP, ICP, CPP, RAP, pressure reactivity index (PRx) and pulse amplitude index (PAx)...
December 6, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29209510/milrinone-in-congenital-diaphragmatic-hernia-a-randomized-pilot-trial-study-protocol-review-of-literature-and-survey-of-current-practices
#4
REVIEW
Satyan Lakshminrusimha, Martin Keszler, Haresh Kirpalani, Krisa Van Meurs, Patricia Chess, Namasivayam Ambalavanan, Bradley Yoder, Maria V Fraga, Holly Hedrick, Kevin P Lally, Leif Nelin, Michael Cotten, Jonathan Klein, Stephanie Guilford, Ashley Williams, Aasma Chaudhary, Marie Gantz, Jenna Gabrio, Dhuly Chowdhury, Kristin Zaterka-Baxter, Abhik Das, Rosemary D Higgins
Background: Congenital diaphragmatic hernia (CDH) is commonly associated with pulmonary hypoplasia and pulmonary hypertension (PH). PH associated with CDH (CDH-PH) is frequently resistant to conventional pulmonary vasodilator therapy including inhaled nitric oxide (iNO) possibly due to right and left ventricular dysfunction. Milrinone is an intravenous inotrope and lusitrope with pulmonary vasodilator properties and has been shown anecdotally to improve oxygenation in PH. We developed this pilot study to determine if milrinone infusion would improve oxygenation in neonates ≥36 weeks postmenstrual age (PMA) with CDH...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/29192867/reduction-of-hyperthermia-in-pediatric-patients-with-severe-traumatic-brain-injury-a-quality-improvement-initiative
#5
Marlina E Lovett, Melissa Moore-Clingenpeel, Onsy Ayad, Nicole O'Brien
OBJECTIVE Severe traumatic brain injury remains a leading cause of morbidity and mortality in the pediatric population. Providers focus on reducing secondary brain injury by avoiding hypoxemia, avoiding hypotension, providing normoventilation, treating intracranial hypertension, and reducing cerebral metabolic demand. Hyperthermia is frequently present in patients with severe traumatic brain injury, contributes to cerebral metabolic demand, and is associated with prolonged hospital admission as well as impaired neurological outcome...
December 1, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29181526/cortical-structures-associated-with-human-blood-pressure-control
#6
Nuria Lacuey, Johnson P Hampson, Wanchat Theeranaew, Bilal Zonjy, Ajay Vithala, Norma J Hupp, Kenneth A Loparo, Jonathan P Miller, Samden D Lhatoo
Importance: A better understanding of the role of cortical structures in blood pressure control may help us understand cardiovascular collapse that may lead to sudden unexpected death in epilepsy (SUDEP). Objective: To identify cortical control sites for human blood pressure regulation. Design, Setting, and Participants: Patients with intractable epilepsy undergoing intracranial electrode implantation as a prelude to epilepsy surgery in the Epilepsy Monitoring Unit at University Hospitals Cleveland Medical Center were potential candidates for this study...
November 27, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/29158865/-anesthesiological-aspects-and-complications-of-intracranial-meningiomas-operated-at-the-sylvanus-olympio-university-hospital-center-lom%C3%A3-about-21-cases
#7
Pilakimwé Egbohou, Tabana Mouzou, Kadanga Beketi, Essossinam Kpelao, Abdel Kader Moumouni, Hamza Doles Sama, Sarakawabalo Assénouwé, Gnimdou Akala-Yoba, Kadjika Tomta
This study aimed to point to both the anesthesiological aspects and the perioperative complications of intracranial meningiomas operated at the Sylvanus Olympio University Hospital Center, Lomé. We conducted a retrospective study by reviewing the medical records of patients with intracranial meningiomas undergoing surgery over the period December 2010-December 2015 (5 years) at the Sylvanus Olympio University Hospital Center, Lomé. Out of 46 patients operated fo brain tumors, 21 (45.6%) had meningioma. The average age was 49 ±20 years, with a male predominance (52...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29150776/hyperpyrexia-as-the-presenting-symptom-of-intracranial-hypotension
#8
Omar Hussein, Michel Torbey
INTRODUCTION: Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension. METHODS: A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever...
November 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29140961/cervical-foraminal-epidural-blood-patch-for-the-targeted-treatment-of-refractory-cerebrospinal-fluid-leakage-from-a-dural-sleeve
#9
Nuj Tontisirin, Pannawit Benjhawaleemas, Sasikaan Nimmaanrat, Pornchai Sathirapanya, Teeranan Laohawiriyakamol, De Q Tran, Roderick J Finlayson
Epidural blood patches (EBPs) are routinely used to treat symptoms (eg, headaches) associated with spontaneous intracranial hypotension. Although cerebrospinal fluid leakage commonly involves the periforaminal areas of the cervical or thoracic spine, EBPs have been historically performed at the lumbar level. Recent evidence suggests that targeting the causative spinal segment may provide greater clinical benefits. While previous reports have targeted foraminal leaks with segmental thoracic or cervical injections, we present a case report detailing the novel use of a navigable epidural catheter to perform a selective EBP at the C7/T1 foramen...
November 14, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29132231/the-use-of-desflurane-for-neurosurgical-procedures-in-rhesus-macaque-macaca-mulatta
#10
Henri Gmj Bertrand, Charlotte Sandersen, Paul A Flecknell
Volatile agents are widely used to anaesthetise laboratory non-human primates as they allow a rapid induction and recovery as well as an easy adjustment of the anaesthesia plan. Desflurane is currently the volatile agent with the lowest solubility in blood, and hence enables the most rapid onset of anaesthesia and most rapid recovery. This study aimed to investigate the suitability of desflurane for maintenance of general anaesthesia in rhesus macaques undergoing elective experimental neurosurgery. Fourteen primates (five males and nine females) were sedated with ketamine (10 mg kg(-1)) and anaesthesia was induced with propofol (usually 8 mg kg(-1) IV)...
January 1, 2017: Laboratory Animals
https://www.readbyqxmd.com/read/29114315/intracranial-hypotension-associated-cerebral-swelling-following-cranioplasty-report-of-two-cases
#11
Masashi Nomura, Takahiro Ota, Mitsugu Ishizawa, Shinsuke Yoshida, Takayuki Hara
Cranioplasty is a comparatively simple neurosurgical procedure, and fatal complications are rare. This report describes two cases of critical brain swelling after otherwise uneventful cranioplasty. Both cases had subarachnoid hemorrhage and extremely similar clinical courses. They underwent decompressive craniotomy and clipping in the acute phase and had cranioplasty in the chronic phase, resulting in serious cerebral swelling and death. Deep venous sinus thrombosis was revealed in the autopsy for one case...
October 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29114312/a-case-of-high-dose-adenosine-usage-for-anterior-communicating-artery-aneurysm-clip-ligation-what-is-the-dose-limit-for-a-resistant-response
#12
Shahid M Nimjee, David L McDonagh, Abhishek Agrawal, Gavin W Britz
Intraoperative adenosine is used to induce asystole to facilitate clip ligation of intracranial aneurysms. Typically, 5-10 mg doses are used per administration and approximately 30 mg is used for a given case. An obvious concern with using adenosine is that the patient can remain in asystole or that prolonged hypotension can result in cerebral or cardiovascular ischemia. The upper limit of adenosine administration remains unclear. We present a case of a patient with a large anterior communicating artery aneurysm requiring large doses of adenosine, far exceeding previously reported cases...
October 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29110769/impaired-cerebrospinal-fluid-pressure
#13
Jan Hoffmann
Abnormalities of cerebrospinal fluid (CSF) pressure are relatively common and may lead to a variety of symptoms, with headache usually being the most prominent one. The clinical presentation of alterations in CSF pressure may vary significantly and show a striking similitude to several primary headache syndromes. While an increase in CSF pressure may be of primary or secondary origin, a pathologic decrease of CSF pressure is usually the result of a meningeal rupture with a resulting leakage of CSF. The pathophysiologic mechanisms of idiopathic intracranial hypertension (IIH) remain largely unknown...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29109872/severe-decompression-illness-case-report-prehospital-recognition-and-regional-transport-considerations
#14
Julie Estrada, David Meurer, Kevin De Boer, Karl Huesgen
A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29103382/spontaneous-intracranial-hypotension-induced-headaches-and-onabotulinum-toxin-a-a-case-report
#15
Tommy L H Chan, Werner J Becker, William Y Hu, Farnaz Amoozegar
No abstract text is available yet for this article.
November 6, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29052799/treatment-and-outcome-of-subdural-hematoma-in-patients-with-spontaneous-intracranial-hypotension-a-report-of-35-cases
#16
Enrico Ferrante, Fabio Rubino, Federica Beretta, Caroline Regna-Gladin, M Mirko Ferrante
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, low CSF pressure and diffuse pachymeningeal enhancement on brain MRI. SIH results from spontaneous CSF leakage leading to brain sag. Sometimes, tearing of bridging veins may produce subdural hematomas (SDHs). Patients with SDH were identified retrospectively from 212 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, treatment and outcome of SDH. Thirty-five patients (16%), (6 women, 29 men; aged 33-68; mean, 50 years) with SDH were recruited...
October 20, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29023155/csf-venous-fistulas-in-spontaneous-intracranial-hypotension-imaging-characteristics-on-dynamic-and-ct-myelography
#17
Peter G Kranz, Timothy J Amrhein, Linda Gray
OBJECTIVE: The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). MATERIALS AND METHODS: We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM)...
December 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28984516/multilevel-ultra-large-volume-epidural-blood-patch-for-the-treatment-of-neurocognitive-decline-associated-with-spontaneous-intracranial-hypotension-case-report
#18
Michael D Staudt, Stephen H Pasternak, Manas Sharma, Sachin K Pandey, Miguel F Arango, David M Pelz, Stephen P Lownie
Spontaneous intracranial hypotension (SIH) is a progressive clinical syndrome characterized by orthostatic headaches, nausea, emesis, and occasionally focal neurological deficits. Rarely, SIH is associated with neurocognitive changes. An epidural blood patch (EBP) is commonly used to treat SIH when conservative measures are inadequate, although some patients require multiple EBP procedures or do not respond at all. Recently, the use of a large-volume (LV) EBP has been described to treat occult leak sites in treatment-refractory SIH...
October 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28969244/spontaneous-intracranial-hypotension
#19
Ankit Balani, Sandhya Shantilal Sarjare, Amit Kumar Dey, Anjani D Kumar, Sapna S Marda
No abstract text is available yet for this article.
August 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28958355/acute-management-of-traumatic-brain-injury
#20
REVIEW
Michael A Vella, Marie L Crandall, Mayur B Patel
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization...
October 2017: Surgical Clinics of North America
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