Background and purposeThe pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue.In recent years, there has been a greater research interest into the various inflammatory biomarkers and growth factors that are secreted during intracerebral hemorrhage. The biomarkers investigated in this study are tumor necrosis factor alpha (TNF alpha), C-reactive protein (CRP), homocysteine (Hcy), and vascular endothelial growth factor (VEGF). The aim of this study was to further investigate the effects of these biomarkers in predicting the acute severity outcome of intracerebral hemorrhage (ICH).MethodsWe conducted a retrospective chart review of patients with spontaneous ICH with TNF alpha, CRP, VEGF, and Hcy levels drawn on admission. Forty-two patients with spontaneous ICH with at least one of the above labs were included in the study. Primary outcomes included death, Glasgow Coma Scale (GCS) on admission, early neurologic decline (END), and hemorrhage size. Secondary outcomes included GCS on discharge, ICH score, functional outcome risk stratification scale of intracerebral hemorrhage (FUNC score), change in hemorrhage size, need for surgical intervention, and length of intensive care unit (ICU) stay.ResultsForty-two patients with spontaneous intracerebral hemorrhage (ICH) were analyzed, 12 patients (28.5%) required surgical intervention, and four patients (9.5%) died. Only low VEGF serum values were found to predict mortality. TNF alpha, CRP, Hcy, and VEGF levels in our patients with ICH were not found to predict early neurologic decline and were not correlated with GCS on admission, initial hemorrhage size, change in hemorrhage size, need for surgical intervention, ICH score, FUNC score, midline shift, and length of ICU stay. CRP and Hcy were elevated in 58% and 31% of patients tested, respectively. GCS on admission and ICH score were significantly associated with mortality.ConclusionAfter careful statistical review of the data obtained from this patient population, only low VEGF values were found to be a significant predictor of mortality. However, elevated CRP and Hcy levels were associated with a non-significant trend in hemorrhage size and mortality suggesting that CRP and Hcy-lowering therapies may decrease hemorrhagic stroke risk and severity.

We studied the interictal EEG of 50 epileptic patients (28 males, 22 females) who had parenchymal neurocysticercosis, diagnosed by CAT/MRI of the brain, positive immunological reaction for cysticercosis in cerebral spinal fluid or both. Age ranged from 5 to 61 years old; the mean age of onset was 24.2 +/- 12.2 years. Thirty-six patients had generalized seizures, 13 partial seizures with secondarily generalized seizures, and 1 had complex partial seizures. Twenty-two patients had parenchymal calcifications (inactive form); 21 had parenchymal cysts (active form) and 7 had both. EEG was abnormal in 14 patients (28%): 8 had focal slowing, 3 had focal sharp or spike activity, and 3 had both. The EEG was normal in patients with inactive forms of neurocysticercosis. The EEG was abnormal in 50% of patients with active and mixed forms of neurocystercosis and in 48% of patients with active form only. We conclude that the active forms of neurocysticercosis should be suspected when the EEG is found to be abnormal. In additional, EEG abnormality does not depend on the number of lesions, but rather on location and viability of the cysts, and on host response.

In contmdistinction to the widespread use of imaging ultrasound in exmnining many other l'egions of the body, ultrasonography of the centralnervow; system has been seriously limited because high· frequency ultrasound dues not readily penetrate the bon y covering of this organ system. The difl'iculty in using ultrasound to visualize lm1in and spinal cord structm·es is a paradox in the history of medical ultr:•sonogmphy hecause much of the interest in the early days of this field of diagnostic imaging was in the central nervous system. ~lore than 30 years ago, French et a!. used A-mode s<:anning to localize il subcortical brain tumor in an e:\+ cised postmortem specimen. U! Advances in central nervous system ultrasonography have been made, however, in applic.ltions in which the skull or vertebral bodies have not impeded the pasage of ultrasound waves. There have been three pl'incipal areas of such applkations: postoperative scanning through craniectomy portals, : l .~ imaging through the fontanels of infants,5·6 and intraoperative ultrasonography.Operative use of imaging ultrasound for brain disease was first employed in the 1960s. ' :' "-II However, the A-mode scanning available then presented problems of interpretation which prevented widespread applkation of this dia~nostic tool. ~lore recent adnmces in ultrasound technology, particularly the development of high-resolution real-time B-mode scanners, have eliminated manv of the em~ lier difHculties in operative imaf,ting. This IHL'i re· suited in u renewed trial of ultrasonic scanning in various types of operations on the hrain 1 :2 -:H and spinal cord. ~. 2l iAs part of a pro~ra m to assess the utility of op· erative ultrasonography in a number of surgical dis· ciplines. we employed ultrasound imaging during brain and spinal cord surgery. \Ve have reviewed our experience of spedfic applications in terms of the impact of ultrasonography on management during opemtion. From this analysis we have de· termined the situations in which ultrasonograph~· during neurosurgery can be most helpful. This analvsis has enabled us to establish criteria for the most productive use of ultrasound during brain and spinal cord surgery and is the basis of this report. METHODSOperative ultrasonography during neurosurgical procedures was performed with real-time B-mode instruments employing mechanically driven sectorscanning transducers. High Stoy. Philips, and Dia-155

Introduction: Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young adults. The clinical outcome may also be difficult to predict. We aim to identify the factors predictive of favorable and unfavorable clinical outcomes for youthful patients with severe TBI who have the option of surgical craniotomy or surgical craniectomy.Methods: A retrospective review at a single Level II trauma center was conducted, identifying patients aged 18 to 30 years with isolated severe TBI with a mass-occupying lesion requiring emergent (< 6 hours from time of arrival) surgical decompression. Glasgow Coma Scale (GCS) score on arrival, type of surgery performed, mechanism of injury, length of hospital stay, Glasgow Outcome Score (GOS), mortality, and radiographic findings were recorded. A favorable outcome was a GOS of four or five at 30 days post operation, while an unfavorable outcome was GOS of 1 to 3.Results: Fifty patients were included in the final analysis. Closed head injuries (skull and dura intact), effacement of basal cisterns, disproportional midline shift (MLS), and GCS 3-5 on arrival all correlated with statistically significant higher rate of mortality and poor 30-day functional outcome. All mortalities (6/50 patients) were positive for each of these findings.Conclusions: Closed head injuries, the presenting GCS 3-5, the presence of MLS disproportional to the space occupying lesion (SOL), and effacement of basal cisterns on the initial computed tomography of the head all correlated with unfavorable 30-day outcome. Future prospective studies investigating a larger cohort may provide further insight into patients suffering from severe TBI.

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