Basic concepts about brain pathophysiology and intracranial pressure monitoring

Rodríguez-Boto, G.; Rivero-Garvía, Mónica; Gutiérrez-González, Raquel; Márquez-Rivas, Javier

doi:10.1016/j.nrleng.2012.09.002

Cited by 26 publications

(20 citation statements)

References 19 publications

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“…Para frenar este proceso, entra en acción un mecanismo compensatorio que consiste en una vasoconstricción autorreguladora que termina generando edema por hipoxia e isquemia cerebral, con una mayor lesión del tejido cerebral, lo cual se explica por la presencia de enfermedad vascular periférica y un aumento en la producción del factor de crecimiento endotelial vascular como reacción a la hipoxia (6 a 24 horas), que genera la formación de vasos sanguíneos e incremento de la permeabilidad endotelial (9).…”

Section: Discussionunclassified

Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictors of bad prognosis

Torres¹,

Delgado²,

Giraldo³

et al. 2016

biomedica

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El síndrome de encefalopatía posterior reversible es una condición que responde a múltiples causas y presenta características clínicas o radiológicas distintivas; los intensivistas y los médicos de urgencias deben conocerlo con el fin de hacer el diagnóstico y ordenar el tratamiento oportuno. Se presenta un caso fatal de síndrome de encefalopatía posterior reversible, en el cual se determinaron los factores de riesgo relacionados con el resultado final. Un hombre de 60 años sin antecedentes médicos ingresó por urgencias con depresión de la conciencia, convulsiones y tensión arterial elevada. Las imágenes de la tomografía revelaron un hematoma cerebeloso posterior, y las de resonancia magnética mostraron zonas isquémicas, edema vasogénico que se extendía desde los tálamos hacia el tallo cerebral, los pedúnculos cerebelosos medios y la sustancia blanca profunda de los hemisferios cerebelosos, así como zonas de transformación hemorrágica. A pesar del tratamiento médico y quirúrgico recibido, el paciente falleció. Se determinaron los factores de riesgo que se han descrito como causa de muerte en este síndrome. Este caso demuestra que dicho síndrome puede ocurrir sin que se hayan detectado factores de riesgo desencadenantes y pone en evidencia la necesidad de su reconocimiento temprano para establecer una intervención adecuada y evitar daños o un desenlace fatal. Además, abre el camino a nuevos estudios sobre la propensión a desarrollarlo y las medidas preventivas que pueden adoptarse.Palabras clave: edema encefálico; sustancia blanca; síndrome de leucoencefalopatía posterior; síndromes de neurotoxicidad; hemorragia cerebral; imagen por resonancia magnética. doi: http://dx.doi.org/10.7705/biomedica.v37i2.3299 Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosisPosterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified. A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible enceph...

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Section: Discussionunclassified

Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictors of bad prognosis

Torres¹,

Delgado²,

Giraldo³

et al. 2016

biomedica

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“…Hydrodynamically, the intracranial system of a healthy individual can be simplified into three components, i.e. brain, CSF and blood 21 . In a pneumocephalus patient, a fourth component, the ICA, is present.…”

Section: Hydrodynamics Of Intracranial Pressurementioning

confidence: 99%

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Lim

Lan

Ooi

et al. 2020

Sci Rep

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This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly. Craniotomy refers to the surgical removal of a portion of the skull to gain access to the contents of the intracranial cavity. The procedure usually involves exposing the brain after opening its membranous coverings 1 , which inevitably expose the human brain to surrounding air. Varying amounts of air within the intracranial cavity (ICA) (known as pneumocephalus) remain after craniotomy 2. In most cases, pneumocephalus is not life-threatening as the ICA is normally absorbed into the systemic circulation over a period of several weeks 3-5. Safety concerns arise when patients with pneumocephalus engage in air travel before the ICA is fully absorbed. Air safety regulations require cabins of commercial aircraft to be pressurized to a standardized minimum of 75 kPa, which is approximately 75% that of atmospheric pressure at sea level (101.3 kPa), at cruising altitude 6,7. Consequently, during air travel, the ambient pressure may be as much as 25 kPa lower than the initial pressure of the ICA, which is at 101.3 kPa. According to Boyle's law, the difference in pressure between the aircraft cabin and the ICA would result in an increase in the ICA volume, as the ICA expands to equilibrate with the cabin pressure. The expansion, which takes place inside the rigid cranium, may cause cerebral compression that can lead to elevations in the intracranial pressure (ICP). A mild increase in ICP is tolerable. However, if the increase in ICP is too large, cerebral herniation may occur, which severely endangers the life of the pneumocephalus patient. In spite of the potential life-threatening event, pneumocephalus and air travel safety remains a controversial topic 8...

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“…Así también, la presencia de comorbilidades en este grupo de estudio no demostró significancia estadística (p 0,5). (12,19,(21)(22)(23)(24) Los hallazgos microbiológicos de este estudio coinciden con el de la literatura . Se encontró un porcentaje similar entre cocos Gram positivos y bacilos Gram negativos, siendo S. aureus, S. epidermidis, A. baumanii, y K. pneumoniae los gérmenes más frecuentemente aislados.…”

Section: %unclassified

External ventricular drainage-related ventriculitis

Martínez

Aveiro

2017

Rev. virtual Soc. Parag. Med. Int

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External ventricular drainage-related ventriculitis ARTÍCULO ORIGINAL ARTÍCULO ORIGINALRev. virtual Soc. Parag. Med. Int. marzo 2017; 4 (1):46-56 RESUMENIntroducción: el drenaje ventricular externo es una herramienta útil en el manejo de muchos pacientes neurocríticos. Sin embargo este dispositivo no está exento de complicaciones. La ventriculitis es la más importante complicación infecciosa asociada.Objetivos: determinar la prevalencia de ventriculitis en pacientes adultos con drenaje ventricular externo del Hospital Nacional, describir los factores de riesgo asociados e identificar gérmenes más frecuentemente aislados.Resultados: se incluyeron 92 pacientes con drenaje ventricular externo de los cuales el 20% desarrolló ventriculitis. La totalidad de los pacientes con ventriculitis presentaron síntomas de infección luego de 7 días de instalación del drenaje, además la mitad de los mismos requirieron recambio del catéter lo cual constituyó factor de riesgo. Los gérmenes aislados más frecuentes fueron Staphylococcus epidermidis y Acinetobacter baumanii.Conclusiones: la ventriculitis asociada a catéter de drenaje ventricular externo fue 20%. El factor de riesgo estadísticamente asociado fue el recambio del catéter. Los gérmenes aislados más frecuentes fueron Staphylococcus epidermidis y Acinetobacter baumanii. Palabras claves: ventriculitis, ventriculostomía, infección ABSTRACTIntroduction: External ventricular drainage is a useful tool in the handling of neurocritical patients. However, this device is not free from complications. Ventriculitis is the most important related complication. Objectives:To determine the prevalence of ventriculitis in adult patients with external ventricular drainage of the National Hospital, to describe the associated risk factors and to identify the most frequently isolated microorganisms. Doi:10.18004/rvspmi/ 2017.04(01) Ventriculitis asociada a drenaje ventricular externoResults: Ninety two patients with external ventricular drainage were included and 20% developed ventriculitis. All patients with ventriculitis presented symptoms of infection seven days after drainage installation and half of them required a change of the catheter which was a risk factor. The most frequent isolated microorganisms were Staphylococcus epidermidis and Acinetobacter baumanii. Conclusions:The prevalence of ventriculitis related to the external ventricular drainage catheter was 20%. The statistically associated risk factor was the change of catheter. The most frequent isolated microorganisms were Staphylococcus epidermidis and Acinetobacter baumanii. Keywords: ventriculitis, ventriculostomy, infection INTRODUCCIÓNLa infección relacionada al drenaje ventricular externo es una complicación que puede presentarse en los pacientes sometidos a ventriculostomía hasta en un 39% según algunas (1)(2)(3)(4) publicaciones . Ésta presenta una tasa de mortalidad y morbilidad variable, que complica la evolución de los pacientes con patologías neuroquirúrgicas, prolonga la estancia hospitalaria y los costes asiste...

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Basic concepts about brain pathophysiology and intracranial pressure monitoring

Cited by 26 publications

References 19 publications

Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictors of bad prognosis

Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictors of bad prognosis

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

External ventricular drainage-related ventriculitis

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