Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression

Bor-Seng-Shu, Edson; Hirsch, Roberto; Teixeira, Manoel Jacobsen; Andrade, Almir Ferreira de; Marino, Raul

doi:10.3171/jns.2006.104.1.93

Cited by 95 publications

(60 citation statements)

References 59 publications

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“…All cases revealed positive culture results (Klebisiella pneumoniae-1, Acinetobacter baumanii-3, Proteus mirabilis-1). CSF cell count never went over 500 cells/mm 3 . Infection contributed neither to patient clinical worsening nor death (p>00.5).…”

Section: Resultsmentioning

confidence: 99%

“…Pathophysiology of this condition remains poorly understood, and, as a consequence, results of its treatment are disappointing. Although it has been demonstrated that decompressive craniectomy may improve cerebral hemodynamics in patients presenting intracranial hypertension associated with severe brain swelling 3 , its clinical efficacy regarding outcome has not been established so far and complications have been related to this method 4 . Furthermore, clear-cut indications for performing such a procedure have not yet been delineated.…”

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confidence: 99%

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Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Andrade

Paiva

Amorim

et al. 2011

Arq. Neuro-Psiquiatr.

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Background: Ventricular drainage has played an important role in the management of traumatic brain-injured patients. The aim of the present study was describe outcomes in a series of 57 patients with diffuse brain swelling underwent to intracranial pressure (ICP) monitoring. Method: Fifty-eight patients with diffuse posttraumatic brain swelling, were evaluated prospectively. The Glasgow Coma Scale (GCS) scores of patients varied from 4 to 12. Patients groups divided according to GCS and age. Patient neurological assessment was classified as favorable, unfavorable, and death. Results: Mechanisms of injury were vehicle accidents in 72.4% and falls in 15.6%. 54% of patients had GCS scores between 6 and 8. There were no statistical differences, regarding outcome, between groups separated by age. In the adults group (n=47), 44.7% evolved favorably. Conclusion: Our results indicate a poor prognosis in patients with brain swelling. We believe that continuous ventricular CSF drainage with ICP monitoring is a simple method as an adjunct in the management of these patients. Key words: decompressive craniectomy, intracranial pressure monitoring, head injury, brain swelling.Drenagem contínua de líquido cefalorraquidiano com monitoração intermitente de pressão intracraniana em pacientes com tumefação cerebral difusa pós-traumática RESUMO Introdução: Monitoração da pressão intracraniana (PIC) tem desempenhado um papel importante nos pacientes com lesão cerebral difusa traumática. O objetivo do presente estudo foi descrever os resultados de uma série de 57 pacientes com tumefação cerebral difusa submetidos à monitoração da PIC. Método: Cinquenta e oito pacientes com lesão axonal difusa foram avaliados prospectivamente. Na Escala de Coma de Glasgow (GCS) os escores variaram de 4 a 12. Os grupos de pacientes, foram divididos de acordo com a GCS e a idade. Avaliação neurológica tardia foi classificada como favorável, desfavorável, e da morte. Resultados: Mecanismos de lesão predominantes foram os acidentes de veículos em 72,4% e quedas em 15,6%; 54% dos pacientes tiveram escores GCS entre 6 e 8. Não houve diferença estatística entre os grupos separados por idade. No grupo de adultos (n=47), 44,7% evoluíram favoravelmente. Conclusão: As lesões difusas tipo III apresentam resultados funcionais desfavoráveis. Acreditamos que a monitoração intermitente de PIC com drenagem de líquido cefalorraquidiano seja um método simples e aplicável no apoio ao tratamento destes pacientes Palavras-chave: traumatismo craniocerebral, líquido cefalorraquidiano, lesão axonal.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Andrade

Paiva

Amorim

et al. 2011

Arq. Neuro-Psiquiatr.

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“…Thus, the PI values are indicative of post-traumatic cerebral blood flow and cerebral ischaemia, as well as ICP and CPP. The PI is dimensionless, unitless and independent of angle of insonation (3,30). It is postulated that PI can be used for noninvasive estimation of ICP in patients with TBI, but it must be known that PI depends on several factors such as arterial pressure pulsatility, heart rate, cerebral perfusion pressure, arterial carbon dioxide concentration, cerebral resistance and compliance of the big vessels (7,12,30).…”

Section: Gura M Et Al: Correlation Of Pulsatility Index With Intracrmentioning

confidence: 99%

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Güra¹,

Elmacı²,

Sarı³

et al. 2010

Turkish Neurosurgery

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AIm:In traumatic brain injury (TBI) patients, it is desired to monitor the intracranial pressure (ICP) to assess the cerebral haemodynamics and guide the therapy. The study was designed to see if the pulsatility index (PI) measured by transcranial Doppler ultrasonography (TCD) predicts information about ICP values. mAterIAl and methOds:In 52 TBI patients with Glasgow Coma Scale (GCS) score < 9, invasive intracranial monitoring and TCD ultrasonography for PI were performed through five days. ICP, cerebral perfusion pressure (CPP), PI values were recorded and calculated. The correlation and regression analysis between ICP, PI and CPP were investigated in the whole group and in patients with a Glasgow Outcome Score (GOS) of 3-5. results:The decline in ICP and PI values was significant through five days. The correlation between ICP and PI was strongly significant (p < 0.0001) on days 1, 3 and 5. In patients with a GOS of 3-5, correlation of ICP and PI was also observed. The only significant correlation observed between CPP and PI was on day 5. COnClusIOn:The strong correlation observed between ICP and PI through the management period of TBI patients can lead us to use TCD ultrasonography-derived PI as a guide if invasive monitoring is not available. BulGulAr: ICP ve PI değerlerindeki 5 gün boyunca olan azalma anlamlıdır. ICP ve PI arasındaki korelasyon 1, 3 ve 5. günlerde kuvvetli bir şekilde anlamlı bulunmuştur (p < 0,0001). Glasgow Outcome Skoru (GOS) 3-5 olan hastalarda da ICP ve PI değerlendirilmiştir. CPP ve PI arasındaki tek önemli korelasyon 5. günde tespit edilmiştir. sOnuÇ: ICP ve PI arasında bulunan güçlü korelasyon, tedavinin yönetilmesi için invaziv monitörizasyon yapmanın mümkün olmadığı hastalarda PI değerlerinin kullanılmasına yönlendirebilir.

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“…These ion transporters and exchangers include Na-K-Cl cotransporter-1, which plays an important role in cell swelling/brain edema. The activation of Na-K-Cl cotransporter-1 is important in astrocyte swelling by ammonia where this activation is mediated by Na-K-Cl cotransporter-1 as well as its oxidation/nitration and phosphorylation 28 . Alterations in blood-brain barrier permeability, if present, appear to play a more secondary and/or facilitating role as opposed to being the central determinant of brain water accumulation in FHF 29 .…”

Section: Role Of the Blood-brain Barriermentioning

confidence: 99%

Cerebral hemodynamic and metabolic changes in fulminant hepatic failure

Paschoal

Nogueira

Oliveira

et al. 2017

Arq. Neuro-Psiquiatr.

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Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. This is an uncommon, but not rare, condition with approximately 2,000 cases annually in the United States and a mortality rate ranging from 50% to 90%, despite intensive care therapy 1,2 . Cerebral edema leading to intracranial hypertension complicates approximately 50% to 80% of patients with severe FHF (grade III or IV coma), in whom it is the leading cause of death 2,3,4 . Brain edema in FHF patients is a relatively recent concept. In a 1944 report of 125 autopsies of military patients who had died from a condition he called fatal hepatitis (previously referred to as idiopathic acute yellow atrophy of the liver), Lucké 5 noted little alteration in the brain except for edema, but did not describe cerebral herniation. The first reports of brain edema and cerebral herniation as complications of FHF only emerged in the 1980s 6,7 . It is also noteworthy that brain edema and intracranial hypertension are not recognized common features of chronic liver failure, despite some case reports and small series 8,9 . The recent recognition of brain edema in FHF patients could be due to the advances in FHF patient care. Previously, FHF patients were dying from early hepatocellular insufficiency complications, mainly hemorrhage or sepsis ABSTRACTIntracranial hypertension and brain swelling are a major cause of morbidity and mortality of patients suffering from fulminant hepatic failure (FHF). The pathogenesis of these complications has been investigated in man, in experimental models and in isolated cell systems. Currently, the mechanism underlying cerebral edema and intracranial hypertension in the presence of FHF is multi-factorial in etiology and only partially understood. The aim of this paper is to review the pathophysiology of cerebral hemodynamic and metabolism changes in FHF in order to improve understanding of intracranial dynamics complication in FHF.Keywords: hepatic insufficiency; intracranial hypertension; brain edema. RESUMOO edema cerebral e a hipertensão intracraniana (HIC) são as principais causas de morbidade e mortalidade de pacientes com insuficiência hepática fulminante (IHF). A patogênese dessas complicações tem sido investigada no homem, em modelos experimentais e em sistemas celulares isolados. Atualmente, o mecanismo subjacente ao edema cerebral e HIC na presença de IHF é multifatorial em etiologia e pouco compreendido na literatura. O objetivo deste trabalho é revisar a fisiopatologia das alterações hemodinâmicas e metabólicas cerebrais na IHF, visando melhorar a compreensão da complicação da hemodinâmica encefálica na IHF.Palavras-chave: insuficiência hepatica; hipertenção intracraniana; edema encefálico.

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Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression

Cited by 95 publications

References 59 publications

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Cerebral hemodynamic and metabolic changes in fulminant hepatic failure

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