Changes of cerebral perfusion after osmotherapy in acute cerebral edema assessed with perfusion weighted MRI

Stoll, M.; Hagen, Thomas; Bartylla, K.; Weber, Max; Jost, V.; Treib, J.

doi:10.1080/01616412.1998.11740551

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…Allocation concealment was adequately described for all but one study (Molyneux 2014), which we judged at unclear risk of bias (2 and 3). We judged Peltola 2007 at unclear risk of allocation bias due to changes in the protocol that occurred during the study, a change from two dexamethasone to one placebo to one dexamethasone to one placebo, as reported by a meta-analysis of individual patient data testing dexamethasone compared to placebo for bacterial meningitis (van de Beek 2010). …”

Section: Resultsmentioning

confidence: 99%

“…The small numbers seen overall in the studies in children were not sufficient to fully exclude the impact of dexamethasone, particularly on neurological disabilities and deafness in children, as this has been shown to be effective elsewhere (van de Beek 2010). …”

Section: Discussionmentioning

confidence: 99%

“…Analysis was mainly weighted on Ajdukiewicz 2011 and Peltola 2007, two large studies that were both well conducted, but limited in their population demographics and follow-up data. Data from Peltola 2007 have been subject to systematic reviews investigating the effect of dexamethasone, and some methodological concerns were raised regarding the randomisation schedule (van de Beek 2010). As a result we have assigned this study an unclear risk of allocation bias.…”

Section: Discussionmentioning

confidence: 99%

“…A Cochrane Review shows a mortality benefit in adults in Europe with meningitis due to S pneumoniae and an overall reduction in deafness in adults and children (Brouwer 2015). Another systematic review of individual patient data from five randomised studies suggests that the effect of dexamethasone on outcomes for bacterial meningitis in these countries is limited to reducing the incidence of hearing loss in survivors (van de Beek 2010). A long-held concern exists over excessive fluids contributing to brain oedema; a further Cochrane Review suggests that judicious fluid resuscitation guided by the clinical condition is appropriate to maximise brain perfusion without contributing to brain oedema (Maconochie 2016).…”

Section: Introductionmentioning

confidence: 99%

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Osmotic therapies added to antibiotics for acute bacterial meningitis

Wall

Ajdukiewicz

Heyderman

et al. 2018

Cochrane Database of Systematic Reviews

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Background Every day children and adults die from acute community‐acquired bacterial meningitis, particularly in low‐income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra‐vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes. This is an update of a Cochrane Review first published in 2013. Objectives To evaluate the effects of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults on mortality, deafness and neurological disability. Search methods We searched CENTRAL (2017, Issue 1), MEDLINE (1950 to 17 February 2017), Embase (1974 to 17 February 2017), CINAHL (1981 to 17 February 2017), LILACS (1982 to 17 February 2017) and registers of ongoing clinical trials (ClinicalTrials.com, WHO ICTRP) (21 February 2017). We also searched conference abstracts and contacted researchers in the field (up to 12 December 2015). Selection criteria Randomised controlled trials testing any osmotic therapy in adults or children with acute bacterial meningitis. Data collection and analysis Two review authors independently screened the search results and selected trials for inclusion. Results are presented using risk ratios (RR) and 95% confidence intervals (CI) and grouped according to whether the participants received steroids or not. We used the GRADE approach to assess the certainty of the evidence. Main results We included five trials with 1451 participants. Four trials evaluated glycerol against placebo, and one evaluated glycerol against 50% dextrose; in addition three trials evaluated dexamethasone and one trial evaluated acetaminophen (paracetamol) in a factorial design. Stratified analysis shows no effect modification with steroids; we present aggregate effect estimates. Compared to placebo, glycerol probably has little or no effect on death in people with bacterial meningitis (RR 1.08, 95% CI 0.90 to 1.30; 5 studies, 1272 participants; moderate‐certainty evidence ), but may reduce neurological disability (RR 0.73, 95% CI 0.53 to 1.00; 5 studies, 1270 participants; low‐certainty evidence ). Glycerol may have little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30; 4 studies, 1090 participants; low‐certainty evidence ). Glycerol may reduce the risk of subsequent deafness (RR 0.64, 95% CI 0.44 to 0.93; 5 studies, 922 participants; low to moderate‐certainty evidence ). Glycerol probably has little or no effect on gastrointestinal bleeding (RR 0.93, 95% CI 0.39 to 2.19; 3 studies, 607 participants; moderate‐certainty evidence ). The evidence on nausea, vomiting and diar...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Osmotic therapies added to antibiotics for acute bacterial meningitis

Wall

Ajdukiewicz

Heyderman

et al. 2018

Cochrane Database of Systematic Reviews

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“…Despite the methodological problems discussed, DSC MRI is currently regarded as an approximative method for the non-invasive quantification of rCBF and rCBV [2,3,10,11,31,32,[36][37][38] that allows a quantitative comparison between patients and volunteers when standardized measurement and analysis techniques are applied.…”

Section: Discussionmentioning

confidence: 99%

Regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE)

et al. 2007

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The aim of the present study was a detailed analysis of the regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE) by means of functional magnetic resonance imaging (MRI). A group of 26 patients with SAE and a group of 16 age-matched healthy volunteers were examined. Using a well-established dynamic susceptibility contrast-enhanced MRI method, the regional cerebral blood flow (rCBF) and blood volume (rCBV) were quantified for each subject in 12 different regions in the brain parenchyma. As compared to healthy volunteers, patients with SAE showed significantly reduced rCBF and rCBV values in white matter regions and in the occipital cortex. Regions containing predominantly grey matter show almost normal rCBF and rCBV values. In conclusion, quantitative analysis of rCBF and rCBV values demonstrates clearly that SAE is a disease that is associated with a reduced microcirculation predominantly in white matter.

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