Sonographic Monitoring of Midline Shift in Space-Occupying Stroke

Gerriets, Tibo; Stolz, Erwin; König, S.; Babacan, Sait Seymen; Fiss, Ingo; Jauß, M.; Kaps, Manfred

doi:10.1161/01.str.32.2.442

Cited by 119 publications

(87 citation statements)

References 65 publications

(62 reference statements)

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“…1 This spaceoccupying effect causes displacement of midline structures and can lead to cerebral herniation and death. 3,4 Mechanical compression of adjacent brain structures further reduces local cerebral blood flow and thus can cause additional ischemic damage. 4 In the present study we evaluated a noninvasive morphometric technique that allows quantification of the spaceoccupying effect of brain edema in a rat stroke model, using T2-weighted MRI.…”

mentioning

confidence: 99%

Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance Imaging

Gerriets

Stolz

Walberer

et al. 2004

Stroke

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182

160

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Background and Purpose-Brain edema is a life-threatening consequence of stroke and leads to an extension of the affected tissue. The space-occupying effect due to brain edema can be quantified in rat stroke models with the use of MRI. The present study was performed to test 2 hypotheses: (1) Can quantification of the space-occupying effect due to brain edema serve as a noninvasive measure for brain water content? (2) Does morphometric assessment of brain swelling allow determination of true infarct size on MRI after correction for the space-occupying effect of edema? Methods-Thirty rats were subjected to permanent suture middle cerebral artery occlusion. MRI was performed after 6 or 24 hours, and hemispheric swelling was assessed morphometrically. Interobserver and intraobserver agreements were determined for MRI measurements. In study I, the space-occupying effect due to brain edema was correlated with the absolute brain water content by the wet/dry method. In study II, lesion volumes corrected and uncorrected for edema were calculated on MRI and on TTC staining and compared. Results-Interobserver and intraobserver agreements for MRI measurements were excellent (rՆ0.97). Brain water content and hemispheric swelling correlated well after 6 and 24 hours (rՆ0.95). Corrected lesion volumes correlated with rϭ0.78 between TTC staining and MRI. Without edema correction, lesion volumes were overestimated by 20.3% after 6 hours and by 29.6% after 24 hours of ischemia. Conclusions-Morphometric assessment of hemispheric swelling on MRI can determine the increase in absolute brain water content noninvasively and can also provide ischemic lesion volumes corrected for brain edema.

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mentioning

confidence: 99%

Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance Imaging

Gerriets

Stolz

Walberer

et al. 2004

Stroke

Self Cite

182

160

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“…Furthermore, monitoring MLS via TCCD safely predicts early mortality and prognosis of conservative clinical treatment of hemispheric ischemic stroke [18] . Unlike ischemic stroke, intracranial hemorrhage MLS is caused by both the volume of hematoma and the formation of edema, which can make outcomes difficult to predict [20] . Patients with FHF who develop brain swelling and IH can benefit from this method, although it has not yet been described in the literature.…”

Section: Transcranial Color-coded Duplex Ultrasonographymentioning

confidence: 99%

Multimodal brain monitoring in fulminant hepatic failure

Paschoal¹,

Nogueira²,

Ronconi³

et al. 2016

WJH

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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. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

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“…Gerriets et al demonstrated that TCCS monitoring of midline shift is a useful tool in management of critically ill patients who cannot undergo repeated CT scans. (Gerriets et al, 2001) It must be pointed out that there are no exact radiologic indicative criteria for performing the DC.…”

Section: Indicationsmentioning

confidence: 99%

“…That means that patients with the MCA or MCA and Internal Carotid Artery (ICA) occlusion where early recanalisation has not been carried out and the brain ischemia in the region of the whole territory of the middle cerebral artery developed are potentially threatened by malignant edema. Patients with midline shift more than 4 mm according to transcranial color-coded sonography at 24 hours from stroke onset reached poor outcome (Gerriets et al, 2001). There is no evidence that patients with the dominance of infarction have a poorer favourable outcome than patients with 78 nondominance supratentorial infarction.…”

Section: Outcomementioning

confidence: 99%