WorldWideScience

Sample records for intracranial pressure reverses

  1. Intracranial Pressure

    DEFF Research Database (Denmark)

    Hvedstrup, Jeppe; Radojicic, Aleksandra; Moudrous, Walid

    2018-01-01

    OBJECTIVE: To compare a new method of noninvasive intracranial pressure (nICP) measurement with conventional lumbar puncture (LP) opening pressure. METHODS: In a prospective multicenter study, patients undergoing LP for diagnostic purposes underwent intracranial pressure measurements with HeadSen...

  2. Increased intracranial pressure

    Science.gov (United States)

    ... the membranes covering the brain and spinal cord) Subdural hematoma (bleeding between the covering of the brain and ... intracranial pressure Patient Instructions Ventriculoperitoneal shunt - discharge Images Subdural hematoma Central nervous system and peripheral nervous system References ...

  3. Elevated intracranial pressure and reversible eye-tracking changes detected while viewing a film clip.

    Science.gov (United States)

    Kolecki, Radek; Dammavalam, Vikalpa; Bin Zahid, Abdullah; Hubbard, Molly; Choudhry, Osamah; Reyes, Marleen; Han, ByoungJun; Wang, Tom; Papas, Paraskevi Vivian; Adem, Aylin; North, Emily; Gilbertson, David T; Kondziolka, Douglas; Huang, Jason H; Huang, Paul P; Samadani, Uzma

    2018-03-01

    OBJECTIVE The precise threshold differentiating normal and elevated intracranial pressure (ICP) is variable among individuals. In the context of several pathophysiological conditions, elevated ICP leads to abnormalities in global cerebral functioning and impacts the function of cranial nerves (CNs), either or both of which may contribute to ocular dysmotility. The purpose of this study was to assess the impact of elevated ICP on eye-tracking performed while patients were watching a short film clip. METHODS Awake patients requiring placement of an ICP monitor for clinical purposes underwent eye tracking while watching a 220-second continuously playing video moving around the perimeter of a viewing monitor. Pupil position was recorded at 500 Hz and metrics associated with each eye individually and both eyes together were calculated. Linear regression with generalized estimating equations was performed to test the association of eye-tracking metrics with changes in ICP. RESULTS Eye tracking was performed at ICP levels ranging from -3 to 30 mm Hg in 23 patients (12 women, 11 men, mean age 46.8 years) on 55 separate occasions. Eye-tracking measures correlating with CN function linearly decreased with increasing ICP (p short film clip. These results suggest that eye tracking may be used as a noninvasive, automatable means to quantitate the physiological impact of elevated ICP, which has clinical application for assessment of shunt malfunction, pseudotumor cerebri, concussion, and prevention of second-impact syndrome.

  4. Raised intracranial pressure

    African Journals Online (AJOL)

    is article presents an approach to raised intracranial pressure (ICP) constructed in a question-answer fashion. ..... Given that raised ICP is a serious and potentially life-threatening emergency, fast and reliable referral and transfer mechanisms should be established to ensure patients with this condition are effectively treated.

  5. Intracranial Pressure Monitoring

    DEFF Research Database (Denmark)

    Raboel, P H; Bartek, J; Andresen, M

    2012-01-01

    Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods...

  6. Monitoring of Intracranial Pressure During Intracranial Endoscopy

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-08-01

    Full Text Available Background: Intracranial endoscopy is a minimum invasive procedure, which reduces trauma to the brain, is cost-effective, and carries a shortened hospital stay with an improved postoperative outcome. Objective: To monitor intracranial pressure changes during intracranial endoscopy among children and adults under general anesthesia/sedation, and to compare the intracranial pressure changes between children and adults receiving general anesthesia and among adults receiving general anesthesia and sedation. Methods: The present cross-sectional study was conducted in one of the tertiary care hospitals of Lucknow. This was carried out in the department of neurosurgery from January 2008 to December 2008. Patients who were not fit for general anesthesia received local anesthesia under sedation. Patients participating in the study were divided into three groups. Intracranial pressure was recorded at specific intervals. Parametric data were subjected to statistical analysis using a student\\s t test. Result: A total of 70 patients were undergoing intracranial endoscopy under general anesthesia during the study period. In both groups A and B, intracranial pressure increases the maximum during inflation of the balloon. In group C, all the variations in ICP were found to be statistically significant. In the comparison of intracranial pressure changes between groups A and B, no significant difference was found. All correlations in the comparison of groups B and C were found to be statistically significant (p< 0.001. Conclusion: There is a need for continuous intraoperative monitoring of ICP intracranial endoscopy, because ICP increases in various stages of the procedure, which can be detrimental to the perfusion of the brain. [Arch Clin Exp Surg 2013; 2(4.000: 240-245

  7. Microoptomechanical sensor for intracranial pressure monitoring

    International Nuclear Information System (INIS)

    Andreeva, A V; Luchinin, V V; Lutetskiy, N A; Sergushichev, A N

    2014-01-01

    The main idea of this research is the development of microoptomechanical sensor for intracranial pressure monitoring. Currently, the authors studied the scientific and technical knowledge in this field, as well as develop and test a prototype of microoptomechanical sensor for intracranial pressure (ICP) monitoring

  8. Increased intracranial pressure: evaluation by computerized tomography

    International Nuclear Information System (INIS)

    Lightfoote, W.E.; Pressman, B.D.

    1975-01-01

    Computerized tomography is clearly very useful in the evaluation of patients with increased intracranial pressure and suspected pseudotumor cerebri. It provides an index of ventricular size and configuration and has the capability of demonstrating intracranial lesions. Moreover, this new technique is rapid and non-invasive, and is without attendant risks. Examinations may be performed serially as the clinical process evolves, thereby giving roentgenographic correlation to the clinical features. (U.S.)

  9. Micro packaged MEMS pressure sensor for intracranial pressure measurement

    International Nuclear Information System (INIS)

    Liu Xiong; Yao Yan; Ma Jiahao; Zhang Zhaohua; Zhang Yanhang; Wang Qian; Ren Tianling

    2015-01-01

    This paper presents a micro packaged MEMS pressure sensor for intracranial pressure measurement which belongs to BioMEMS. It can be used in lumbar puncture surgery to measure intracranial pressure. Miniaturization is key for lumbar puncture surgery because the sensor must be small enough to allow it be placed in the reagent chamber of the lumbar puncture needle. The size of the sensor is decided by the size of the sensor chip and package. Our sensor chip is based on silicon piezoresistive effect and the size is 400 × 400 μm 2 . It is much smaller than the reported polymer intracranial pressure sensors such as liquid crystal polymer sensors. In terms of package, the traditional dual in-line package obviously could not match the size need, the minimal size of recently reported MEMS-based intracranial pressure sensors after packaging is 10 × 10 mm 2 . In this work, we are the first to introduce a quad flat no-lead package as the package form of piezoresistive intracranial pressure sensors, the whole size of the sensor is minimized to only 3 × 3 mm 2 . Considering the liquid measurement environment, the sensor is gummed and waterproof performance is tested; the sensitivity of the sensor is 0.9 × 10 −2 mV/kPa. (paper)

  10. Robust Peak Recognition in Intracranial Pressure Signals

    Directory of Open Access Journals (Sweden)

    Bergsneider Marvin

    2010-10-01

    Full Text Available Abstract Background The waveform morphology of intracranial pressure pulses (ICP is an essential indicator for monitoring, and forecasting critical intracranial and cerebrovascular pathophysiological variations. While current ICP pulse analysis frameworks offer satisfying results on most of the pulses, we observed that the performance of several of them deteriorates significantly on abnormal, or simply more challenging pulses. Methods This paper provides two contributions to this problem. First, it introduces MOCAIP++, a generic ICP pulse processing framework that generalizes MOCAIP (Morphological Clustering and Analysis of ICP Pulse. Its strength is to integrate several peak recognition methods to describe ICP morphology, and to exploit different ICP features to improve peak recognition. Second, it investigates the effect of incorporating, automatically identified, challenging pulses into the training set of peak recognition models. Results Experiments on a large dataset of ICP signals, as well as on a representative collection of sampled challenging ICP pulses, demonstrate that both contributions are complementary and significantly improve peak recognition performance in clinical conditions. Conclusion The proposed framework allows to extract more reliable statistics about the ICP waveform morphology on challenging pulses to investigate the predictive power of these pulses on the condition of the patient.

  11. Organic electronics based pressure sensor towards intracranial pressure monitoring

    Science.gov (United States)

    Rai, Pratyush; Varadan, Vijay K.

    2010-04-01

    The intra-cranial space, which houses the brain, contains cerebrospinal fluid (CSF) that acts as a fluid suspension medium for the brain. The CSF is always in circulation, is secreted in the cranium and is drained out through ducts called epidural veins. The venous drainage system has inherent resistance to the flow. Pressure is developed inside the cranium, which is similar to a rigid compartment. Normally a pressure of 5-15 mm Hg, in excess of atmospheric pressure, is observed at different locations inside the cranium. Increase in Intra-Cranial Pressure (ICP) can be caused by change in CSF volume caused by cerebral tumors, meningitis, by edema of a head injury or diseases related to cerebral atrophy. Hence, efficient ways of monitoring ICP need to be developed. A sensor system and monitoring scheme has been discussed here. The system architecture consists of a membrane less piezoelectric pressure sensitive element, organic thin film transistor (OTFT) based signal transduction, and signal telemetry. The components were fabricated on flexible substrate and have been assembled using flip-chip packaging technology. Material science and fabrication processes, subjective to the device performance, have been discussed. Capability of the device in detecting pressure variation, within the ICP pressure range, is investigated and applicability of measurement scheme to medical conditions has been argued for. Also, applications of such a sensor-OTFT assembly for logic sensor switching and patient specific-secure monitoring system have been discussed.

  12. Visual Impairment/Intracranial Pressure Risk Assessment

    Science.gov (United States)

    Fogarty, Jennifer A.; Durham, T.; Otto, C.; Grounds, D.; Davis, J. R.

    2010-01-01

    Since 2006 there have been 6 reported cases of altered visual acuity and intracranial pressure (ICP) in long duration astronauts. In order to document this risk and develop an integrated approach to its mitigation, the NASA Space Life Sciences Directorate (SLSD) and Human Research Program (HRP) have chosen to use the Human System Risk Board (HSRB) and the risk management analysis tool (RMAT). The HSRB is the venue in which the stakeholders and customers discuss and vet the evidence and the RMAT is the tool that facilitates documentation and comparison of the evidence across mission profiles as well as identification of risk factors, and documentation of mitigation strategies. This process allows for information to be brought forward and dispositioned so that it may be properly incorporated into the RMAT and contribute to the design of the research and mitigation plans. The evidence thus far has resulted in the identification of a visual impairment/intracranial pressure (VIIP) project team, updating of both short and long duration medical requirements designed to assess visual acuity, and a research plan to characterize this issue further. In order to understand this issue more completely, a plan to develop an Accelerated Research Collaboration (ARC) has been approved by the HSRB. The ARC is a novel research model pioneered by the Myelin Repair Foundation. It is a patient centered research model that brings together researchers and clinicians, under the guidance of a scientific advisory panel, to collaborate and produce results much quickly than accomplished through traditional research models. The data and evidence from the updated medical requirements and the VIIP ARC will be reviewed at the HSRB on a regular basis. Each review package presented to the HSRB will include an assessment and recommendation with respect to continuation of research, countermeasure development, occupational surveillance modalities, selection criteria, etc. This process will determine the

  13. Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Skau, M; Yri, H; Sander, B

    2013-01-01

    BACKGROUND: Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary...... optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH). METHODS: We conducted a case-control study of 20 newly diagnosed, 21 long-term IIH patients...

  14. Probabilistic Modeling of Intracranial Pressure Effects on Optic Nerve Biomechanics

    Science.gov (United States)

    Ethier, C. R.; Feola, Andrew J.; Raykin, Julia; Myers, Jerry G.; Nelson, Emily S.; Samuels, Brian C.

    2016-01-01

    Altered intracranial pressure (ICP) is involved/implicated in several ocular conditions: papilledema, glaucoma and Visual Impairment and Intracranial Pressure (VIIP) syndrome. The biomechanical effects of altered ICP on optic nerve head (ONH) tissues in these conditions are uncertain but likely important. We have quantified ICP-induced deformations of ONH tissues, using finite element (FE) and probabilistic modeling (Latin Hypercube Simulations (LHS)) to consider a range of tissue properties and relevant pressures.

  15. Monitoring of Intracranial Pressure in Meningitis.

    Science.gov (United States)

    Depreitere, Bart; Bruyninckx, Dominike; Güiza, Fabian

    2016-01-01

    The literature on intracranial pressure (ICP) monitoring in meningitis is limited to case reports and a handful of descriptive series. The aim of this study is to investigate relationships among ICP, cerebral perfusion pressure (CPP), and outcome in meningitis and to identify whether ICP affected clinical decisions. Between 1999 and 2011, a total of 17 patients with meningitis underwent ICP monitoring at the University Hospitals Leuven. Charts were reviewed for clinical history, ICP/CPP data, imaging findings, and Glasgow Outcome Scale score. Univariate correlations were computed for outcome and ICP/CPP variables, computed tomography characteristics, and Corticosteroid Randomization After Significant Head Injury outcome model variables. Treatment decisions were assessed regarding whether or not they were based on ICP. At drain placement, Glasgow Coma Scale scores showed a median of 8 (range 3-12). Six of 17 patients had either one or two nonreactive pupils. Significant correlations with outcome were found for the highest documented ICP value (r = -0.70), the number of episodes when CPP meningitis high ICP and low CPP represent secondary insults. The poor condition of the patients illustrates that the level of suspicion for increased ICP in meningitis may not be high enough.

  16. A whole-body mathematical model for intracranial pressure dynamics.

    Science.gov (United States)

    Lakin, William D; Stevens, Scott A; Tranmer, Bruce I; Penar, Paul L

    2003-04-01

    Most attempts to study intracranial pressure using lumped-parameter models have adopted the classical "Kellie-Monro Doctrine," which considers the intracranial space to be a closed system that is confined within the nearly-rigid skull, conserves mass, and has equal inflow and outflow. The present work revokes this Doctrine and develops a mathematical model for the dynamics of intracranial pressures, volumes, and flows that embeds the intracranial system in extensive whole-body physiology. The new model consistently introduces compartments representing the tissues and vasculature of the extradural portions of the body, including both the thoracic region and the lower extremities. In addition to vascular connections, a spinal-subarachnoid cerebrospinal fluid (CSF) compartment bridges intracranial and extracranial physiology allowing explict buffering of intracranial pressure fluctuations by the spinal theca. The model contains cerebrovascular autoregulation, regulation of systemic vascular pressures by the sympathetic nervous system, regulation of CSF production in the choroid plexus, a lymphatic system, colloid osmotic pressure effects, and realistic descriptions of cardiac output. To validate the model in situations involving normal physiology, the model's response to a realistic pulsatile cardiac output is examined. A well-known experimentally-derived intracranial pressure-volume relationship is recovered by using the model to simulate CSF infusion tests, and the effect on cerebral blood flow of a change in body position is also examined. Cardiac arrest and hemorrhagic shock are simulated to demonstrate the predictive capabilities of the model in pathological conditions.

  17. Reversible Holmes' tremor due to spontaneous intracranial hypotension.

    Science.gov (United States)

    Iyer, Rajesh Shankar; Wattamwar, Pandurang; Thomas, Bejoy

    2017-07-27

    Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Routine intracranial pressure monitoring in acute coma.

    Science.gov (United States)

    Forsyth, Rob J; Raper, Joseph; Todhunter, Emma

    2015-11-02

    We know that the brain damage resulting from traumatic and other insults is not due solely to the direct consequences of the primary injury. A significant and potentially preventable contribution to the overall morbidity arises from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) prevents adequate cerebral perfusion with well-oxygenated blood.Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury. To determine whether routine ICP monitoring in severe coma of any cause reduces the risk of all-cause mortality or severe disability at final follow-up. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL Plus, ISI Web of Science (SCI-EXPANDED & CPCI-S), clinical trials registries and reference lists. We ran the most recent search on 22 May 2015. All randomised controlled studies of real-time ICP monitoring by invasive or semi-invasive means in acute coma (traumatic or non-traumatic aetiology) versus clinical care without ICP monitoring (that is, guided only by clinical or radiological inference of the presence of raised ICP). Two authors (ET and RF) worked independently to identify the one study that met inclusion criteria. JR and RF independently extracted data and assessed risk of bias. We contacted study authors for additional information, including details of methods and outcome data. One randomized controlled trial (RCT) meeting the selection criteria has been identified to date.The included study had 324 participants. We judged risk of bias to be low for all categories except blinding of participants and personnel, which is not feasible for this intervention. There were few missing data, and we analysed all on an intention-to-treat basis.Participants could be 13 years of age or older (mean age of sample 29

  19. Intracranial Pressure Is a Determinant of Sympathetic Activity

    Directory of Open Access Journals (Sweden)

    Eric A. Schmidt

    2018-02-01

    Full Text Available Intracranial pressure (ICP is the pressure within the cranium. ICP rise compresses brain vessels and reduces cerebral blood delivery. Massive ICP rise leads to cerebral ischemia, but it is also known to produce hypertension, bradycardia and respiratory irregularities due to a sympatho-adrenal mechanism termed Cushing response. One still unresolved question is whether the Cushing response is a non-synaptic acute brainstem ischemic mechanism or part of a larger physiological reflex for arterial blood pressure control and homeostasis regulation. We hypothesize that changes in ICP modulates sympathetic activity. Thus, modest ICP increase and decrease were achieved in mice and patients with respectively intra-ventricular and lumbar fluid infusion. Sympathetic activity was gauged directly by microneurography, recording renal sympathetic nerve activity in mice and muscle sympathetic nerve activity in patients, and gauged indirectly in both species by heart-rate variability analysis. In mice (n = 15, renal sympathetic activity increased from 29.9 ± 4.0 bursts.s−1 (baseline ICP 6.6 ± 0.7 mmHg to 45.7 ± 6.4 bursts.s−1 (plateau ICP 38.6 ± 1.0 mmHg and decreased to 34.8 ± 5.6 bursts.s−1 (post-infusion ICP 9.1 ± 0.8 mmHg. In patients (n = 10, muscle sympathetic activity increased from 51.2 ± 2.5 bursts.min−1 (baseline ICP 8.3 ± 1.0 mmHg to 66.7 ± 2.9 bursts.min−1 (plateau ICP 25 ± 0.3 mmHg and decreased to 58.8 ± 2.6 bursts.min−1 (post-infusion ICP 14.8 ± 0.9 mmHg. In patients 7 mmHg ICP rise significantly increases sympathetic activity by 17%. Heart-rate variability analysis demonstrated a significant vagal withdrawal during the ICP rise, in accordance with the microneurography findings. Mice and human results are alike. We demonstrate in animal and human that ICP is a reversible determinant of efferent sympathetic outflow, even at relatively low ICP levels. ICP is a biophysical stress related to the forces within the brain. But ICP

  20. Disappearance of Intracranial Extradural Hematomas: Role of Diastatic Cranial Fracture and Intracranial Pressure - An Institutional Experience

    Science.gov (United States)

    Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Mohammed Afzal

    2018-01-01

    Context: The intracranial extradural hematoma (EDH) occupies space and creates a mass effect on the brain but the tenacious-adhesions of dura to the inner table of skull counters this effect. The intracranial pressure also pushes the hematoma back while it is held by dural tensile-force. Aims: The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures to decompress a hematoma out of extradural space into subgaleal/subperiosteal space without surgical intervention. Settings and Design: In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively. Materials and Methods: The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery from January 2000 to December 2014 in 15 years. Statistical Analysis Used: The statistical law of variance was used as applicable. Results: Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were children and the youngest being 9 months old. All the patients had a diastatic fracture overlying-EDH and were fully conscious. The cause of head injury in most was the fall from height. The hospital stay ranged from 2 to 4 days. All the patients had a good recovery at the time of discharging. Conclusion: The trial of the conservative or spontaneous disappearance of an EDH through a diastatic fracture into the subgaleal space is similar to burr-hole drainage without surgical intervention but depends upon the neurological status, the intracranial pressure of the patient, and the availability of all the modern neurosurgical gadgets. PMID:29682037

  1. Model-Based, Noninvasive Monitoring of Intracranial Pressure

    Science.gov (United States)

    2013-07-01

    vasoactive medication drip rates and ventilator settings, nursing progress notes, discharge summaries, radiology reports, provider order entry data...the interaction of intracranial pressure and cerebral hemodynamics . Journal of Applied Physiology 82(4):1256-1269, 1997. [5] M Saeed, M Villarroel, AT

  2. Wavelet entropy characterization of elevated intracranial pressure.

    Science.gov (United States)

    Xu, Peng; Scalzo, Fabien; Bergsneider, Marvin; Vespa, Paul; Chad, Miller; Hu, Xiao

    2008-01-01

    Intracranial Hypertension (ICH) often occurs for those patients with traumatic brain injury (TBI), stroke, tumor, etc. Pathology of ICH is still controversial. In this work, we used wavelet entropy and relative wavelet entropy to study the difference existed between normal and hypertension states of ICP for the first time. The wavelet entropy revealed the similar findings as the approximation entropy that entropy during ICH state is smaller than that in normal state. Moreover, with wavelet entropy, we can see that ICH state has the more focused energy in the low wavelet frequency band (0-3.1 Hz) than the normal state. The relative wavelet entropy shows that the energy distribution in the wavelet bands between these two states is actually different. Based on these results, we suggest that ICH may be formed by the re-allocation of oscillation energy within brain.

  3. Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure?

    Science.gov (United States)

    Higgins, J Nicholas P; Pickard, John D; Lever, Andrew M L

    2017-08-01

    Though not discussed in the medical literature or considered in clinical practice, there are similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) which ought to encourage exploration of a link between them. The cardinal symptoms of each - fatigue and headache - are common in the other and their multiple other symptoms are frequently seen in both. The single discriminating factor is raised intracranial pressure, evidenced in IIH usually by the sign of papilloedema, regarded as responsible for the visual symptoms which can lead to blindness. Some patients with IIH, however, do not have papilloedema and these patients may be clinically indistinguishable from patients with chronic fatigue syndrome. Yet IIH is rare, IIH without papilloedema (IIHWOP) seems rarer still, while chronic fatigue syndrome is common. So are the clinical parallels spurious or is there a way to reconcile these conflicting observations? We suggest that it is a quirk of clinical measurement that has created this discrepancy. Specifically, that the criteria put in place to define IIH have led to a failure to appreciate the existence, clinical significance or numerical importance of patients with lower level disturbances of intracranial pressure. We argue that this has led to a grossly implausible distortion of the epidemiology of IIH such that the milder form of the illness (IIHWOP) is seen as less common than the more severe and that this would be resolved by recognising a connection with chronic fatigue syndrome. We hypothesise, therefore, that IIH, IIHWOP, lesser forms of IIH and an undetermined proportion of chronic fatigue cases are all manifestations of the same disorder of intracranial pressure across a spectrum of disease severity, in which this subset of chronic fatigue syndrome would represent the most common and least severe and IIH the least common and most extreme. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Time reversibility of intracranial human EEG recordings in mesial temporal lobe epilepsy

    Science.gov (United States)

    van der Heyden, M. J.; Diks, C.; Pijn, J. P. M.; Velis, D. N.

    1996-02-01

    Intracranial electroencephalograms from patients suffering from mesial temporal lobe epilepsy were tested for time reversibility. If the recorded time series is irreversible, the input of the recording system cannot be a realisation of a linear Gaussian random process. We confirmed experimentally that the measurement equipment did not introduce irreversibility in the recorded output when the input was a realisation of a linear Gaussian random process. In general, the non-seizure recordings are reversible, whereas the seizure recordings are irreversible. These results suggest that time reversibility is a useful property for the characterisation of human intracranial EEG recordings in mesial temporal lobe epilepsy.

  5. Vasomotor origin of intracranial pressure waves in hydrocephalic infants

    Energy Technology Data Exchange (ETDEWEB)

    Barritault, L; Rimbert, J N; Hirsch, J F; Pierr-Kahn, A; Lacombe, J; Zouaoui, A; Mises, J; Gabersek, V

    1980-12-01

    By measuring cerebral blood volume (CBV) and intracranial pressure (ICP) variations at the same running time during sleep, it has been demonstrated that the ICP wave which appears during the REM sleep in hydrocephalic infants is produced by intracerebral vaso-dilatation. Nine infants with stabilized hydrocephalus were investigated by non-invasive means: REM phases were distinguished with the usual polysomnographic electrodes. Intracranial pressure was measured with a fontanel palpation transducer and CBV variations were obtained by recording /sup 99/sup(m)Tc activity at the head level after in vivo labelling of red cells with /sup 99/sup(m)Tc-pertechnetate. The time activity curves, obtained from regions of interest and selected on the sequential radioisotope images, show that an increased ICP wave, occurring during the REM period, is related to a simultaneous increase in the blood volume, limited to the cerebral sector and not to the area of the external carotid artery.

  6. Use of intracranial pressure monitoring in bacterial meningitis

    DEFF Research Database (Denmark)

    Larsen, Lykke; Rom Poulsen, Frantz; Nielsen, Troels H

    2017-01-01

    BACKGROUND: The aim of this study was to evaluate the clinical outcome of patients with severe bacterial meningitis where intracranial pressure (ICP) monitoring has been performed. METHODS: A retrospective observational study including patients admitted 1st(.) January 2005 to 31st(.) December 2014...... CT scans with signs of elevated ICP. CONCLUSIONS: Patients with severe meningitis should be admitted to intensive care units and evaluated for ICP monitoring regardless of head CT findings....

  7. PATHOGENESIS OF OPTIC DISC EDEMA IN RAISED INTRACRANIAL PRESSURE

    Science.gov (United States)

    Hayreh, Sohan Singh

    2015-01-01

    Optic disc edema in raised intracranial pressure was first described in 1853. Ever since, there has been a plethora of controversial hypotheses to explain its pathogenesis. I have explored the subject comprehensively by doing basic, experimental and clinical studies. My objective was to investigate the fundamentals of the subject, to test the validity of the previous theories, and finally, based on all these studies, to find a logical explanation for the pathogenesis. My studies included the following issues pertinent to the pathogenesis of optic disc edema in raised intracranial pressure: the anatomy and blood supply of the optic nerve, the roles of the sheath of the optic nerve, of the centripetal flow of fluids along the optic nerve, of compression of the central retinal vein, and of acute intracranial hypertension and its associated effects. I found that, contrary to some previous claims, an acute rise of intracranial pressure was not quickly followed by production of optic disc edema. Then, in rhesus monkeys, I produced experimentally chronic intracranial hypertension by slowly increasing in size space-occupying lesions, in different parts of the brain. Those produced raised cerebrospinal fluid pressure (CSFP) and optic disc edema, identical to those seen in patients with elevated CSFP. Having achieved that, I investigated various aspects of optic disc edema by ophthalmoscopy, stereoscopic color fundus photography and fluorescein fundus angiography, and light microscopic, electron microscopic, horseradish peroxidase and axoplasmic transport studies, and evaluated the effect of opening the sheath of the optic nerve on the optic disc edema. This latter study showed that opening the sheath resulted in resolution of optic disc edema on the side of the sheath fenestration, in spite of high intracranial CSFP, proving that a rise of CSFP in the sheath was the essential pre-requisite for the development of optic disc edema. I also investigated optic disc edema with

  8. Increased Intracranial Pressure in the Setting of Enterovirus and Other Viral Meningitides

    Directory of Open Access Journals (Sweden)

    Jules C. Beal

    2017-01-01

    Full Text Available Increased intracranial pressure due to viral meningitis has not been widely discussed in the literature, although associations with Varicella and rarely Enterovirus have been described. Patients with increased intracranial pressure and cerebrospinal fluid analysis suggestive of a viral process are sometimes classified as having atypical idiopathic intracranial hypertension (IIH. However, a diagnosis of IIH requires normal cerebrospinal fluid, and therefore in these cases an infection with secondary intracranial hypertension may be a more likely diagnosis. Here seven patients are presented with elevated intracranial pressure and cerebrospinal fluid suggestive of viral or aseptic meningitis. Of these, 1 had Enterovirus and the remainder were diagnosed with nonspecific viral meningitis. These data suggest that viral meningitis may be associated with elevated intracranial pressure more often than is commonly recognized. Enterovirus has previously been associated with increased intracranial pressure only in rare case reports.

  9. Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging.

    Science.gov (United States)

    Lublinsky, Svetlana; Kesler, Anat; Friedman, Alon; Horev, Anat; Shelef, Ilan

    2018-04-01

    Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a clear cause. To investigate dynamic imaging findings in IIH and their relation to mechanisms underlying intracranial pressure normalization. Prospective. Eighteen IIH patients and 30 healthy controls. T 1 -weighted, venography, fluid attenuation inversion recovery, and apparent diffusion coefficients were acquired on 1.5T scanner. The dural sinus was measured before and after lumbar puncture (LP). The degree of sinus occlusion was evaluated, based on 95% confidence intervals of controls. We studied a number of neuroimaging biomarkers associated with IIH (sinus occlusion; optic nerve; distribution of cerebrospinal fluid into the subarachnoid space, sulci and lateral ventricles (LVs); Meckel's caves; arachnoid granulation; pituitary and choroid plexus), before and after LP, using a set of specially developed quantification techniques. Relationships among various biomarkers were investigated (Pearson correlation coefficient) and linked to long-term disease outcomes (logistic regression). The t-test and the Wilcoxon rank test were used to compare between controls and before and after LP data. As a result of LP, the following were found to be in good accordance with the opening pressure: relative compression of cerebrospinal fluid (R = -0.857, P < 0.001) and brain volumes (R = -0.576, P = 0.012), LV expansion (R = 0.772, P < 0.001) and venous volume (R = 0.696, P = 0.001), enlargement of the pituitary (R = 0.640, P = 0.023), and shrinkage of subarachnoid space (R = -0.887, P < 0.001). The only parameter that had an impact on long-term prognosis was cross-sectional size of supplemental drainage veins after LP (sensitivity of 92%, specificity of 20%, and area under the curve of 0.845, P < 0.001). We present an approach for quantitative characterization of the intracranial venous system and its implementation as a diagnostic assistance

  10. Dynamics of inner ear pressure change caused by intracranial pressure manipulation in the guinea pig

    NARCIS (Netherlands)

    Thalen, EO; Wit, HP; Segenhout, JM; Albers, FWJ

    Previous studies have shown that pressure changes in the cerebrospinal fluid compartment are transmitted to the inner ear. The main route for pressure transfer is the cochlear aqueduct, about which little is known with regard to its dynamic properties. In the present study, sudden intracranial

  11. Visual Impairment/Increased Intracranial Pressure (VIIP): Layman's Summary

    Science.gov (United States)

    Fogarty, Jennifer

    2011-01-01

    To date NASA has documented that seven long duration astronauts have experienced in-flight and post-flight changes in vision and eye anatomy including degraded distant vision, swelling of the back of the eye, and changes in the shape of the globe. We have also documented in a few of these astronauts post-flight, increases in the pressure of the fluid that surrounds the brain and spinal cord. This is referred to as increased intracranial pressure (ICP). The functional and anatomical changes have varied in severity and duration. In the post-flight time period, some individuals have experienced a return to a pre-flight level of visual function while others have experienced changes that remain significantly altered compared to pre-flight. In addition, the increased ICP also persists in the post-flight time period. Currently, the underlying cause or causes of these changes is/are unknown but the spaceflight community at NASA suspects that the shift of blood toward the head and the changes in physiology that accompany it, such as increased intracranial pressure, play a significant role.

  12. Intracranial Pressure Monitoring—Review and Avenues for Development

    Directory of Open Access Journals (Sweden)

    Maya Harary

    2018-02-01

    Full Text Available Intracranial pressure (ICP monitoring is a staple of neurocritical care. The most commonly used current methods of monitoring in the acute setting include fluid-based systems, implantable transducers and Doppler ultrasonography. It is well established that management of elevated ICP is critical for clinical outcomes. However, numerous studies show that current methods of ICP monitoring cannot reliably define the limit of the brain’s intrinsic compensatory capacity to manage increases in pressure, which would allow for proactive ICP management. Current work in the field hopes to address this gap by harnessing live-streaming ICP pressure-wave data and a multimodal integration with other physiologic measures. Additionally, there is continued development of non-invasive ICP monitoring methods for use in specific clinical scenarios.

  13. Treatments for Reversing Warfarin Anticoagulation in Patients with Acute Intracranial Hemorrhage: A Structured Literature Review

    Science.gov (United States)

    2011-07-08

    available soon. Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review...DATE 08 JUL 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Treatments For Reversing Warfarin ...distribution unlimited 13. SUPPLEMENTARY NOTES International Journal of Emergency Medicine 2011 14. ABSTRACT The acute management of patients on warfarin

  14. Single pulse analysis of intracranial pressure for a hydrocephalus implant.

    Science.gov (United States)

    Elixmann, I M; Hansinger, J; Goffin, C; Antes, S; Radermacher, K; Leonhardt, S

    2012-01-01

    The intracranial pressure (ICP) waveform contains important diagnostic information. Changes in ICP are associated with changes of the pulse waveform. This change has explicitly been observed in 13 infusion tests by analyzing 100 Hz ICP data. An algorithm is proposed which automatically extracts the pulse waves and categorizes them into predefined patterns. A developed algorithm determined 88 %±8 % (mean ±SD) of all classified pulse waves correctly on predefined patterns. This algorithm has low computational cost and is independent of a pressure drift in the sensor by using only the relationship between special waveform characteristics. Hence, it could be implemented on a microcontroller of a future electromechanic hydrocephalus shunt system to control the drainage of cerebrospinal fluid (CSF).

  15. Intracranial Pressure during HighVolume Hemofiltration in Severe Sepsis

    Directory of Open Access Journals (Sweden)

    A. P. Berdnikov

    2014-01-01

    Full Text Available Objective: to define the prognostic value of intracranial pressure (ICP changes in highvolume hemofiltration (HVHF in patients with severe sepsis and normal preperfusion ICP.Subjects and methods. A retrospective study was conducted in 50 patients (a total of 134 sessions with severe sepsis and normal baseline ICP who received ther apy using HVHF for extrarenal indications. Based on ICP changes before and after HVHF, the investigators identified 2 groups: 1 no ICP changes (n=81; 2 elevated ICP (n=53.Conclusion. HVHF is ineffective when the normal preperfusion ICP is increased in patients with severe sepsis who have a concurrence of an arteriovenous carbon dioxide difference of more than 8 mm Hg and a Glasgow coma score of less than 10.

  16. Non-Invasive Measurement of Pulsatile Intracranial Pressures Using Ultrasound

    Science.gov (United States)

    Ueno, Toshiaki; Ballard, Richard E.; Shuer, Lawrence M.; Cantrell, John H.; Cantrell, John H.; Hargens, Alan R.

    1997-01-01

    Early detection of elevated intracranial pressure (ICP) will aid clinical decision-making for head trauma, brain tumor and other cerebrovascular diseases. Conventional methods, however, require surgical procedures which take time and are accompanied by increased risk of infection. Accordingly we have developed and refined a new ultrasound device to measure skull movements which are known to occur in conjunction with altered ICP. The principle of this device is based upon pulse phase locked loop (PPLL), which enables us to detect changes in distance on the order of microns between an ultrasound transducer on one side of the skull and the opposite inner surface of the cranium. The present study was designed to verify this measurement technique in cadavera. Transcranial distance was increased in steps of 10 mmHg from zero to 50 mmHg by saline infusion into the lateral ventricle of two cadavera. In separate experiments, pulsations of ICP with the amplitudes of zero to 2 mmHg were generated by rhythmic injections of saline using a syringe. When the ICP was stepwise increased from zero to 50 mmHg, transcranial distance increased in proportion with the ICP increase (y=12 x - 76, r=0.938), where y is changes in transcranial distance in microns and x is ICP in mmHg. In the data recorded while ICP pulsations were generated, fast Fourier transform analysis demonstrated that cranial pulsations were clearly associated with ICP pulsations. The results indicate that changes in transcranial distance is linearly correlated with those in ICP, and also that the PPLL device has sufficient sensitivity to detect transcranial pulsations which occur in association with the cardiac cycle. By analyzing the magnitude of cranial pulsations, we may be able to estimate the pressure-volume index in the cranium. As a result, estimates of intracranial compliance may be possible by using the PPLL device. Further studies are necessary in normal subjects and patients.

  17. Non-invasive assessment of pulsatile intracranial pressure with phase-contrast magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Geir Ringstad

    Full Text Available Invasive monitoring of pulsatile intracranial pressure can accurately predict shunt response in patients with idiopathic normal pressure hydrocephalus, but may potentially cause complications such as bleeding and infection. We tested how a proposed surrogate parameter for pulsatile intracranial pressure, the phase-contrast magnetic resonance imaging derived pulse pressure gradient, compared with its invasive counterpart. In 22 patients with suspected idiopathic normal pressure hydrocephalus, preceding invasive intracranial pressure monitoring, and any surgical shunt procedure, we calculated the pulse pressure gradient from phase-contrast magnetic resonance imaging derived cerebrospinal fluid flow velocities obtained at the upper cervical spinal canal using a simplified Navier-Stokes equation. Repeated measurements of the pulse pressure gradient were also undertaken in four healthy controls. Of 17 shunted patients, 16 responded, indicating high proportion of "true" normal pressure hydrocephalus in the patient cohort. However, there was no correlation between the magnetic resonance imaging derived pulse pressure gradient and pulsatile intracranial pressure (R = -.18, P = .43. Pulse pressure gradients were also similar in patients and healthy controls (P = .26, and did not differ between individuals with pulsatile intracranial pressure above or below established thresholds for shunt treatment (P = .97. Assessment of pulse pressure gradient at level C2 was therefore not found feasible to replace invasive monitoring of pulsatile intracranial pressure in selection of patients with idiopathic normal pressure hydrocephalus for surgical shunting. Unlike invasive, overnight monitoring, the pulse pressure gradient from magnetic resonance imaging comprises short-term pressure fluctuations only. Moreover, complexity of cervical cerebrospinal fluid flow and -pulsatility at the upper cervical spinal canal may render the pulse pressure gradient a poor surrogate

  18. Biotelemetric Wireless Intracranial Pressure Monitoring: An In Vitro Study

    Directory of Open Access Journals (Sweden)

    Mohammad H. Behfar

    2015-01-01

    Full Text Available Assessment of intracranial pressure (ICP is of great importance in management of traumatic brain injuries (TBIs. The existing clinically established ICP measurement methods require catheter insertion in the cranial cavity. This increases the risk of infection and hemorrhage. Thus, noninvasive but accurate techniques are attractive. In this paper, we present two wireless, batteryless, and minimally invasive implantable sensors for continuous ICP monitoring. The implants comprise ultrathin (50 μm flexible spiral coils connected in parallel to a capacitive microelectromechanical systems (MEMS pressure sensor. The implantable sensors are inductively coupled to an external on-body reader antenna. The ICP variation can be detected wirelessly through measuring the reader antenna’s input impedance. This paper also proposes novel implant placement to improve the efficiency of the inductive link. In this study, the performance of the proposed telemetry system was evaluated in a hydrostatic pressure measurement setup. The impact of the human tissues on the inductive link was simulated using a 5 mm layer of pig skin. The results from the in vitro measurement proved the capability of our developed sensors to detect ICP variations ranging from 0 to 70 mmHg at 2.5 mmHg intervals.

  19. Cerebral blood volume changes in cats with acute increased intracranial pressure

    International Nuclear Information System (INIS)

    Kondo, Takashi; Kano, Mitsumasa; Ikeda, Takuya.

    1984-01-01

    We measured the changes in cerebral blood volume in cats with increased intracranial pressure with a high-speed CT scanner, employing contrast effects by the iodine agent. In acute increased intracranial pressure caused by raising the extradural pressure by 20 mmHg, cerebral blood volume showed a significant decrease by 32% in comparison with that at normal intracranial pressure. There was also a tendency that a decline of iodine was delayed with time at increased intracranial pressure than that at normal pressure. This was supposed to be a delay of cerebral circulation due to venous congestion. This experimental model and measuring method provide the changes in CBV in the same individual without any tedious procedure, and therefore this is a reliable method with respect to precision. (author)

  20. Quantification of abnormal intracranial pressure waves and isotope cisternography for diagnosis of occult communicating hydrocephalus

    International Nuclear Information System (INIS)

    Cardoso, E.R.; Piatek, D.; Del Bigio, M.R.; Stambrook, M.; Sutherland, J.B.

    1989-01-01

    Nineteen consecutive patients with suspected occult communicating hydrocephalus were investigated by means of clinical evaluation, neuropsychological testing, isotope cisternography, computed tomography scanning, and continuous intracranial pressure monitoring. Semi-quantitative grading systems were used in the evaluation of the clinical, neuropsychological, and cisternographic assessments. Clinical examination, neuropsychological testing, and computed tomography scanning were repeated 3 months after ventriculoperitoneal shunting. All patients showed abnormal intracranial pressure waves and all improved after shunting. There was close correlation between number, peak, and pulse pressures of B waves and the mean intracranial pressure. However, quantification of B waves by means of number, frequency, and amplitude did not help in predicting the degree of clinical improvement postshunting. The most sensitive predictor of favorable response to shunting was enlargement of the temporal horns on computed tomography scan. Furthermore, the size of temporal horns correlated with mean intracranial pressure. There was no correlation between abnormalities on isotope cisternography and clinical improvement

  1. Raised intracranial pressure: What it is and how to recognise it

    African Journals Online (AJOL)

    This article presents an approach to raised intracranial pressure (ICP) constructed in a question-answer fashion. ... involves shifts of CSF and venous blood out .... by changes in posture, position and .... ICP can be measured by a number of.

  2. Non-Invasive Measurement of Intracranial Pressure Pulsation using Ultrasound

    Science.gov (United States)

    Ueno, Toshiaki; Ballard, R. E.; Yost, W. T.; Hargens, A. R.

    1997-01-01

    Exposure to microgravity causes a cephalad fluid shift which may elevate intracranial pressure (ICP). Elevation in ICP may affect cerebral hemodynamics in astronauts during space flight. ICP is, however, a difficult parameter to measure due to the invasiveness of currently available techniques. We already reported our development of a non-invasive ultrasound device for measurement of ICP. We recently modified the device so that we might reproducibly estimate ICP changes in association with cardiac cycles. In the first experiment, we measured changes in cranial distance with the ultrasound device in cadavera while changing ICP by infusing saline into the lateral ventricle. In the second experiment, we measured changes in cranial distance in five healthy volunteers while placing them in 60 deg, 30 deg head-up tilt, supine, and 10 deg head-down tilt position. In the cadaver study, fast Fourier transformation revealed that cranial pulsation is clearly associated with ICP pulsation. The ratio of cranial distance and ICP pulsation is 1.3microns/mmHg. In the tilting study, the magnitudes of cranial pulsation are linearly correlated to tilt angles (r=0.87). The ultrasound device has sufficient sensitivity to detect cranial pulsation in association with cardiac cycles. By analyzing the magnitude of cranial pulsation, estimates of ICP during space flight are possible.

  3. MRI measurements of intracranial pressure in the upright posture: The effect of the hydrostatic pressure gradient.

    Science.gov (United States)

    Alperin, Noam; Lee, Sang H; Bagci, Ahmet M

    2015-10-01

    To add the hydrostatic component of the cerebrospinal fluid (CSF) pressure to magnetic resonance imaging (MRI)-derived intracranial pressure (ICP) measurements in the upright posture for derivation of pressure value in a central cranial location often used in invasive ICP measurements. Additional analyses were performed using data previously collected from 10 healthy subjects scanned in supine and sitting positions with a 0.5T vertical gap MRI scanner (GE Medical). Pulsatile blood and CSF flows to and from the brain were quantified using cine phase-contrast. Intracranial compliance and pressure were calculated using a previously described method. The vertical distance between the location of the CSF flow measurement and a central cranial location was measured manually in the mid-sagittal T1 -weighted image obtained in the upright posture. The hydrostatic pressure gradient of a CSF column with similar height was then added to the MR-ICP value. After adjustment for the hydrostatic component, the mean ICP value was reduced by 7.6 mmHg. Mean ICP referenced to the central cranial level was -3.4 ± 1.7 mmHg compared to the unadjusted value of +4.3 ± 1.8 mmHg. In the upright posture, the hydrostatic pressure component needs to be added to the MRI-derived ICP values for compatibility with invasive ICP at a central cranial location. © 2015 Wiley Periodicals, Inc.

  4. Clinical evaluation of a new intracranial pressure monitoring device.

    Science.gov (United States)

    Stendel, R; Heidenreich, J; Schilling, A; Akhavan-Sigari, R; Kurth, R; Picht, T; Pietilä, T; Suess, O; Kern, C; Meisel, J; Brock, M

    2003-03-01

    Continuous monitoring of intracranial pressure (ICP) still plays a key role in the management of patients at risk from intracranial hypertension. Numerous ICP-measuring devices are available. The aim of the present study was to investigate the clinical characteristics and the magnetic resonance imaging (MRI) compatibility of the recently developed Neurovent-P(REHAU AG+CO, REHAU, Germany) ICP monitoring device. In a prospective two-center study, a total of 98 patients with severe head injury, subarachnoid haemorrhage, intracerebral haemorrhage, and non-traumatic brain edema underwent intraparenchymal monitoring of ICP using the Neurovent-P. A control group comprising 50 patients underwent implantation of the Camino-OLM-110-4B ICP monitor. The zero drift of the probes was determined before and after the ICP recording period. Technical and medical complications were documented. The MRI compatibility of the Neurovent-P ICP probe was investigated by evaluating artifacts caused by the probe, probe function and temperature changes during MRI, and probe movement caused by the magnetic field. The mean zero drift was 0.2+/-0.41 mmHg (maximum 3 mmHg) for the Neurovent-P ICP probes and 0.4+/-0.57 mmHg (maximum 12 mmHg) for the Camino-OLM-110-4B ICP probes. No significant correlation was identified between the extent of zero drift following the removal of the probes and the length of monitoring. Intraparenchymal haemorrhage spatially related to the probe occurred in 1 out of 50 (2%) patients with a Camino-OLM-110-4B probe and in 1 out of 98 (1%) with a Neurovent-P. Damage of the probe due to kinking or overextension of the cable or glass fiber occurred in 4 of the 50 (8%) Camino-OLM-110-4B ICP probes and in 5 of the 98 (5%) Neurovent-P probes. On T2-weighted MR images, the Neurovent-P ICP probe induced only small artifacts with very good discrimination of the surrounding tissue. On T1-weighted MR images, there was a good imaging quality but artifact-related local disturbances

  5. Non-Invasive Ultrasonic Diagnosing and Monitoring of Intracranial Pressure/Volume

    Science.gov (United States)

    2001-10-01

    Libraria, Padoue (Italia) 53 37. Guinduiz G, Viernstein LW (1979). Intracranial pressure in the normal monkey while awake and asleep. J Neurosurg 51, 206...cerebral microcirculation of awake rabbits. Heart Circ Physiol 23, H67-H71 46. Hyndman BW, Kitney RI, Sayers BM (1971). Spontaneous rhythms in...intracranial pressure monitoring. Exclusion criteria: patients with wounds, scars or a craniotomy overlying the optimal window for transintracranial

  6. Cerebrospinal Fluid Corticosteroid Levels and Cortisol Metabolism in Patients with Idiopathic Intracranial Hypertension : A Link between 11 beta-HSD1 and Intracranial Pressure Regulation?

    NARCIS (Netherlands)

    Sinclair, Alexandra J.; Walker, Elizabeth A.; Burdon, Michael A.; van Beek, Andre P.; Kema, Ido P.; Hughes, Beverly A.; Murray, Philip I.; Nightingale, Peter G.; Stewart, Paul M.; Rauz, Saaeha; Tomlinson, Jeremy W.

    2010-01-01

    Context: The etiology of idiopathic intracranial hypertension (IIH) is unknown. We hypothesized that obesity and elevated intracranial pressure may be linked through increased 11 beta-hydroxysteroid dehydrogenase type 1 (11 beta-HSD1) activity. Objective: The aim was to characterize 11 beta-HSD1 in

  7. Telemetric intra-cranial pressure monitoring: clinical and financial considerations.

    Science.gov (United States)

    Barber, James M; Pringle, Catherine J; Raffalli-Ebezant, Helen; Pathmanaban, Omar; Ramirez, Roberto; Kamaly-Asl, Ian D

    2017-06-01

    Intracranial pressure (ICP) measurement is an important diagnostic tool in Neurosurgery. Until relatively recently, conventional monitoring has required that subjects be admitted to a hospital bed and the device is only able to be left in-situ for limited periods of time. We have evaluated a Telemetric ICP monitoring system that has been proven, by several other groups worldwide, to permit rapid, repeated and prolonged ICP measurement, in multiple environments. In our unit, 4 patients have been implanted to-date, between the ages of 4 and 16, manifesting a wide range of complex neurosurgical conditions. The sensors have been left in-situ for between 460 and 632 days. There have been no clinical complications and the system has been universally well tolerated. Clinical events, costs and patient experience were all assessed prior to and following implantation. Overall, there was a significant reduction in associated admissions (44.3%), imaging requirements (72.5%) and costs (50.0%). Subjective feedback from both the patients (where possible) and their families was overwhelmingly positive, partly due to (a) the system's ease of use, (b) its ability to reduce the number of admissions/tests required and (c) the facility for rapid measurement of ICP that permitted on-the-spot reassurance of concerns. Additionally, the ability to monitor ICP at home and/or whilst ambulant, has provided measurements that were hitherto inaccessible to our team, facilitating all the potential benefits that analysis of such information would provide. Indeed, we have seen the resultant management in each case has been completely altered by the availability of this data, reaffirming that the importance of being able to obtain it should not be underestimated. The combination of both this and the ability to markedly improve patient experience, along with generating significant cost-savings, lead the authors to suggest that the implantation of this system should be strongly considered in selected

  8. Intracranial pressure following complete removal of a small demarcated brain tumor

    DEFF Research Database (Denmark)

    Andresen, Morten; Juhler, Marianne

    2014-01-01

    OBJECTIVES: Current published normal values for intracranial pressure (ICP) are extrapolated from lumbar CSF pressure measurements and ICP measurements in patients treated for CSF pressure disorders. There is an emerging agreement that true normal ICP values are needed for diagnostic and therapeu...... and the ICP target range in hydrocephalus treatment....

  9. Headaches caused by decreased intracranial pressure: diagnosis and management.

    Science.gov (United States)

    Mokri, Bahram

    2003-06-01

    More patients with spontaneous intracranial hypotension are now being diagnosed, and it is realized that most cases result from spontaneous cerebrospinal fluid leaks. A broader clinical and imaging spectrum of the disorder is recognized. This paper reviews new insights into the variability of clinical manifestations, imaging features, etiological factors, anatomy of leaks, and implications of these in patient management. Spontaneous intracranial hypotension should not be equated with post-lumbar puncture headaches. In a substantial minority of patients, headaches are not orthostatic and may mimic other types of headache. Additional diverse neurological manifestations may dominate the clinical picture and patients may occasionally have no headache at all. Reports on unusual presentations of the disorder continue to appear in the literature. Furthermore, additional imaging features of cerebrospinal fluid leaks are recognized. High-flow and slow-flow leaks may present diagnostic challenges, and require modification of diagnostic studies aimed at locating the site of the leak. Stigmata of connective tissue abnormality, especially abnormalities of fibrillin and elastin, are seen in a notable minority of patients, pointing to weakness of the dural sac as one of the etiological factors. After treatment of spontaneous intracranial hypotension, surgically or by epidural blood patch, a rebound and self-limiting intracranial hypertension may sometimes develop. In the past decade, interest in spontaneous intracranial hypotension has been rekindled, with a substantial growth of knowledge on various aspects of the disorder. We are in the learning phase, and new information will probably appear in the future, with notable diagnostic and therapeutic implications.

  10. Increased Intracranial Pressure in a Boy with Gorham-Stout Disease

    Directory of Open Access Journals (Sweden)

    Manisha K. Patel

    2016-04-01

    Full Text Available Gorham-Stout disease (GSD, also known as vanishing bone disease, is a rare disorder, which most commonly presents in children and young adults and is characterized by an excessive proliferation of lymphangiomatous tissue within the bones. This lymphangiomatous proliferation often affects the cranium and, due to the proximate location to the dura surrounding cerebrospinal fluid (CSF spaces, can result in CSF leaks manifesting as intracranial hypotension with clinical symptoms to include orthostatic headache, nausea, and vertigo. We present the case of a boy with GSD and a known history of migraine headaches who presented with persistent headaches due to increased intracranial pressure. Although migraine had initially been suspected, he was eventually diagnosed with intracranial hypertension after developing ophthalmoplegia and papilledema. We describe the first known instance of successful medical treatment of increased intracranial pressure in a patient with GSD.

  11. CT changes in children with drained hydrocephalus and intermittently raised intracranial pressure

    International Nuclear Information System (INIS)

    Schmidt, H.; Korinthenberg, R.; Erlemann, R.; Lengerke, H.J. von; Muenster Univ.

    1987-01-01

    Seven children with drained hydrocephalus are described who showed increasingly severe and frequent episodes of intermittently raised intracranial pressure. CT examinations during symptom-free intervals, or after conservative treatment, showed collapsed slit-like ventricles. Examination during attacks of raised pressure showed relative dilatation of the ventricles as compared with earlier examinations. Children with ventricular shunts of long duration may develop a shunt-dependent syndrome; CT may show normal or narrow ventricles and this does not exclude the possibility of a rise of intracranial pressure. These findings may help in making the diagnosis by means of CT without any further invasive procedure. (orig.) [de

  12. Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure.

    Science.gov (United States)

    Frischholz, M; Sarmento, L; Wenzel, M; Aquilina, K; Edwards, R; Coakham, H B

    2007-01-01

    Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

  13. The baseline pressure of intracranial pressure (ICP) sensors can be altered by electrostatic discharges.

    Science.gov (United States)

    Eide, Per K; Bakken, André

    2011-08-22

    The monitoring of intracranial pressure (ICP) has a crucial role in the surveillance of patients with brain injury. During long-term monitoring of ICP, we have seen spontaneous shifts in baseline pressure (ICP sensor zero point), which are of technical and not physiological origin. The aim of the present study was to explore whether or not baseline pressures of ICP sensors can be affected by electrostatics discharges (ESD's), when ESD's are delivered at clinically relevant magnitudes. We performed bench-testing of a set of commercial ICP sensors. In our experimental setup, the ICP sensor was placed in a container with 0.9% NaCl solution. A test person was charged 0.5-10 kV, and then delivered ESD's to the sensor by touching a metal rod that was located in the container. The continuous pressure signals were recorded continuously before/after the ESD's, and the pressure readings were stored digitally using a computerized system A total of 57 sensors were tested, including 25 Codman ICP sensors and 32 Raumedic sensors. When charging the test person in the range 0.5-10 kV, typically ESD's in the range 0.5-5 kV peak pulse were delivered to the ICP sensor. Alterations in baseline pressure ≥ 2 mmHg was seen in 24 of 25 (96%) Codman sensors and in 17 of 32 (53%) Raumedic sensors. Lasting changes in baseline pressure > 10 mmHg that in the clinical setting would affect patient management, were seen frequently for both sensor types. The changes in baseline pressure were either characterized by sudden shifts or gradual drifts in baseline pressure. The baseline pressures of commercial solid ICP sensors can be altered by ESD's at discharge magnitudes that are clinically relevant. Shifts in baseline pressure change the ICP levels visualised to the physician on the monitor screen, and thereby reveal wrong ICP values, which likely represent a severe risk to the patient.

  14. Inner ear pressure changes following square wave intracranial or ear canal pressure manipulation in the same guinea pig

    NARCIS (Netherlands)

    Thalen, E; Wit, H; Segenhout, H; Albers, F

    Inner ear pressure was measured in scala tympani with a micropipette during square wave pressure manipulation of the intracranial compartment and, subsequently, of the external ear canal (EEC) in the same guinea pig. As expected, the combination of the cochlear aqueduct and the inner ear behaves as

  15. Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Marcelo Adriano da Cunha Silva Vieira

    2015-04-01

    Full Text Available Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001. The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

  16. Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.

    Science.gov (United States)

    Luo, Chao-Bao; Lai, Yen-Jun; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

    2013-09-01

    Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Poor correlation between intracranial pressure and intraocular pressure by hand-held tonometry

    Directory of Open Access Journals (Sweden)

    Golan S

    2013-06-01

    Full Text Available Shani Golan,1 Shimon Kurtz,1 Daphna Mezad-Koursh,1 Michael Waisbourd,1 Anat Kesler,1 Pinchas Halpern2 1Departments of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Emergency Medicine, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose: The aim of this study is to provide data on the controversial issue of whether handheld measurements of intraocular pressure (IOP are capable of accurately predicting elevated intracranial pressure (ICP in patients undergoing lumbar puncture (LP. Methods: All patients over the age of 18 years who underwent an LP in the emergency or neurological departments at the Tel Aviv Medical center for any reason between October 2007 and July 2010 were eligible to participate in this prospective observational pilot study. IOP was measured with the Tono-Pen XL while patients were in the supine position before undergoing LP. ICP was measured in the lateral recumbent position. ICP and bilateral IOP were measured, and the mean and maximum values of IOP were calculated. The association between ICP and each one of the four IOP measures was evaluated by the Pearson correlation coefficient. Results: Twenty-four patients (mean age 37.8 ± 15.8 years, ten males and 14 females were enrolled. The reasons for their requiring an LP were headache (19/24 patients, evaluation for hemiparesis (2/24, cognitive deterioration (1/24, and seizures (2/24. Nine had elevated mean opening pressure (>20 cm H2O, six had an elevated mean IOP (>20 mmHg, and four of these six also had an elevated opening pressure. There was no significant correlation between the ICP measurements and any of the IOP measurements. Conclusion: Handheld ocular tonometry has poor sensitivity and specificity for the prediction of increased ICP and is not an effective tool for screening for ICP in the ED or in the

  18. The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy

    DEFF Research Database (Denmark)

    Rasmussen, Mads; Tankisi, A; Cold, G E

    2004-01-01

    We compared the effects of indomethacin (bolus of 0.2 mg.kg-1 followed by an infusion of 0.2 mg.kg-1.h-1) and placebo on intracranial pressure and cerebral haemodynamics in 30 patients undergoing craniotomy for supratentorial brain tumours under propofol and fentanyl anaesthesia. Indomethacin...

  19. Visual Impairment/Intracranial Pressure Research Clinical Advisory Panel (RCAP) Meeting. [Summary Report

    Science.gov (United States)

    Villarreal, Jennifer

    2014-01-01

    The Visual Impairment/Intracranial Pressure (VIIP) Research and Clinical Advisory Panel convened on December 1, 2014 at the ISS Conference Facility in Houston. The panel members were provided updates to the current clinical cases and treatment plans along with the latest research activities (http://humanresearchroadmap.nasa.gov/Risks/?i=105) and preliminary study results. The following is a summary of this meeting.

  20. Clinical experience with telemetric intracranial pressure monitoring in a Danish neurosurgical center

    DEFF Research Database (Denmark)

    Lilja, Alexander; Andresen, Morten; Hadi, Amer

    2014-01-01

    kinds of hydrocephalus, seven patients had idiopathic intracranial hypertension (IIH) and three patients had normal pressure hydrocephalus (NPH). Fifteen patients had a shunt prior to implantation. Median duration of implantation was 248 (49-666) days and median duration from implantation to last...

  1. The Course of Intracranial Pressure in Traumatic Brain Injury : Relation with Outcome and CT-characteristics

    NARCIS (Netherlands)

    Bremmer, Rosette; de Jong, Bauke M.; Wagemakers, Michiel; Regtien, Joost G.; van der Naalt, Joukje

    One of the predictive factors of outcome in traumatic brain injury is high intracranial pressure (ICP). Recently, the time course of ICP has been described but few data are available on the relation of these ICP profiles and outcome. The aim of this study is to investigate the relation of the time

  2. The Relationship Between Intracranial Pressure and Age-Chasing Age-Related Reference Values

    DEFF Research Database (Denmark)

    Pedersen, Sarah Hornshøj; Lilja-Cyron, Alexander; Andresen, Morten

    2018-01-01

    Background: No true reference values for intracranial pressure (ICP) in humans exist; current values are estimated from measurements in adults who undergo treatment in order to correct ICP. We report ICP values in a "pseudonormal" group of children and adults to examine if age affects ICP. Method...

  3. Evaluation of Intracranial Pressure in Different Body Postures and Disease Entities

    DEFF Research Database (Denmark)

    Andresen, Morten; Hadi, Amer; Juhler, Marianne

    2016-01-01

    We currently do not have sufficient knowledge regarding appropriate boundaries between "normal" and "abnormal" intracranial pressure (ICP) in humans. Our objective in this study was to quantify the effects of postural changes on ICP in normal and ill subjects. As a model for normal patients, we i...

  4. Plateau Waves of Intracranial Pressure and Partial Pressure of Cerebral Oxygen.

    Science.gov (United States)

    Lang, Erhard W; Kasprowicz, Magdalena; Smielewski, Peter; Pickard, John; Czosnyka, Marek

    2016-01-01

    This study investigates 55 intracranial pressure (ICP) plateau waves recorded in 20 patients after severe traumatic brain injury (TBI) with a focus on a moving correlation coefficient between mean arterial pressure (ABP) and ICP, called PRx, which serves as a marker of cerebrovascular reactivity, and a moving correlation coefficient between ABP and cerebral partial pressure of oxygen (pbtO2), called ORx, which serves as a marker for cerebral oxygen reactivity. ICP and ICPamplitude increased significantly during the plateau waves, whereas CPP and pbtO2 decreased significantly. ABP, ABP amplitude, and heart rate remained unchanged. In 73 % of plateau waves PRx increased during the wave. ORx showed an increase during and a decrease after the plateau waves, which was not statistically significant. Our data show profound cerebral vasoparalysis on top of the wave and, to a lesser extent, impairment of cerebral oxygen reactivity. The different behavior of the indices may be due to the different latencies of the cerebral blood flow and oxygen level control mechanisms. While cerebrovascular reactivity is a rapidly reacting mechanism, cerebral oxygen reactivity is slower.

  5. Negative-Pressure Hydrocephalus: A Case Report on Successful Treatment Under Intracranial Pressure Monitoring with Bilateral Ventriculoperitoneal Shunts.

    Science.gov (United States)

    Pandey, Sajan; Jin, Yi; Gao, Liang; Zhou, Cheng Cheng; Cui, Da Ming

    2017-03-01

    Negative-pressure hydrocephalus (NegPH), a very rare condition of unknown etiology and optimal treatment, usually presents postneurosurgery with clinical and imaging features of hydrocephalus, but with negative cerebrospinal fluid pressure. We describe a NegPH case of -3 mm Hg intracranial pressure that was successfully treated to achieve 5 mm Hg under continuous intracranial pressure monitoring with horizontal positioning, head down and legs elevated to 10°-15°, neck wrapping for controlled venous drainage, chest and abdomen bandages, infusion of 5% dextrose fluid to lower plasma osmolarity (Na + , 130-135 mmol/L), daily cerebrospinal fluid drainage >200 mL, and arterial blood gas partial pressure of carbon dioxide >40 mm Hg. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves.

    Science.gov (United States)

    Lang, Erhard W; Kasprowicz, Magdalena; Smielewski, Peter; Pickard, John; Czosnyka, Marek

    2015-08-01

    Plateau waves in intracranial pressure (ICP) are frequently recorded in neuro intensive care and are not yet fully understood. To further investigate this phenomenon, we analyzed partial pressure of cerebral oxygen (pbtO2) and a moving correlation coefficient between ICP and mean arterial blood pressure (ABP), called PRx, along with the cerebral oxygen reactivity index (ORx), which is a moving correlation coefficient between cerebral perfusion pressure (CPP) and pbtO2 in an observational study. We analyzed 55 plateau waves in 20 patients after severe traumatic brain injury. We calculated ABP, ABP pulse amplitude (ampABP), ICP, CPP, pbtO2, heart rate (HR), ICP pulse amplitude (ampICP), PRx, and ORx, before, during, and after each plateau wave. The analysis of variance with Bonferroni post hoc test was used to compare the differences in the variables before, during, and after the plateau wave. We considered all plateau waves, even in the same patient, independent because they are separated by long intervals. We found increases for ICP and ampICP according to our operational definitions for plateau waves. PRx increased significantly (p = 0.00026), CPP (p pressure remains stable in ICP plateau waves, while cerebral autoregulatory indices show distinct changes, which indicate cerebrovascular reactivity impairment at the top of the wave. PbtO2 decreases during the waves and may show a slight overshoot after normalization. We assume that this might be due to different latencies of the cerebral blood flow and oxygen level control mechanisms. Other factors may include baseline conditions, such as pre-plateau wave cerebrovascular reactivity or pbtO2 levels, which differ between studies.

  7. A glucagon-like peptide-1 receptor agonist reduces intracranial pressure in a rat model of hydrocephalus

    DEFF Research Database (Denmark)

    Botfield, Hannah F; Uldall, Maria S; Westgate, Connar S J

    2017-01-01

    Current therapies for reducing raised intracranial pressure (ICP) under conditions such as idiopathic intracranial hypertension or hydrocephalus have limited efficacy and tolerability. Thus, there is a pressing need to identify alternative drugs. Glucagon-like peptide-1 receptor (GLP-1R) agonists...

  8. Relationship between intracranial pressure and antifungal agents levels in the CSF of patients with cryptococcal meningitis.

    Science.gov (United States)

    Wirth, Fernanda; de Azevedo, Maria Isabel; Pilla, Carmen; Aquino, Valério Rodrigues; Neto, Gustavo Wissmann; Goldani, Luciano Zubaran

    2018-04-01

    The purpose of this study was to evaluate the influence of intracranial hypertension in the cerebrospinal fluid (CSF) levels of amphotericin B and fluconazole levels of patients with cryptococcal meningitis. CSF samples and intracranial pressure were obtained by means of routine punctures performed at days 1, 7, and 14 of therapy, respectively. Amphotericin B and fluconazole CSF levels were measured by HPLC method as previously described. The minimum inhibitory concentration for amphotericin B, fluconazole, 5΄flucytosine, and voriconazole of each Cryptococcus isolate was performed according to CLSI. The predominant Cryptococcus species found was C. neoformans, and the major underlying condition was AIDS. Only one CSF sample had a detectable level for amphotericin B during the 14 days of therapy. Fluconazole CSF levels progressively increased from day 1 to day 14 of therapy for most cases. Fluconazole levels in the CSF were above the minimum inhibitory concentrations (MICs) for Cryptococcus during the initial 14 days of antifungal therapy. Variations of intracranial pressure did not affect amphotericin B and fluconazole levels in the CSF. The generalized estimating correlation (GEE) and Spearman correlation test (SCT) showed no significant correlation between the amphotericin B or fluconazole concentrations in the CSF and intracranial pressure (P = .953 and P = .093, respectively for GEE test and P = .477 and P = .847, respectively, for SCT). Combination therapy of amphotericin B with fluconazole was effective in 60% of the patients considering CSF cultures were negative in 9 of 15 patients after 14 days of therapy. Further studies are necessary to evaluate the role of intracranial hypertension on the therapeutic efficacy of different antifungal agents in patients with cryptococcal meningitis.

  9. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Takamasa Nanba

    2016-01-01

    Full Text Available Although posterior reversible encephalopathy syndrome (PRES is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

  10. Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Tai-Hsin Tsai

    2013-10-01

    Full Text Available Intraoperative intracranial pressure (ICP and cerebral perfusion pressure (CPP were evaluated for use as prognostic indicators after surgery for severe traumatic brain injury (TBI, and threshold ICP and CPP values were determined to provide guidelines for patient management. This retrospective study reviewed data for 66 patients (20 females and 46 males aged 13–83 years (average age, 48 years who had received decompressive craniectomy and hematoma evacuation for severe TBI. The analysis of clinical characteristics included Glascow Coma Scale score, trauma mechanism, trauma severity, cerebral hemorrhage type, hematoma thickness observed on computed tomography scan, Glasgow Outcome Scale score, and mortality. Patients whose treatment included ICP monitoring had significantly better prognosis (p < 0.001 and significantly lower mortality (p = 0.016 compared to those who did not receive ICP monitoring. At all three major steps of the procedure, i.e., creation of the burr hole, evacuation of the hematoma, and closing of the wound, intraoperative ICP and CPP values significantly differed. The ICP and CPP values were also significantly associated with surgical outcome in the severe TBI patients. Between hematoma evacuation and wound closure, ICP and CPP values differed by 6.8 ± 4.5 and 6.5 ± 4.6 mmHg, respectively (mean difference, 6 mmHg. Intraoperative thresholds were 14 mmHg for ICP and 56mmH for CPP. Monitoring ICP and CPP during surgery improves management of severe TBI patients and provides an early prognostic indicator. During surgery for severe TBI, early detection of increased ICP is also crucial for enabling sufficiently early treatment to improve surgical outcome. However, further study is needed to determine the optimal intraoperative ICP and CPP thresholds before their use as subjective guidelines for managing severe TBI patients.

  11. Effects of hyperbaric treatment in cerebral air embolism on intracranial pressure, brain oxygenation, and brain glucose metabolism in the pig

    NARCIS (Netherlands)

    van Hulst, Robert A.; Drenthen, Judith; Haitsma, Jack J.; Lameris, Thomas W.; Visser, Gerhard H.; Klein, Jan; Lachmann, Burkhard

    2005-01-01

    OBJECTIVE: To evaluate the effects of hyperbaric oxygen treatment after cerebral air embolism on intracranial pressure, brain oxygenation, brain glucose/lactate metabolism, and electroencephalograph. DESIGN: Prospective animal study. SETTING: Hyperbaric chamber. SUBJECTS: Eleven Landrace/Yorkshire

  12. Effects of dexamethasone and cox inhibitors on intracranial pressure and cerebral perfusion in the lipopolysaccharide treated rats with hyperammonemia

    DEFF Research Database (Denmark)

    Rohde, Johan; Pedersen, Hans; Bjerring, Peter N

    2015-01-01

    INTRODUCTION: Systemic inflammation may affect the brain by aggravating the stage of encephalopathy and increasing intracranial pressure (ICP) especially if liver insufficiency with hyperammonemia is present. The aim of this study was to determine if the influence of concomitant hyperammonemia...

  13. Intracranial pressure-induced optic nerve sheath response as a predictive biomarker for optic disc edema in astronauts

    NARCIS (Netherlands)

    Wostyn, Peter; De Deyn, Peter Paul

    2017-01-01

    A significant proportion of the astronauts who spend extended periods in microgravity develop ophthalmic abnormalities. Understanding this syndrome, called visual impairment and intracranial pressure (VIIP), has become a high priority for National Aeronautics and Space Administration, especially in

  14. Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

    Science.gov (United States)

    Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

    2017-05-12

    Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

  15. The Visual Impairment Intracranial Pressure Syndrome in Long Duration NASA Astronauts: An Integrated Approach

    Science.gov (United States)

    Otto, C. A.; Norsk, P.; Shelhamer, M. J.; Davis, J. R.

    2015-01-01

    The Visual Impairment Intracranial Pressure (VIIP) syndrome is currently NASA's number one human space flight risk. The syndrome, which is related to microgravity exposure, manifests with changes in visual acuity (hyperopic shifts, scotomas), changes in eye structure (optic disc edema, choroidal folds, cotton wool spots, globe flattening, and distended optic nerve sheaths). In some cases, elevated cerebrospinal fluid pressure has been documented postflight reflecting increased intracranial pressure (ICP). While the eye appears to be the main affected end organ of this syndrome, the ocular affects are thought to be related to the effect of cephalad fluid shift on the vascular system and the central nervous system. The leading hypotheses for the development of VIIP involve microgravity induced head-ward fluid shifts along with a loss of gravity-assisted drainage of venous blood from the brain, both leading to cephalic congestion and increased ICP. Although not all crewmembers have manifested clinical signs or symptoms of the VIIP syndrome, it is assumed that all astronauts exposed to microgravity have some degree of ICP elevation in-flight. Prolonged elevations of ICP can cause long-term reduced visual acuity and loss of peripheral visual fields, and has been reported to cause mild cognitive impairment in the analog terrestrial population of Idiopathic Intracranial Hypertension (IIH). These potentially irreversible health consequences underscore the importance of identifying the factors that lead to this syndrome and mitigating them.

  16. Bernoulli's Principle Applied to Brain Fluids: Intracranial Pressure Does Not Drive Cerebral Perfusion or CSF Flow.

    Science.gov (United States)

    Schmidt, Eric; Ros, Maxime; Moyse, Emmanuel; Lorthois, Sylvie; Swider, Pascal

    2016-01-01

    In line with the first law of thermodynamics, Bernoulli's principle states that the total energy in a fluid is the same at all points. We applied Bernoulli's principle to understand the relationship between intracranial pressure (ICP) and intracranial fluids. We analyzed simple fluid physics along a tube to describe the interplay between pressure and velocity. Bernoulli's equation demonstrates that a fluid does not flow along a gradient of pressure or velocity; a fluid flows along a gradient of energy from a high-energy region to a low-energy region. A fluid can even flow against a pressure gradient or a velocity gradient. Pressure and velocity represent part of the total energy. Cerebral blood perfusion is not driven by pressure but by energy: the blood flows from high-energy to lower-energy regions. Hydrocephalus is related to increased cerebrospinal fluid (CSF) resistance (i.e., energy transfer) at various points. Identification of the energy transfer within the CSF circuit is important in understanding and treating CSF-related disorders. Bernoulli's principle is not an abstract concept far from clinical practice. We should be aware that pressure is easy to measure, but it does not induce resumption of fluid flow. Even at the bedside, energy is the key to understanding ICP and fluid dynamics.

  17. MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Meinel, Felix G.; Fischer, Judith; Pomschar, Andreas; Wöhrle, Natalie; Koerte, Inga K.; Steffinger, Denise [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Laubender, Rüdiger P. [Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Muacevic, Alexander [European Cyberknife Center Munich, 81377 Munich (Germany); Reiser, Maximilian F. [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Alperin, Noam [Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136 (United States); Ertl-Wagner, Birgit, E-mail: birgit.ertl-wagner@med.uni-muenchen.de [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany)

    2014-08-15

    Purpose: The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs. Methods: Thirty consecutive patients with arteriovenous malformations (median age 38.7 years, 27/30 previously treated with radiosurgery) and 30 age- and gender-matched healthy controls were investigated on a 3.0 T MR scanner. Nidus volume was quantified on dynamic MR angiography. Total arterial cerebral blood flow (tCBF), venous outflow as well as aqueductal and craniospinal stroke volumes were obtained using velocity-encoded cine-phase contrast MRI. Intracranial volume change during the cardiac cycle was calculated and intracranial pressure (ICP) was derived from systolic intracranial volume change (ICVC) and pulse pressure gradient. Results: TCBF was significantly higher in AVM patients as compared to healthy controls (median 799 vs. 692 mL/min, p = 0.007). There was a trend for venous flow to be increased in both the ipsilateral internal jugular vein (IJV, 282 vs. 225 mL/min, p = 0.16), and in the contralateral IJV (322 vs. 285 mL/min, p = 0.09), but not in secondary veins. There was no significant difference in median ICP between AVM patients and control subjects (6.9 vs. 8.6 mmHg, p = 0.30) and ICP did not correlate with nidus volume in AVM patients (ρ = −0.06, p = 0.74). There was a significant positive correlation between tCBF and craniospinal CSF stroke volume (ρ = 0.69, p = 0.02). Conclusions: The elevated cerebral blood flow in patients with AVMs is drained through an increased flow in IJVs but not secondary veins. ICP is maintained within ranges of normal and does not correlate with nidus volume.

  18. Abnormalities of Microcirculation and Intracranial and Cerebral Perfusion Pressures in Severe Brain Injury

    Directory of Open Access Journals (Sweden)

    Yu. A. Churlyaev

    2008-01-01

    Full Text Available Objective: to evaluate the states of microcirculation, cerebral perfusion intracranial pressures in patients with isolated severe brain injury (SBI and to determine their possible relationships. Subjects and methods. 148 studies were performed in 16 victims with SBI. According to the outcome of brain traumatic disease, the patients were divided into two groups: 1 those who had a good outcome (n=8 and 2 those who had a fatal outcome (n=8. Microcirculation was examined by skin laser Doppler flowmetry using a LAKK-01 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation. All the victims underwent surgical interventions to remove epi-, subdural, and intracerebral hematomas. A Codman subdural/intraparenchymatous intracranial pressure (ICD sensor (Johnson & Johnson, United Kingdom was intraoperatively inserted in the victims. Cerebral perfusion pressure (CPP was calculated using the generally accepted formula: CPP = MBP (mean blood pressure — ICD. ICD, CPP, and microcirculation were studied on postoperative days 1, 3, 5, and 7. Their values were recorded simultaneously. Ninety and 58 studies were conducted in the group of patients with good and fatal outcomes, respectively. Results. No correlation between the changes in MBP, ICD, and microcirculatory parameters suggested that the value of ICD was determined by the nature of brain damage and it was the leading and determining indicator in the diagnosis and treatment of secondary cerebral lesions. The amplitude of low-frequency fluctuations directly correlated with ICD, which indicated that they might be used to evaluate cerebral perfusion and impaired cerebral circulation indirectly in victims with severe brain injury. Conclusion. The laser Doppler flowmetric technique makes it possible not only to qualitatively, but also quantitatively determine changes in the tissue blood flow system in severe brain injury. With this technique, both the local and central

  19. Occipital Intraosseous Hemangioma over Torcula: Unusual Presentation with Raised Intracranial Pressure.

    Science.gov (United States)

    Rao, K V L N; Beniwal, Manish; Vazhayil, Vikas; Somanna, Sampath; Yasha, T C

    2017-12-01

    Hemangiomas of the bone are benign, uncommon, slow-growing lesions accounting for occipital hemangiomas are rare, and occipital hemangiomas presenting with features of raised intracranial tension are, with only 2 cases reported to date. In this case report, we describe the unique case of a 30-year-old male patient presenting with raised intracranial pressure due to venous obstruction at the torcula. The patient underwent excision of the lesion and became symptom free. Although these are benign lesions, they can have a varied clinical presentation. An understanding of the different clinical presentations and surgical nuances in excising such tumors can lead to early diagnosis and good patient outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. A Quad-Cantilevered Plate micro-sensor for intracranial pressure measurement.

    Science.gov (United States)

    Lalkov, Vasko; Qasaimeh, Mohammad A

    2017-07-01

    This paper proposes a new design for pressure-sensing micro-plate platform to bring higher sensitivity to a pressure sensor based on piezoresistive MEMS sensing mechanism. The proposed design is composed of a suspended plate having four stepped cantilever beams connected to its corners, and thus defined as Quad-Cantilevered Plate (QCP). Finite element analysis was performed to determine the optimal design for sensitivity and structural stability under a range of applied forces. Furthermore, a piezoresistive analysis was performed to calculate sensor sensitivity. Both the maximum stress and the change in resistance of the piezoresistor associated with the QCP were found to be higher compared to previously published designs, and linearly related to the applied pressure as desired. Therefore, the QCP demonstrates greater sensitivity, and could be potentially used as an efficient pressure sensor for intracranial pressure measurement.

  1. Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients

    DEFF Research Database (Denmark)

    Petersen, Lonnie Grove; Petersen, Johan Casper Grove; Andresen, Morten

    2016-01-01

    .4±4.2 mmHg when standing up (Phydrostatic pressure gradient with reference just below the heart, likely reflecting the venous hydrostatic...... indifference point. When upright, the decrease in ICP was attenuated, corresponding to formation of a separate hydrostatic gradient with reference to the base of the skull, likely reflecting the site of venous collapse. ICP therefore seems to be governed by pressure in the draining veins and collapse of neck......We evaluated postural effects on intracranial pressure (ICP) and cerebral perfusion pressure (CPP: mean arterial pressure (MAP) - ICP) in neurosurgical patients undergoing 24-hour ICP monitoring as part of their diagnostic workup. We identified 9 patients (5 women, age 44±20 yrs.; mean±SD) who were...

  2. Electrostatic discharges and their effect on the validity of registered values in intracranial pressure monitors

    DEFF Research Database (Denmark)

    Andresen, Morten; Thomsen, Ole Cornelius; Juhler, Marianne

    2013-01-01

    Object Intracranial pressure (ICP) monitoring is used extensively in clinical practice, and as such, the accuracy of registered ICP values is paramount. Clinical observations of nonphysiological changes in ICP have called into question the accuracy of registered ICP values. Subsequently, the auth......Object Intracranial pressure (ICP) monitoring is used extensively in clinical practice, and as such, the accuracy of registered ICP values is paramount. Clinical observations of nonphysiological changes in ICP have called into question the accuracy of registered ICP values. Subsequently......, the authors have tried to determine if the ICP monitors from major manufacturers were affected by electrostatic discharges (ESDs), if the changes were permanent or transient in nature, and if the changes were modified by the addition of different electrical appliances normally used in the neurointensive care....... Results Five pressure monitors from 4 manufacturers were evaluated. Three monitors containing electrical circuitry at the tip of the transducer were all affected by ESDs. Clinically significant permanent changes in the reported ICP values for 1 pressure monitor were observed, as well as temporary...

  3. Reversal in the Diameter of the Superior Ophthalmic Vein after an Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Hsiao, Chen Yu; Tsai, Yuh Feng

    2011-01-01

    Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the 'reversal of the SOV' sign.

  4. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

    Directory of Open Access Journals (Sweden)

    Anton Lund

    2017-01-01

    Full Text Available Dialysis disequilibrium syndrome (DDS is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

  5. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury.

    Science.gov (United States)

    Lund, Anton; Damholt, Mette B; Strange, Ditte G; Kelsen, Jesper; Møller-Sørensen, Hasse; Møller, Kirsten

    2017-01-01

    Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

  6. Assessment of the usability of a digital learning technology prototype for monitoring intracranial pressure

    Directory of Open Access Journals (Sweden)

    Lilian Regina de Carvalho

    Full Text Available ABSTRACT Objective: to assess the usability of a digital learning technology prototype as a new method for minimally invasive monitoring of intracranial pressure. Method: descriptive study using a quantitative approach on assessing the usability of a prototype based on Nielsen's ten heuristics. Four experts in the area of Human-Computer interaction participated in the study. Results: the evaluation delivered eight violated heuristics and 31 usability problems in the 32 screens of the prototype. Conclusion: the suggestions of the evaluators were critical for developing an intuitive, user-friendly interface and will be included in the final version of the digital learning technology.

  7. Isoflurane rescue therapy for bronchospasm reduces intracranial pressure in a patient with traumatic brain injury.

    Science.gov (United States)

    Gradisek, Primoz; Dolenc, Simon

    2016-01-01

    To assess the unusual use of a volatile anaesthetic for treatment of life-threatening bronchospasm in a patient with traumatic brain injury (TBI). Case report. This study presents a previously healthy 30-year-old man with severe TBI and bronchospasm-induced acute hypercapnia. He was treated with inhaled isoflurane in combination with monitoring of intracranial pressure (ICP) and regional cerebral blood flow (rCBF). Three-day-long isoflurane treatment resolved drug-refractory bronchospasm, decreased airway pressure and improved gas exchange, even at a low end-tidal concentration (0.3-0.5 vol%). Although rCBF was increased by 18 ml min(-1) 100 g(-1) during isoflurane treatment, there was a significant decrease in ICP (21 (SD = 3) mmHg, 9 (SD = 5) mmHg, 2 (SD = 3) mmHg; during pre-treatment, treatment and post-treatment, respectively; p < 0.001). Improved autoregulation due to lower partial pressure of carbon dioxide, restoration of carbon dioxide reactivity, isoflurane-induced regional differences in rCBF and improved microcirculation may have been responsible for the prompt and long-lasting normalization of ICP. The patient had no TBI-related disability at 6 months post-injury. Isoflurane at a low dose can be an effective and safe treatment option for drug-refractory bronchospasm in a patient with traumatic intracranial hypertension, provided that multimodality neuromonitoring is used.

  8. EFFECTS OF L-LYSINE AESCINAT ON INTRACRANIAL PRESSURE IN CRITICALLY ILL PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

    Directory of Open Access Journals (Sweden)

    S. S. Petrikov

    2016-01-01

    Full Text Available Abstract. Increased intracranial pressure results in cerebral blood flow decrease and cerebral edema formation. Correction of intracranial hypertension is one of the most important goals of intensive care in patients with severe traumatic brain injury. Objectives To determine the effects of L-lysine aescinat on ICP in patients with severe TBI.Material and methods. Twenty patients with TBI and Glasgow coma scale below 9 enrolled in the study. All patients were operated: 6 patients underwent craniotomy and intracranial hematoma removing; 11 — decompressive craniotomy and intracranial hematoma removing. In 3 patients only ICP-sensor was implanted. ICP-monitoring was used in all patients. Ten patients were randomized to L-lysine aescinat treatment (daily dose of 20 ml for 7 days after surgery (study group, 10 — to standard therapy (control group. We perfomed a comparative analysis of the mean ICP and the incidence of ICH within 7 days after surgery in the study and control groups.Results. The length of ICP monitoring was 6.4±3.7 days: in the control group — 7.6±4.9 days, in the study group — 5.2±1.4 days. Mean intracranial pressure was less in the study group as compared to patients in the control group. The number of intracranial hypertension episodes was higher in the control group compared with patients who received L-lysine aescinat.Conclusion. L-lysine aescinat treatment in patients with severe traumatic brain injury is accompanied by reduction of mean intracranial pressure and the number of intracranial hypertension episodes.

  9. Frank-ter Haar syndrome associated with sagittal craniosynostosis and raised intracranial pressure.

    Science.gov (United States)

    Bendon, Charlotte L; Fenwick, Aimée L; Hurst, Jane A; Nürnberg, Gudrun; Nürnberg, Peter; Wall, Steven A; Wilkie, Andrew O M; Johnson, David

    2012-11-09

    Frank-ter Haar syndrome is a rare disorder associated with skeletal, cardiac, ocular and craniofacial features including hypertelorism and brachycephaly. The most common underlying genetic defect in Frank-ter Haar syndrome appears to be a mutation in the SH3PXD2B gene on chromosome 5q35.1. Craniosynostosis, or premature fusion of the calvarial sutures, has not previously been described in Frank-ter Haar syndrome. We present a family of three affected siblings born to consanguineous parents with clinical features in keeping with a diagnosis of Frank-ter Haar syndrome. All three siblings have a novel mutation caused by the deletion of exon 13 of the SH3PXD2B gene. Two of the three siblings also have non-scaphocephalic sagittal synostosis associated with raised intracranial pressure. The clinical features of craniosynostosis and raised intracranial pressure in this family with a confirmed diagnosis of Frank-ter Haar syndrome expand the clinical spectrum of the disease. The abnormal cranial proportions in a mouse model of the disease suggests that the association is not coincidental. The possibility of craniosynostosis should be considered in individuals with a suspected diagnosis of Frank-ter Haar syndrome.

  10. Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?

    Science.gov (United States)

    Bateman, Grant A; Lechner-Scott, Jeannette; Copping, Ross; Moeskops, Christopher; Yap, Swee Leong

    2017-07-06

    There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls. The SSS area was reduced by 25% in hydrocephalus (p = 0.0008), increased by 22% (p = 0.037) in SIH and unchanged in IIH compared to matched controls. In MS there was a 16% increase in SSS area (p = 0.01).The findings suggest that changes in SSS cross-sectional are common between MS and SIH patients, while in hydrocephalus and IIH these are different.

  11. A preliminary study for investigating idiopatic normal pressure hydrocephalus by means of statistical parameters classification of intracranial pressure recordings.

    Science.gov (United States)

    Calisto, A; Bramanti, A; Galeano, M; Angileri, F; Campobello, G; Serrano, S; Azzerboni, B

    2009-01-01

    The objective of this study is to investigate Id-iopatic Normal Pressure Hydrocephalus (INPH) through a multidimensional and multiparameter analysis of statistical data obtained from accurate analysis of Intracranial Pressure (ICP) recordings. Such a study could permit to detect new factors, correlated with therapeutic response, which are able to validate a predicting significance for infusion test. The algorithm developed by the authors computes 13 ICP parameter trends on each of the recording, afterward 9 statistical information from each trend is determined. All data are transferred to the datamining software WEKA. According to the exploited feature-selection techniques, the WEKA has revealed that the most significant statistical parameter is the maximum of Single-Wave-Amplitude: setting a 27 mmHg threshold leads to over 90% of correct classification.

  12. An investigation into the regulation of intra-cranial pressure and its influence upon the surrounding cranial bones.

    Science.gov (United States)

    Gard, Graham

    2009-07-01

    The aim of this study is to present a rational coherent hypothesis to explain the palpable involuntary movements of the cranium. The arterial and venous anatomy inside and around the skull and spinal column presents a complete vascular system with the capacity to regulate intra-cranial pressure to a level of equilibrium slightly higher than atmospheric pressure. Variations in cerebrospinal fluid (csf) pressure control the volume of blood draining through the cavernous sinus and hence into the inter-vertebral venous plexus in relation to the jugular vein. Stable intra-cranial pressure is maintained by a controlled release of venous blood through the inter-vertebral venous plexus (slow) and the jugular vein (fast) in the cavernous sinus. Any distortion of the skull from its healthy state will lead to reduced intra-cranial volume. The process of release from the state of compression has been interpreted as "cranial rhythm" but may be a mechanical adjustment increasing the internal volume of the skull, aided by the continual maintenance of stable intracranial pressure. This involuntary movement is capable of being assisted manually.

  13. Understanding idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Markey, Keira A; Mollan, Susan P; Jensen, Rigmor H

    2016-01-01

    Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus...

  14. Intracranial hemorrhage in normotensive and hypertensive patients receiving streptokinase after decreasing elevated blood pressure

    Directory of Open Access Journals (Sweden)

    H Shemirani

    2005-09-01

    Full Text Available Background: Many patients with suspected acute myocardial infarction (AMI and eligible for thrombolytic therapy may not be treated because of association between hemorrhagic complications especially intracranial hemorrhage (ICH, and severe hypertension (HTN at presentation. Unfortunately, this leads to under use or delay in thrombolytic therapy. We assessed effect of decreasing elevated blood pressure before thrombolytic therapy in order to reduce the incidence of ICH without increasing mortality rate. Methods: This observational and analytical cohort study enrolled 293 patients (215males and 78 female with STsegment elevation (AMI that were hospitalized in emergency department of Noor hospital, Isfahan, Iran. Severe hypertension (blood pressure ≥180/110mmHg was diagnosed in 132 patients. All of them received 1.5 million units streptokinase within one hour intravenously. In the hypertensive group, elevated blood pressure was lowered to less than180/110mmhg before thrombolysis and they were observed to detect development of symptomatic ICH and they underwent Brain CT scan, if required. Results: The incidence of total stroke, ICH and death were 1.4%, 0.7% and 4.8%, respectively. The incidence of death and ICH in patients with severe hypertension was less than control group (P value=0.13 and 0.59, respectively Conclusion: Although we did not find any increase in ICH incidence in severe hypertensive patients treated be streptokinase due to AMI, but we recommend a multi-centric study with more cases and varied thrombolytic protocols. Key words: Acute myocardial infarction, Intracranial hemorrhage, Thrombolytic therapy

  15. Blood Pressure and Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Mariusz Niemczyk

    2014-12-01

    Full Text Available Background/Aims: Autosomal dominant polycystic kidney disease (ADPKD is correlated with an increased frequency of both intracranial aneurysms (ICANs, and arterial hypertension (AH. The aim of our study was to search for the association between blood pressure (BP and ICANs in ADPKD patients. Methods: Sixty-eight adult, pre-dialysis phase ADPKD patients underwent both screening for ICANs with magnetic resonance angiography of the brain, and ambulatory blood pressure monitoring (ABPM. Results: ICANs were diagnosed in 10 patients (ICAN(+ group, while in 58 were not (ICAN(- group. The nighttime maximum diastolic blood pressure (DBP, maximum increase in DBP from measurement to measurement (positive delta of DBP at night, and the standard deviation of the daytime mean arterial pressure were significantly higher in ICAN(+ compared to ICAN(- patients. Additionally, in a subgroup of patients after 45 years-of-age, ICAN(+ patients had significantly higher maximum 24-hour and daytime systolic blood pressure, maximum 24-hour, daytime, nighttime DBP, maximum daytime and nighttime positive delta of DBP compared to ICAN(- cases. Conclusions: Development of ICANs in hypertensive ADPKD patients is accompanied with higher values of some BP parameters measured by ABPM. Hypertensive ADPKD patients with substantial fluctuations in BP assessed by ABPM, especially those after 45 years-of-age, should become candidates for screening for ICANs.

  16. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  17. Modification of encapsulation pressure of reverse micelles in liquid ethane.

    Science.gov (United States)

    Peterson, Ronald W; Nucci, Nathaniel V; Wand, A Joshua

    2011-09-01

    Encapsulation within reverse micelles dissolved in low viscosity fluids offers a potential solution to the slow tumbling problem presented by large soluble macromolecules to solution NMR spectroscopy. The reduction in effective macromolecular tumbling is directly dependent upon the viscosity of the solvent. Liquid ethane is of sufficiently low viscosity at pressures below 5000 psi to offer a significant advantage. Unfortunately, the viscosity of liquid ethane shows appreciable pressure dependence. Reverse micelle encapsulation in liquid ethane often requires significantly higher pressures, which obviates the potential advantages offered by liquid ethane over liquid propane. Addition of co-surfactants or co-solvents can be used to manipulate the minimum pressure required to obtain stable, well-behaved solutions of reverse micelles prepared in liquid ethane. A library of potential additives is examined and several candidates suitable for use with encapsulated proteins are described. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Fluid Shifts Before, During and After Prolonged Space Flight and Their Association with Intracranial Pressure and Visual Impairment

    Science.gov (United States)

    Stenger, Michael; Hargens, Alan; Dulchavsky, Scott

    2014-01-01

    Future human space travel will primarily consist of long duration missions onboard the International Space Station or exploration class missions to Mars, its moons, or nearby asteroids. Current evidence suggests that long duration missions might increase risk of permanent ocular structural and functional changes, possibly due to increased intracranial pressure resulting from a spaceflight-induced cephalad (headward) fluid shift.

  19. Automated intracranial pressure-controlled cerebrospinal fluid external drainage with LiquoGuard.

    Science.gov (United States)

    Linsler, Stefan; Schmidtke, Mareike; Steudel, Wolf Ingo; Kiefer, Michael; Oertel, Joachim

    2013-08-01

    LiquoGuard is a new device for intracranial pressure (ICP)-controlled drainage of cerebrospinal fluid (CSF). This present study evaluates the accuracy of ICP measurement via the LiquoGuard device in comparison with Spiegelberg. Thus, we compared data ascertained from simultaneous measurement of ICP using tip-transducer and tip-sensor devices. A total of 1,764 monitoring hours in 15 patients (range, 52-219 h) were analysed. All patients received an intraventricular Spiegelberg III probe with the drainage catheter connected to the LiquoGuard system. ICP reading of both devices was performed on an hourly basis. Statistical analysis was done by applying Pearson correlation and Wilcoxon-matched pair test (p drainage. However, LiquoGuard tends to provide misleading results in slit ventricles. Thus, before these drawbacks are further analysed, the authors recommend additional ICP measurement with internal tip-sensor devices to avoid dangerous erroneous interpretation of ICP data.

  20. Ophthalmic changes and increased intracranial pressure associated with long duration spaceflight: An emerging understanding

    Science.gov (United States)

    Marshall-Bowman, Karina; Barratt, Michael R.; Gibson, C. Robert

    2013-06-01

    For many years, there have been anecdotal reports of vision changes by astronauts following short and long-duration spaceflight. Much of this was attributed to hyperopic shifts related to the age of the flying population. However, it has recently been recognized that vision changes are actually quite common in astronauts and are associated with a constellation of findings including elevated intracranial pressure, optic disc edema, globe flattening, optic nerve sheath thickening, hyperopic shifts and retinal changes. With advanced imaging modalities available on the ground along with the fidelity of in-flight diagnostic capabilities previously unavailable, information on this newly recognized syndrome is accumulating. As of this writing, 11 cases of visual impairment experienced by astronauts during missions on-board the International Space Station (ISS) have been documented and studied. Although the exact mechanisms of the vision changes are unknown, it is hypothesized that increased intracranial pressure (ICP) is a contributing factor. Microgravity is the dominant cause of many physiological changes during spaceflight and is thought to contribute significantly to the observed ophthalmic changes. However, several secondary factors that could contribute to increased ICP and vision changes in spaceflight have been proposed. Possible contributors include microgravity-induced cephalad fluid shift, venous obstruction due to microgravity-induced anatomical shifts, high levels of spacecraft cabin carbon dioxide, heavy resistive exercise, and high sodium diet. Individual susceptibility to visual impairment is not fully understood, though a demographic of affected astronauts is emerging. This paper describes the current understanding of this newly recognized syndrome, presents data from 11 individual cases, and discusses details of potential contributing factors. The occurrence of visual changes in long duration missions in microgravity is one of the most significant

  1. Research on simulation and experiment of noninvasive intracranial pressure monitoring based on acoustoelasticity effects

    Directory of Open Access Journals (Sweden)

    Wu J

    2013-08-01

    Full Text Available Jun Wu1, Wei He2, Wei-min Chen1, Lian Zhu21Key Laboratory of Optoelectronic Technology and Systems, 2State Key Laboratory of Power Transmission Equipment and System Security and New Technology, Chongqing University, Chongqing, People’s Republic of ChinaAbstract: The real-time monitoring of intracranial pressure (ICP is very important for craniocerebrally critically ill patients, but it is very difficult to realize long-time monitoring for the traditional invasive method, which very easily infects patients. Many noninvasive methods have emerged, but these have not been able to monitor ICP for long periods in real time, and they are not ready for clinical application. In order to realize long-time, online, real-time, noninvasive monitoring for ICP, a new method based on acoustoelasticity of ultrasound is herein proposed. Experimental models were devised to research the new method for experiment and simulation. Polymethyl methacrylate and hydrogel were adopted for the experiment, and their mechanical properties were very close to the real brain. A numerical solution for acoustoelasticity theory was acquired by simulating calculation based on a finite-element method. This was compared to the experimental value. The results showed a consistent match between theoretical solution and experimental value, with maximum error at most 5%. Thus, the effectiveness of the new method was verified. Theoretical and practical foundation is provided for this new method, and it could be used for animal experimentation or clinical testing in further research.Keywords: medical instruments, noninvasive, intracranial pressure, ultrasonic, acoustoelasticity, biomechanics

  2. Feasibility of Telemetric Intracranial Pressure Monitoring in the Neuro Intensive Care Unit.

    Science.gov (United States)

    Lilja-Cyron, Alexander; Kelsen, Jesper; Andresen, Morten; Fugleholm, Kåre; Juhler, Marianne

    2018-05-03

    Intracranial pressure (ICP) monitoring is crucial in the management of acute neurosurgical conditions such as traumatic brain injury (TBI). However, pathological ICP may persist beyond the admission to the neuro intensive care unit (NICU). We investigated the feasibility of telemetric ICP monitoring in the NICU, as this technology provides the possibility of long-term ICP assessment beyond NICU discharge. In this prospective investigation, we implanted telemetric ICP sensors (Raumedic Neurovent-P-tel) instead of conventional, cabled ICP sensors in patients undergoing decompressive craniectomy. We recorded ICP curves, duration of ICP monitoring, signal quality, and complications. Seventeen patients were included (median age 55 years) and diagnoses were: severe TBI (8), malignant middle cerebral artery infarction (8), and spontaneous intracerebral hemorrhage (1). In total, 3015 h of ICP monitoring were performed, and the median duration of ICP monitoring was 188 h (interquartile range [IQR] 54-259). The ICP signal was lost 613 times (displacement of the reader unit on the skin) for a median of 1.5 min, corresponding to 0.8% of the total monitoring period. When the signal was lost, it could always be restored by realignment of the reader unit on the skin above the telemetric sensor. Sixteen of 17 patients survived the NICU admission, and ICP gradually decreased from 10.7 mm Hg (IQR 7.5-13.6) during the first postoperative day to 6.3 mm Hg (IQR 4.0-8.3) after 1 week in the NICU. All 17 implanted telemetric sensors functioned throughout the NICU admission, and no wound infections were observed. Therefore, telemetric ICP monitoring in an acute neurosurgical setting is feasible. Signal quality and stability are sufficient for clinical decision making based on mean ICP. The low sampling frequency (5 Hz) does not permit analysis of intracranial pulse wave morphology, but resolution is sufficient for calculation of derived indices such as the pressure reactivity

  3. High Pressure Reverse Flow APS Engine

    Science.gov (United States)

    Senneff, J. M.

    1972-01-01

    A design and test demonstration effort was undertaken to evaluate the concept of the reverse flow engine for the APS engine application. The 1500 lb (6672 N) thrust engine was designed to operate on gaseous hydrogen and gaseous oxygen propellants at a mixture ratio of 4 and to achieve the objective performance of 435 sec (4266 Nsec/kg) specific impulse. Superimposed durability requirements called for a million-cycle capability with 50 hours duration. The program was undertaken as a series of tasks including the initial preliminary design, design of critical test components and finally, the design and demonstration of an altitude engine which could be used interchangeably to examine operating parameters as well as to demonstrate the capability of the concept. The program results are reported with data to indicate that all of the program objectives were met or exceeded within the course of testing on the program. The analysis effort undertaken is also reported in detail and supplemented with test data in some cases where prior definitions could not be made. The results are contained of these analyses as well as the test results conducted throughout the course of the program. Finally, the test data and analytical results were combined to allow recommendations for a flight weight design. This preliminary design effort is also detailed.

  4. Risk of Microgravity-Induced Visual Impairment and Elevated Intracranial Pressure (VIIP)

    Science.gov (United States)

    Otto, Christian

    2011-01-01

    Eight cases identified, represent 23.5% of the 34 crewmembers flown on the ISS, with inflight visual changes and pre-to-postflight refractive changes. In some cases, the changes were transient while in others they are persistent with varying degrees of visual impairment. (1) Decreased intraocular pressure (IOP) postflight was observed in 3 cases. (2) Fundoscopic exams revealed postflight findings of choroidal folds in 4 cases, optic disc edema in 5 cases and presence of cotton wool spots in 3 cases. (3) Optical coherence tomography (OCT) confirmed findings of choroidal folds and disc edema and documented retinal nerve fiber layer thickening (4 cases). (4) Findings from MRI examinations showed posterior globe flattening (5 cases) and optic nerve sheath distension (6 cases). (5) Opening cerebrospinal fluid (CSF) pressure was elevated in 4 cases postflight reflecting raised intracranial pressure. While the etiology remains unknown, hypotheses speculate that venous insufficiency or hypertension in the brain caused by cephalad fluid shifts during spaceflight are possible mechanisms for ocular changes in astronauts.

  5. Increased Intracranial Pressure and Visual Impairment Associated with Long-Duration Spaceflight

    Science.gov (United States)

    Marshall-Bowman, Karina

    2011-01-01

    Although humans have been flying in space since the 1960s, more recent missions have revealed a new suite of physiological adaptations and consequences of space flight. Notably, 60% of long-duration crewmembers (ISS/MIR) and >25% of short-duration (Shuttle) crewmembers have reported subjective degradation in vision (based on debrief comments) (Gibson 2011). Decreased near-visual acuity was demonstrated in 46% of ISS/Mir and 21% of Shuttle crewmembers, resulting in a shift of up to 1-2 diopters in their refractive correction. It is likely that the recently revealed ophthalmic changes have been present since the first days of human space flight, but have been overlooked or attributed to other causations. The reported changes in vision have occurred at various time points throughout missions, with ranging degrees of visual degradation. Although some cases resolved upon return to Earth, several astronauts have not regained preflight visual acuity, indicating that the damage may be permanent. While observing these changes over the years, without other overt symptomology and with the given age range of the flying population, this has largely been attributed to an expected hyperopic shift due to aging. However, the availability of onboard analysis techniques, including visual acuity assessments, retinal imagery, and ultrasounds of the eye and optic nerve tracts, along with more detailed post-flight techniques, has led to the recent recognition of a wider syndrome. Along with vision changes, findings include flattening of the globe, swelling of the optic disc (papilledema), choroidal folds in the retina, swelling of the optic nerve sheath, and visual field defects. It is widely hypothesized that this constellation of findings may be explained by an elevation of intracranial pressure (ICP). Out of the 60% of long-duration astronauts that have reported a subjective degradation in vision, a subset (currently 10 astronauts) have developed this syndrome. The National

  6. Cerebral blood flow changes in response to elevated intracranial pressure in rabbits and bluefish: a comparative study.

    Science.gov (United States)

    Beiner, J M; Olgivy, C S; DuBois, A B

    1997-03-01

    In mammals, the cerebrovascular response to increases in intracranial pressure may take the form of the Cushing response, which includes increased mean systemic arterial pressure, bradycardia and diminished respirations. The mechanism, effect and value of these responses are debated. Using laser-Doppler flowmetry to measure cerebral blood flow, we analyzed the cardiovascular responses to intracranial pressure raised by epidural infusion of mock cerebrospinal fluid in the bluefish and in the rabbit, and compare the results. A decline in cerebral blood flow preceding a rise in mean systemic arterial pressure was observed in both species. Unlike bluefish, rabbits exhibit a threshold of intracranial pressure below which cerebral blood flow was maintained and no cardiovascular changes were observed. The difference in response between the two species was due to the presence of an active autoregulatory system in the cerebral tissue of rabbits and its absence in bluefish. For both species studied, the stimulus for the Cushing response seems to be a decrement in cerebral blood flow. The resulting increase in the mean systemic arterial pressure restores cerebral blood flow to levels approaching controls.

  7. Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome

    DEFF Research Database (Denmark)

    Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan

    2013-01-01

    We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have...... an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led...

  8. Continuous monitoring of intracranial pressure after endoscopic third ventriculostomy in the management of CSF shunt failure.

    Science.gov (United States)

    Elgamal, E A

    2010-04-01

    The effectiveness of continuous intracranial pressure (ICP) monitoring in the adaptation period, after endoscopic third ventriculostomy (ETV), and removal of the failed shunt in the management of CSF shunt failure is assessed. Nine patients with active hydrocephalus presenting with CSF shunt obstruction or infection were managed by ETV, removal of the shunt and insertion of an external ventricular drain (EVD) containing an ICP sensor for the purpose of postoperative monitoring of the ICP, and intermittent drainage of CSF. Patient ages ranged from 8 months to 24 years, and six of them were females. Hydrocephalus was obstructive in seven patients, and multiloculated in two. Six patients had an ventriculoperitoneal shunt (VPS), one with a bilateral VPS, one patient had a ventriculoatrial shunt, and one had a VPS and cystoperitoneal shunt (CPS). Shunt failure was caused by obstruction in six patients and infection in three. The post-operative ICP monitoring period ranged from 1-7 days. Intracranial hypertension was persistent in the first day after ETV in 3 patients, and up to 110 mL of CSF were drained to improve its symptoms. ETV was successful in six patients and 3 had permanent VPS. Post-operative continuous ICP monitoring and EVD insertion were very useful in the treatment of CSF shunt failure with ETV. This procedure allowed intermittent CSF drainage, relieving symptoms of elevated ICP, and provided accurate assessment of the success of the ETV and patency of the stoma in the early postoperative days by CT ventriculography and can also be used to install antibiotics in cases of infection.

  9. Serum IL-6: a candidate biomarker for intracranial pressure elevation following isolated traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Ward Norman H

    2010-03-01

    Full Text Available Abstract Background Increased intracranial pressure (ICP is a serious, life-threatening, secondary event following traumatic brain injury (TBI. In many cases, ICP rises in a delayed fashion, reaching a maximal level 48-96 hours after the initial insult. While pressure catheters can be implanted to monitor ICP, there is no clinically proven method for determining a patient's risk for developing this pathology. Methods In the present study, we employed antibody array and Luminex-based screening methods to interrogate the levels of inflammatory cytokines in the serum of healthy volunteers and in severe TBI patients (GCS≤8 with or without incidence of elevated intracranial pressure (ICP. De-identified samples and ELISAs were used to confirm the sensitivity and specificity of IL-6 as a prognostic marker of elevated ICP in both isolated TBI patients, and polytrauma patients with TBI. Results Consistent with previous reports, we observed sustained increases in IL-6 levels in TBI patients irrespective of their ICP status. However, the group of patients who subsequently experienced ICP ≥ 25 mm Hg had significantly higher IL-6 levels within the first 17 hours of injury as compared to the patients whose ICP remained ≤20 mm Hg. When blinded samples (n = 22 were assessed, a serum IL-6 cut-off of 128 pg/ml correctly identified 85% of isolated TBI patients who subsequently developed elevated ICP, and values between these cut-off values correctly identified 75% of all patients whose ICP remained ≤20 mm Hg throughout the study period. In contrast, the marker had no prognostic value in predicting elevated ICP in polytrauma patients with TBI. When the levels of serum IL-6 were assessed in patients with orthopedic injury (n = 7 in the absence of TBI, a significant increase was found in these patients compared to healthy volunteers, albeit lower than that observed in TBI patients. Conclusions Our results suggest that serum IL-6 can be used for the

  10. Miniature Coplanar Implantable Antenna on Thin and Flexible Platform for Fully Wireless Intracranial Pressure Monitoring System

    Directory of Open Access Journals (Sweden)

    M. Waqas A. Khan

    2017-01-01

    Full Text Available Minimally invasive approach to intracranial pressure monitoring is desired for long-term diagnostics. The monitored pressure is transmitted outside the skull through an implant antenna. We present a new miniature (6 mm × 5 mm coplanar implant antenna and its integration on a sensor platform to establish a far-field data link for the sensor readout at distances of 0.5 to 1 meter. The implant antenna was developed using full-wave electromagnetic simulator and measured in a liquid phantom mimicking the dielectric properties of the human head. It achieved impedance reflection coefficient better than −10 dB from 2.38 GHz to 2.54 GHz which covers the targeted industrial, scientific, and medical band. Experiments resulted in an acceptable peak gain of approximately −23 dBi. The implant antenna was submerged in the liquid phantom and interfaced to a 0.5 mW voltage controlled oscillator. To verify the implant antenna performance as a part of the ICP monitoring system, we recorded the radiated signal strength using a spectrum analyzer. Using a half-wavelength dipole as the receiving antenna, we captured approximately −58.7 dBm signal at a distance of 1 m from the implant antenna which is well above for the reader with sensitivity of −80 dBm.

  11. An Embedded Device for Real-Time Noninvasive Intracranial Pressure Estimation.

    Science.gov (United States)

    Matthews, Jonathan M; Fanelli, Andrea; Heldt, Thomas

    2018-01-01

    The monitoring of intracranial pressure (ICP) is indicated for diagnosing and guiding therapy in many neurological conditions. Current monitoring methods, however, are highly invasive, limiting their use to the most critically ill patients only. Our goal is to develop and test an embedded device that performs all necessary mathematical operations in real-time for noninvasive ICP (nICP) estimation based on a previously developed model-based approach that uses cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) waveforms. The nICP estimation algorithm along with the required preprocessing steps were implemented on an NXP LPC4337 microcontroller unit (MCU). A prototype device using the MCU was also developed, complete with display, recording functionality, and peripheral interfaces for ABP and CBFV monitoring hardware. The device produces an estimate of mean ICP once per minute and performs the necessary computations in 410 ms, on average. Real-time nICP estimates differed from the original batch-mode MATLAB implementation of theestimation algorithm by 0.63 mmHg (root-mean-square error). We have demonstrated that real-time nICP estimation is possible on a microprocessor platform, which offers the advantages of low cost, small size, and product modularity over a general-purpose computer. These attributes take a step toward the goal of real-time nICP estimation at the patient's bedside in a variety of clinical settings.

  12. A Novel Intracranial Pressure Readout Circuit for Passive Wireless LC Sensor.

    Science.gov (United States)

    Wang, Fa; Zhang, Xuan; Shokoueinejad, Mehdi; Iskandar, Bermans J; Medow, Joshua E; Webster, John G

    2017-10-01

    We present a wide frequency range, low cost, wireless intracranial pressure monitoring system, which includes an implantable passive sensor and an external reader. The passive sensor consists of two spiral coils and transduces the pressure change to a resonant frequency shift. The external portable reader reads out the sensor's resonant frequency over a wide frequency range (35 MHz-2.7 GHz). We propose a novel circuit topology, which tracks the system's impedance and phase change at a high frequency with low-cost components. This circuit is very simple and reliable. A prototype has been developed, and measurement results demonstrate that the device achieves a suitable measurement distance (>2 cm), sufficient sample frequency (>6 Hz), fine resolution, and good measurement accuracy for medical practice. Responsivity of this prototype is 0.92 MHz/mmHg and resolution is 0.028 mmHg. COMSOL specific absorption rate simulation proves that this system is safe. Considerations to improve the device performance have been discussed, which include the size of antenna, the power radiation, the Analog-to-digital converter (ADC) choice, and the signal processing algorithm.

  13. Reciprocal Influence of Slow Waves Extracted in Intracranial Pressure, Arterial Pressure and Cerebral Blood Velocity Signals

    National Research Council Canada - National Science Library

    Cervenansky, F

    2001-01-01

    ...), and arterial blood pressure (ABP). To clarify the links, we compared two frequency methods based on coherence function to estimate the influence of ICP, ABP, and CBV on couples, respectively CBV-ABP, ICP-CBV and ICP-ABP, of slow waves...

  14. Intracranial pressure-induced optic nerve sheath response as a predictive biomarker for optic disc edema in astronauts.

    Science.gov (United States)

    Wostyn, Peter; De Deyn, Peter Paul

    2017-11-01

    A significant proportion of the astronauts who spend extended periods in microgravity develop ophthalmic abnormalities. Understanding this syndrome, called visual impairment and intracranial pressure (VIIP), has become a high priority for National Aeronautics and Space Administration, especially in view of future long-duration missions (e.g., Mars missions). Moreover, to ensure selection of astronaut candidates who will be able to complete long-duration missions with low risk of the VIIP syndrome, it is imperative to identify biomarkers for VIIP risk prediction. Here, we hypothesize that the optic nerve sheath response to alterations in intracranial pressure may be a potential predictive biomarker for optic disc edema in astronauts. If confirmed, this biomarker could be used for preflight identification of astronauts at risk for developing VIIP-associated optic disc edema.

  15. Intracranial Pressure-Guided Shunt Valve Adjustments with the Miethke Sensor Reservoir.

    Science.gov (United States)

    Antes, Sebastian; Stadie, Axel; Müller, Simon; Linsler, Stefan; Breuskin, David; Oertel, Joachim

    2018-01-01

    Telemetric intracranial pressure (ICP) monitoring seems to be a promising therapy-supporting option in shunt-treated patients. Benefits become obvious when headaches are unspecific and clinical symptoms cannot be related to possible overdrainage or underdrainage. In this study, we evaluated a new telemetric device to individually adjust shunt valves according to ICP measurements. Between December 2015 and November 2016, 25 patients with suspected suboptimal shunt valve settings underwent insertion of a telemetric ICP sensor (Sensor Reservoir; Christoph Miethke, Potsdam, Germany). Over a 1-year period, a total of 183 telemetric ICP measurements and 85 shunt valve adjustments were carried out. Retrospective statistic analyses focused on valve adjustments, ICP values, and clinical outcomes. ICP-guided valve adjustments positively changed the clinical state in 18 out of 25 patients. Clinical improvement over time was associated with significant changes of the valve settings and ICP values. Interestingly, a therapeutically normalized ICP profile was not automatically associated with clinical improvement. The Sensor Reservoir is an important and valuable tool for shunt-treated patients suffering from drainage-related problems. The possibility to simultaneously recognize and solve shunt problems represents the decisive advantage. Nevertheless, measurements with the Sensor Reservoir did not allow for the determination of default valve settings or universal target ICP values. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. [Intracranial pressure monitoring and CSF dynamics in patients with neurological disorders: indications and practical considerations].

    Science.gov (United States)

    Poca, M; Sahuquillo, J

    2001-01-01

    The study of cerebrospinal fluid (CSF) dynamics is central to the diagnosis of adult chronic hydrocephalus (ACH). At present, many neurology and neurosurgery departments use one or more tests to guide diagnosis of this syndrome and to predict patient response to shunting. In specialised centres, the study of CSF dynamics is combined with continuous intracranial pressure (ICP) monitoring. Determination of several variables of CSF dynamics and definitions of qualitative and quantitative characteristics of ICP can be used to establish whether the hydrocephalus is active, compensated or arrested. CSF dynamics and ICP monitoring can also be used to check the correct functioning of the shunt and can be of use in the clinical management of patients with pseudotumor cerebri. Moreover, ICP monitoring is used to guide the treatment of several acute neurological processes. The aim of this review is to describe the fundamentals of CSF dynamics studies and the bases of continuous ICP monitoring. The advantages and disadvantages of several hydrodynamic tests that can be performed by lumbar puncture, as well as the normal and abnormal characteristics of an ICP recording, are discussed.

  17. NASA's Current Evidence and Hypothesis for the Visual Impairment and Intracranial Pressure Risk

    Science.gov (United States)

    Otto, Christian A.; Norsk, Peter; Oubre, Cherie M.; Pass, Anastas F.; Tarver, William

    2012-01-01

    While 40 years of human spaceflight exploration has reported visual decrement to a certain extent in a subgroup of astronauts, recent data suggests that there is indeed a subset of crewmembers that experience refraction changes (hyperoptic shift), cotton wool spot formation, choroidal fold development, papilledema, optic nerve sheath distention and/or posterior globe flattening with varying degrees of severity and permanence. Pre and postflight ocular measures have identified a potential risk of permanent visual changes as a result of microgravity exposure, which has been defined as the Visual Impairment and Intracranial Pressure risk (VIIP). The combination of symptoms are referred to as the VIIP syndrome. It is thought that the ocular structural and optic nerve changes are caused by events precipitated by the cephalad fluid shift crewmembers experience during long-duration spaceflight. Three important systems, ocular, cardiovascular, and central nervous, seem to be involved in the development of symptoms, but the etiology is still under speculation. It is believed that some crewmembers are more susceptible to these changes due to genetic/anatomical predisposition or lifestyle (fitness) related factors. Future research will focus on determining the etiology of the VIIP syndrome and development of mechanisms to mitigate the spaceflight risk.

  18. Non-invasive estimation of intracranial pressure. MR-based evaluation in children with hydrocephalus

    International Nuclear Information System (INIS)

    Muehlmann, M.; Steffinger, D.; Ertl-Wagner, B.; Koerte, I.K.; Peraud, A.; Lehner, M.; Heinen, F.; Alperin, N.

    2012-01-01

    The intracranial pressure (ICP) is a crucially important parameter for diagnostic and therapeutic decision-making in patients with hydrocephalus. So far there is no standard method to non-invasively assess the ICP. Various approaches to obtain the ICP semi-invasively or non-invasively are discussed and the clinical application of a magnetic resonance imaging (MRI)-based method to estimate ICP (MR-ICP) is demonstrated in a group of pediatric patients with hydrocephalus. Arterial inflow, venous drainage and craniospinal cerebrospinal fluid (CSF) flow were quantified using phase-contrast imaging to derive the MR-ICP. A total of 15 patients with hydrocephalus (n=9 treated with shunt placement or ventriculostomy) underwent MRI on a 3 T scanner applying retrospectively-gated cine phase contrast sequences. Of the patients six had clinical symptoms indicating increased ICP (age 2.5-14.61 years, mean 7.4 years) and nine patients had no clinical signs of elevated ICP (age 2.1-15.9 years; mean 9.8 years; all treated with shunt or ventriculostomy). Median MR-ICP in symptomatic patients was 24.5 mmHg (25th percentile 20.4 mmHg; 75th percentile 44.6 mmHg). Median MR-ICP in patients without acute signs of increased ICP was 9.8 mmHg (25th percentile 8.6 mmHg; 75th percentile 11.4 mmHg). Group differences were significant (p [de

  19. The effect of head-down tilt and water immersion on intracranial pressure in nonhuman primates

    Science.gov (United States)

    Keil, Lanny C.; Mckeever, Kenneth H.; Skidmore, Michael G.; Hines, John; Severs, Walter B.

    1992-01-01

    Intracranial pressure (ICP) is investigated in primates during and after -6-deg head-down tilt (HDT) and immersion in water to examine the effects of the headward fluid shift related to spaceflight. Following the HDT the primates are subjected to head-out thermoneutral water immersion, and the ICP is subsequently measured. ICP is found to increase from 3.8 +/- 1.1 to 5.3 +/- 1.3 mm Hg during the horizontal control period. ICP stabilizes at -6.3 +/- 1.3 mm Hg and then increases to -2.2 +/- 1.9 mm Hg during partial immersion, and ICP subsequently returns to preimmersion levels after immersion. These data indicate that exposure to HDT or water immersion lead to an early sharp increase in ICP, and water immersion alone leads to higher ICP levels. A significant conclusion of the work is that the ICP did not approach pathological levels, and this finding is relevant to human spaceflight research.

  20. Intracranial pressure monitoring in severe blunt head trauma: does the type of monitoring device matter?

    Science.gov (United States)

    Aiolfi, Alberto; Khor, Desmond; Cho, Jayun; Benjamin, Elizabeth; Inaba, Kenji; Demetriades, Demetrios

    2018-03-01

    OBJECTIVE Intracranial pressure (ICP) monitoring has become the standard of care in the management of severe head trauma. Intraventricular devices (IVDs) and intraparenchymal devices (IPDs) are the 2 most commonly used techniques for ICP monitoring. Despite the widespread use of these devices, very few studies have investigated the effect of device type on outcomes. The purpose of the present study was to compare outcomes between 2 types of ICP monitoring devices in patients with isolated severe blunt head trauma. METHODS This retrospective observational study was based on the American College of Surgeons Trauma Quality Improvement Program database, which was searched for all patients with isolated severe blunt head injury who had an ICP monitor placed in the 2-year period from 2013 to 2014. Extracted variables included demographics, comorbidities, mechanisms of injury, head injury specifics (epidural, subdural, subarachnoid, intracranial hemorrhage, and diffuse axonal injury), Abbreviated Injury Scale (AIS) score for each body area, Injury Severity Score (ISS), vital signs in the emergency department, and craniectomy. Outcomes included 30-day mortality, complications, number of ventilation days, intensive care unit and hospital lengths of stay, and functional independence. RESULTS During the study period, 105,721 patients had isolated severe traumatic brain injury (head AIS score ≥ 3). Overall, an ICP monitoring device was placed in 2562 patients (2.4%): 1358 (53%) had an IVD and 1204 (47%) had an IPD. The severity of the head AIS score did not affect the type of ICP monitoring selected. There was no difference in the median ISS; ISS > 15; head AIS Score 3, 4, or 5; or the need for craniectomy between the 2 device groups. Unadjusted 30-day mortality was significantly higher in the group with IVDs (29% vs 25.5%, p = 0.046); however, stepwise logistic regression analysis showed that the type of ICP monitoring was not an independent risk factor for death

  1. Quantitative relations between the eyeball, the optic nerve, and the optic canal important for intracranial pressure monitoring.

    Science.gov (United States)

    Vaiman, Michael; Gottlieb, Paul; Bekerman, Inessa

    2014-08-17

    To find correlations between diameters of the optic nerve sheath (ONSD), the eyeball, and the optic canal that might be important for intracranial pressure monitoring. In a prospective cohort study, the CT data of consecutive 400 adults (18+) with healthy eyes and optic nerves and absence of neurological diseases were collected and analyzed. When the CT scans were obtained, the diameters of the optic nerve sheath, the eyeball, and the optic canal were measured and statistically analyzed. The data obtained from the left and from the right eyeballs and optic nerves were compared. The correlation analysis was performed within these variables, with the gender, and the age. In healthy persons, the ONSD varies from 3.65 mm to 5.17 mm in different locations within the intraorbital space with no significant difference between sexes and age groups. There is a strong correlation between the eyeball transverse diameter (ETD) and ONSD that can be presented as ONSD/ETD index. In healthy subjects, the ONSD/ETD index equals 0.19. The calculation of an index when ONSD is divided by the ETD of the eyeball presents precise normative database for ONSD intracranial pressure measurement technique. When the ONSD is measured for intracranial pressure monitoring, the most stable results can be obtained if the diameter is measured 10 mm from the globe. These data might serve as a normative database at emergency departments and in general neurological practice.

  2. System for Rapid, Precise Modulation of Intraocular Pressure, toward Minimally-Invasive In Vivo Measurement of Intracranial Pressure.

    Directory of Open Access Journals (Sweden)

    Max A Stockslager

    Full Text Available Pathologic changes in intracranial pressure (ICP are commonly observed in a variety of medical conditions, including traumatic brain injury, stroke, brain tumors, and glaucoma. However, current ICP measurement techniques are invasive, requiring a lumbar puncture or surgical insertion of a cannula into the cerebrospinal fluid (CSF-filled ventricles of the brain. A potential alternative approach to ICP measurement leverages the unique anatomy of the central retinal vein, which is exposed to both intraocular pressure (IOP and ICP as it travels inside the eye and through the optic nerve; manipulating IOP while observing changes in the natural pulsations of the central retinal vein could potentially provide an accurate, indirect measure of ICP. As a step toward implementing this technique, we describe the design, fabrication, and characterization of a system that is capable of manipulating IOP in vivo with <0.1 mmHg resolution and settling times less than 2 seconds. In vitro tests were carried out to characterize system performance. Then, as a proof of concept, we used the system to manipulate IOP in tree shrews (Tupaia belangeri while video of the retinal vessels was recorded and the caliber of a selected vein was quantified. Modulating IOP using our system elicited a rapid change in the appearance of the retinal vein of interest: IOP was lowered from 10 to 3 mmHg, and retinal vein caliber sharply increased as IOP decreased from 7 to 5 mmHg. Another important feature of this technology is its capability to measure ocular compliance and outflow facility in vivo, as demonstrated in tree shrews. Collectively, these proof-of-concept demonstrations support the utility of this system to manipulate IOP for a variety of useful applications in ocular biomechanics, and provide a framework for further study of the mechanisms of retinal venous pulsation.

  3. Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11beta-HSD1 and intracranial pressure regulation?

    Science.gov (United States)

    Sinclair, Alexandra J; Walker, Elizabeth A; Burdon, Michael A; van Beek, Andre P; Kema, Ido P; Hughes, Beverly A; Murray, Philip I; Nightingale, Peter G; Stewart, Paul M; Rauz, Saaeha; Tomlinson, Jeremy W

    2010-12-01

    The etiology of idiopathic intracranial hypertension (IIH) is unknown. We hypothesized that obesity and elevated intracranial pressure may be linked through increased 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity. The aim was to characterize 11β-HSD1 in human cerebrospinal fluid (CSF) secretory [choroid plexus (CP)] and drainage [arachnoid granulation tissue (AGT)] structures, and to evaluate 11β-HSD1 activity after therapeutic weight loss in IIH. We conducted in vitro analysis of CP and AGT and a prospective in vivo cohort study set in two tertiary care centers. Twenty-five obese adult female patients with active IIH were studied, and 22 completed the study. Fasted serum, CSF, and 24-h urine samples were collected at baseline, after 3-month observation, and after a 3-month diet. Changes in urine, serum, and CSF glucocorticoids (measured by gas chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry) after weight loss were measured. 11β-HSD1 and key elements of the glucocorticoid signaling pathway were expressed in CP and AGT. After weight loss (14.2±7.8 kg; Plevels correlated with weight loss (r=-0.512; P=0.018). Therapeutic weight loss in IIH is associated with a reduction in global 11β-HSD1 activity. Elevated 11β-HSD1 may represent a pathogenic mechanism in IIH, potentially via manipulation of CSF dynamics at the CP and AGT. Although further clarification of the functional role of 11β-HSD1 in IIH is needed, our results suggest that 11β-HSD1 inhibition may have therapeutic potential in IIH.

  4. Noninvasive Intracranial Pressure and Tissue Oxygen Measurements for Space and Earth

    Science.gov (United States)

    Hargens, A. R.; Ballard, R. E.; Murthy, G.; Watenpaugh, D. E.

    1994-01-01

    The paper discusses the following: Increasing intracranial pressure in humans during simulated microgravity. and near-infrared monitoring of model chronic compartment syndrome in exercising skeletal muscle. Compared to upright-seated posture, 0 deg. supine, 6 deg. HDT, and 15 deg. HDT produced TMD changes of 317 +/- 112, 403 +/- 114, and 474 +/- 112 n1 (means +/- S.E.), respectively. Furthermore, postural transitions from 0 deg. supine to 6 deg. HDT and from 6 deg. to 15 deg. HDT generated significant TMD changes (p less than 0.05). There was no hysteresis when postural transitions to HDT were compared to reciprocal transitions toward upright seated posture. Currently, diagnosis of chronic compartment syndrome (CCS) depends on measurement of intramuscular pressure by invasive catheterization. We hypothesized that this syndrome can be detected noninvasively by near-infrared (NIR) spectroscopy, which tracks variations in muscle hemoglobin/myoglobin oxygen saturation. CCS was simulated in the tibialis anterior muscle of 7 male and 3 female subjects by gradual inflation of a cuff placed around the leg to 40 mmHg during 14 minutes of cyclic isokinetic dorsiflexion exercise. On a separate day, subjects underwent the identical exercise protocol with no external compression. In both cases, tissue oxygenation (T(sub O2) was measured in the tibialis anterior by NIR spectroscopy and normalized to a percentage scale between baseline and a T(sub O2) nadir reached during exercise to ischemic exhaustion. Over the course of exercise, T(sub O2) declined at a rate of 1.4 +/- 0.3% per minute with model CCS, yet did not decrease during control exercise. Post-exercise recovery of T(sub O2) was slower with model CCS (2.5 +/- 0.6 min) than in control (1.3 +/- 0.2 min). These results demonstrate that NIR spectroscopy can detect muscle deoxygenation caused by pathologically elevated intramuscular pressure in exercising skeletal muscle. Consequently, this technique shows promise as a

  5. Proteomic Assessment of Fluid Shifts and Association with Visual Impairment and Intracranial Pressure in Twin Astronauts

    Science.gov (United States)

    Rana, Brinda K.; Stenger, Michael B.; Lee, Stuart M. C.; Macias, Brandon R.; Siamwala, Jamila; Piening, Brian Donald; Hook, Vivian; Ebert, Doug; Patel, Hemal; Smith, Scott; hide

    2016-01-01

    BACKGROUND: Astronauts participating in long duration space missions are at an increased risk of physiological disruptions. The development of visual impairment and intracranial pressure (VIIP) syndrome is one of the leading health concerns for crew members on long-duration space missions; microgravity-induced fluid shifts and chronic elevated cabin CO2 may be contributing factors. By studying physiological and molecular changes in one identical twin during his 1-year ISS mission and his ground-based co-twin, this work extends a current NASA-funded investigation to assess space flight induced "Fluid Shifts" in association with the development of VIIP. This twin study uniquely integrates physiological and -omic signatures to further our understanding of the molecular mechanisms underlying space flight-induced VIIP. We are: (i) conducting longitudinal proteomic assessments of plasma to identify fluid regulation-related molecular pathways altered by long-term space flight; and (ii) integrating physiological and proteomic data with genomic data to understand the genomic mechanism by which these proteomic signatures are regulated. PURPOSE: We are exploring proteomic signatures and genomic mechanisms underlying space flight-induced VIIP symptoms with the future goal of developing early biomarkers to detect and monitor the progression of VIIP. This study is first to employ a male monozygous twin pair to systematically determine the impact of fluid distribution in microgravity, integrating a comprehensive set of structural and functional measures with proteomic, metabolomic and genomic data. This project has a broader impact on Earth-based clinical areas, such as traumatic brain injury-induced elevations of intracranial pressure, hydrocephalus, and glaucoma. HYPOTHESIS: We predict that the space-flown twin will experience a space flight-induced alteration in proteins and peptides related to fluid balance, fluid control and brain injury as compared to his pre-flight protein

  6. Semi-supervised detection of intracranial pressure alarms using waveform dynamics

    International Nuclear Information System (INIS)

    Scalzo, Fabien; Hu, Xiao

    2013-01-01

    Patient monitoring systems in intensive care units (ICU) are usually set to trigger alarms when abnormal values are detected. Alarms are generated by threshold-crossing rules that lead to high false alarm rates. This is a recognized issue that causes alarm fatigue, waste of human resources, and increased patient risks. Recently developed smart alarm models require alarms to be validated by experts during the training phase. The manual annotation process involved is time-consuming and virtually impossible to achieve for the thousands of alarms recorded in the ICU every week. To tackle this problem, we investigate in this study if the use of semi-supervised learning methods, that can naturally integrate unlabeled data samples in the model, can be used to improve the accuracy of the alarm detection. As a proof of concept, the detection system is evaluated on intracranial pressure (ICP) signal alarms. Specific morphological and trending features are extracted from the ICP signal waveform to capture the dynamic of the signal prior to alarms. This study is based on a comprehensive dataset of 4791 manually labeled alarms recorded from 108 neurosurgical patients. A comparative analysis is provided between kernel spectral regression (SR-KDA) and support vector machine (SVM) both modified for the semi-supervised setting. Results obtained during the experimental evaluations indicate that the two models can significantly reduce false alarms using unlabeled samples; especially in the presence of a restrained number of labeled examples. At a true alarm recognition rate of 99%, the false alarm reduction rates improved from 9% (supervised) to 27% (semi-supervised) for SR-KDA, and from 3% (supervised) to 16% (semi-supervised) for SVM. (paper)

  7. Optic nerve sheath diameter on fat-saturated T2-weighted orbital MR imaging reflects intracranial pressure

    International Nuclear Information System (INIS)

    Watanabe, Arata; Kinouchi, Hiroyuki; Horikoshi, Toru; Uchida, Mikito; Sakatsume, Satoshi

    2009-01-01

    Although dilated optic nerve sheath (ONS) is observed in the setting of increased intracranial pressure (ICP) such as idiopathic intracranial hypertension or hydrocephalus, the relationship between ONS diameter and ICP is unclear. We analyzed the relationship between subdural pressure measured during surgery in patients with chronic subdural fluid collections and ONS diameter measured on MR images. Orbital thin slice fat-saturated MR images were obtained within 24 hours before surgery and ONS diameters were measured just behind the optic globe. Subdural pressure was measured using a manometer before opening the dura mater during surgery. Significant correlation was found between the ONS diameter and subdural pressure (y=0.0618x+4.8219. y: ONS diameter (mm), x: subdural pressure (cmH 2 O), correlation coefficient: 0.505). The ONS diameter before surgery (6.1±0.7 mm) was significantly reduced after surgery (4.8±0.9 mm, p=0.003). Increased ONS diameter on MR images is a strong indicator of increased ICP we propose 6 mm as the normal limit of diameter just behind the eyeball because this value corresponds to the upper normal limit of ICP of around 20 cmH 2 O with above mentioned approximate curve. (author)

  8. Intracranial Monitoring after Severe Traumatic Brain Injury

    OpenAIRE

    Donnelly, Joseph

    2018-01-01

    Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated ...

  9. A fluid-structure interaction model of the internal carotid and ophthalmic arteries for the noninvasive intracranial pressure measurement method.

    Science.gov (United States)

    Misiulis, Edgaras; Džiugys, Algis; Navakas, Robertas; Striūgas, Nerijus

    2017-05-01

    Accurate and clinically safe measurements of intracranial pressure (ICP) are crucial for secondary brain damage prevention. There are two methods of ICP measurement: invasive and noninvasive. Invasive methods are clinically unsafe; therefore, safer noninvasive methods are being developed. One of the noninvasive ICP measurement methods implements the balance principle, which assumes that if the velocity of blood flow in both ophthalmic artery segments - the intracranial (IOA) and extracranial (EOA) - is equal, then the acting ICP on the IOA and the external pressure (Pe) on the EOA are also equal. To investigate the assumption of the balance principle, a generalized computational model incorporating a fluid-structure interaction (FSI) module was created and used to simulate noninvasive ICP measurement by accounting for the time-dependent behavior of the elastic internal carotid (ICA) and ophthalmic (OA) arteries and their interaction with pulsatile blood flow. It was found that the extra balance pressure term, which incorporates the hydrodynamic pressure drop between measurement points, must be added into the balance equation, and the corrections on a difference between the velocity of blood flow in the IOA and EOA must be made, due to a difference in the blood flow rate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Intracranial Hemorrhage

    Science.gov (United States)

    2011-01-01

    Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy. PMID:22167847

  11. Diffusion tensor imaging detects early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus

    Science.gov (United States)

    Zhao, Cailei; Li, Yongxin; Cao, Weiguo; Xiang, Kui; Zhang, Heye; Yang, Jian; Gan, Yungen

    2016-01-01

    Abstract To explore the use of diffusion tensor imaging (DTI) parameters in the quantitative assessment of early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus. Ten patients with communicating hydrocephalus (age: 2–36 months) and 14 age-/gender-matched controls (age: 2–36 months) were enrolled in this study. All patients underwent the ventriculoperitoneal shunt procedure. The imaging data were collected before and 3 months after the operation. Regions of interests (ROIs) included the white matter near the frontal horn of the lateral ventricles (FHLV), the occipital horn of the lateral ventricles (OHLV), occipital subcortical (OS) area, frontal subcortical (FS) area, and thalamus. Fractional anisotropies (FA) and apparent diffusion coefficients (ADC) of the ROIs before and after ventriculoperitoneal shunt were compared between the patients and the controls. Three months after surgery, the patients recovered from the surgery with ameliorated intracranial pressure and slight improvement of clinical intelligence scale and motor scale. Before ventriculoperitoneal shunt, the FA values (except the right FHLV) were significantly decreased and the ADC values were significantly increased in the patients with hydrocephalus, compared with the controls. After the ventriculoperitoneal shunt, the FA values in the FHLV and OHLV of the patients were similar to the controls, but the FA values in other ROIs were still significantly lower than controls. The ADC values in the FS and OS white matter areas of the patients were similar to the controls; however, the ADC values in other ROIs were still significantly higher in patients. The increase of FA and the reduction in ADC in the ROIs preceded the clinical function improvement in patients with high intracranial pressure hydrocephalus and reflected the early changes in brain tissue microstructure, such as the compression of the white matter areas in

  12. Intracranial Pressure Response to Non-Penetrating Ballistic Impact: An Experimental Study Using a Pig Physical Head Model and Live Pigs

    Science.gov (United States)

    Liu, Hai; Kang, Jianyi; Chen, Jing; Li, Guanhua; Li, Xiaoxia; Wang, Jianmin

    2012-01-01

    This study was conducted to characterize the intracranial pressure response to non-penetrating ballistic impact using a "scalp-skull-brain" pig physical head model and live pigs. Forty-eight ballistic tests targeting the physical head model and anesthetized pigs protected by aramid plates were conducted with standard 9 mm bullets at low (279-297 m/s), moderate (350-372 m/s), and high (409-436 m/s) velocities. Intracranial pressure responses were recorded with pressure sensors embedded in similar brain locations in the physical head model and the anesthetized pigs. Three parameters of intracranial pressure were determined from the measured data: intracranial maximum pressure (Pmax), intracranial maximum pressure impulse (PImax), and the duration of the first positive phase (PPD). The intracranial pressure waves exhibited blast-like characteristics for both the physical model and l live pigs. Of all three parameters, Pmax is most sensitive to impact velocity, with means of 126 kPa (219 kPa), 178 kPa (474 kPa), and 241 kPa (751 kPa) for the physical model (live pigs) for low, moderate, and high impact velocities, respectively. The mean PPD becomes increasingly short as the impact velocity increases, whereas PImax shows the opposite trend. Although the pressure parameters of the physical model were much lower than those of the live pigs, good correlations between the physical model and the live pigs for the three pressure parameters, especially Pmax, were found using linear regression. This investigation suggests that Pmax is a preferred parameter for predicting the severity of the brain injury resulting from behind armor blunt trauma (BABT). PMID:23055817

  13. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

    DEFF Research Database (Denmark)

    Lund, Anton; Damholt, Mette B; Strange, Ditte G

    2017-01-01

    Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strateg...

  14. Assessment of the usability of a digital learning technology prototype for monitoring intracranial pressure.

    Science.gov (United States)

    Carvalho, Lilian Regina de; Évora, Yolanda Dora Martinez; Zem-Mascarenhas, Silvia Helena

    2016-08-29

    to assess the usability of a digital learning technology prototype as a new method for minimally invasive monitoring of intracranial pressure. descriptive study using a quantitative approach on assessing the usability of a prototype based on Nielsen's ten heuristics. Four experts in the area of Human-Computer interaction participated in the study. the evaluation delivered eight violated heuristics and 31 usability problems in the 32 screens of the prototype. the suggestions of the evaluators were critical for developing an intuitive, user-friendly interface and will be included in the final version of the digital learning technology. avaliar a usabilidade de um protótipo educacional digital sobre um novo método para monitoração da pressão intracraniana de forma minimamente invasivo para enfermeiros e médicos. estudo descritivo com abordagem quantitativa sobre a avaliação de usabilidade de um protótipo com base nas dez Heurísticas de Nielsen. Participaram quatro especialistas da área de Interação Humano Computador. a avaliação resultou em oito heurísticas violadas e 31 problemas de usabilidade nas 32 telas do protótipo. as sugestões dos avaliadores foram cruciais para o desenvolvimento de uma interface amigável e intuitiva e serão consideradas na versão final da tecnologia educacional digital. evaluar la usabilidad de un prototipo educacional digital sobre un nuevo método para monitorización de la presión intracraneal, de manera mínimamente invasiva. estudio descriptivo con abordaje cuantitativo sobre la evaluación de usabilidad de un prototipo con base en las diez reglas Heurísticas de Nielsen. Participaron cuatro especialistas del área de Interacción Humana Computador. la evaluación resultó en ocho reglas heurísticas violadas y 31 problemas de usabilidad en las 32 pantallas del prototipo. las sugestiones de los evaluadores fueron cruciales para el desarrollo de una interfaz amigable e intuitiva y éstas serán consideradas en la

  15. Transethmoidal encephalocele after reduction of high intracranial pressure in aqueductal stenosis.

    Science.gov (United States)

    Sharifi, Guive; Alavi, Ehsan; Jalessi, Maryam; Haddadian, Karim; Faramarzi, Faezeh

    2014-01-01

    Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature. We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma. CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur.

  16. Temperature variability in the day-night cycle is associated with further intracranial pressure during therapeutic hypothermia.

    Science.gov (United States)

    Nogueira, Adriano Barreto; Annen, Eva; Boss, Oliver; Farokhzad, Faraneh; Sikorski, Christopher; Keller, Emanuela

    2017-08-03

    To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia. We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP 24 ). We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm. ICP 24 ranged from 11.5 ± 3.1 to 24.2 ± 6.2 mmHg. The ratio between the coefficient of variation of temperature during the nocturnal period (18:00-6:00) and the preceding diurnal period (6:00-18:00) [temperature variability (TV)] ranged from 0.274 to 1.97. Regression analysis showed that TV correlated with ICP 24 (Pearson correlation = -0.861, adjusted R square = 0.725, p TV) mmHg or, for 80% prediction interval, [Formula: see text] mmHg. The results indicate that the occurrence of ICP 24 higher than 20 mmHg is unlikely after a day with TV ≥1.0. TV correlates with further ICP during hypothermia regardless the strict range that temperature is maintained. Further studies with larger series could clarify whether intracranial hypertension in severe brain injury can be predicted by analysis of oscillation patterns of autonomic parameters across a period of 24 h or its harmonics.

  17. The Cushing Reflex: Oliguria as a Reflection of an Elevated Intracranial Pressure

    Directory of Open Access Journals (Sweden)

    K. Leyssens

    2017-01-01

    Full Text Available Oliguria is one of the clinical hallmarks of renal failure. The broad differential diagnosis is well known, but a rare cause of oliguria is intracranial hypertension (ICH. The actual knowledge to explain this relationship is scarce. Almost all literature is about animals where authors describe the Cushing reflex in response to ICH. We hypothesize that the Cushing reflex is translated towards the sympathetic nervous system and renin-angiotensin-aldosterone system with a subsequent reduction in medullary blood flow and oliguria. Recently, we were confronted with a patient who had complicated pituitary surgery and displayed multiple times an oliguria while he developed ICH.

  18. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique.

    Science.gov (United States)

    Tsunoda, A; Mitsuoka, H; Sato, K; Kanayama, S

    2000-06-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin-echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH.

  19. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique

    International Nuclear Information System (INIS)

    Tsunoda, A.; Mitsuoka, H.; Sato, K.; Kanayama, S.

    2000-01-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin- echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH. (orig.)

  20. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique

    Energy Technology Data Exchange (ETDEWEB)

    Tsunoda, A. [Department of Neurosurgery, Koshigaya Municipal Hospital, 10-47-1 Higashikoshigaya, Koshigaya City, Saitama 343-0023 (Japan); Mitsuoka, H.; Sato, K. [Department of Neurosurgery, Juntendo University (Japan); Kanayama, S. [Research and Development Centre, Toshiba Corporation (Japan)

    2000-06-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin- echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH. (orig.)

  1. Effect of Elevated Intracranial Pressure on Amplitudes and Frequency Tuning of Ocular Vestibular Evoked Myogenic Potentials Elicited by Bone-Conducted Vibration.

    Science.gov (United States)

    Gürkov, Robert; Speierer, Guillaume; Wittwer, Luis; Kalla, Roger

    Recently, it could be demonstrated that an increased intracranial pressure causes a modulation of the air conducted sound evoked ocular vestibular evoked myogenic potential (oVEMP). The mechanism for this modulation is not resolved and may depend on a change of either receptor excitability or sound energy transmission. oVEMPs were elicited in 18 healthy subjects with a minishaker delivering 500 and 1000 Hz tone bursts, in supine and tilted positions. The study could confirm the frequency tuning of oVEMP. However, at neither stimulus frequency could a modulating effect of increased intracranial pressure be observed. These data suggest that the observed modulation of the oVEMP response by an increased intracranial pressure is primarily due to the effect of an increased intralabyrinthine pressure onto the stiffness of the inner ear contents and the middle ear-inner ear junction. Future studies on the effect of intracranial pressure on oVEMP should use air-conducted sound and not bone-conducted vibration.

  2. Time Course of Changes in Extravascular Lung Water Index, Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders

    Directory of Open Access Journals (Sweden)

    Yu. A. Churlyaev

    2009-01-01

    Full Text Available Objective: to study the time course of changes in extravascular lung water index (ELWI and intracranial and cerebral perfusion pressures (ICP and CPP and to determine their possible relationships in acute cerebral circulatory disorders (ACCD. Subject and methods. ELWI, pulmonary vascular permeability index (PVPI, ICP, CPP, and central hemodynamics were studied by transpulmonary thermodilution and current X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. Results. Examinations revealed a supratentorial dislocation of the brain in 6 persons; its subtento-rial dislocation was found in 1 case; supra- and subtentorial dislocations were seen in 6. In patients, ELWI and PVPI increased from days 1 and 5, respectively. The high baseline ICP increased over time. CPP remained unchanged. Preserved left ventricular contractility, enhanced myocardial one, a significant direct correlation between ELWI and PVPI, as well as their increase confirmed that the noncardiogenic genesis was responsible for increased ELWI. A direct significant correlation was found between ICP and ELWI, ICP and PVPI. Against this background, acute respiratory distress syndrome developed in 14 patients with pneumonia evolving in its presence in 7 patients. Conclusion. In ACCD, ELWI increases in the first 24 hours of the acute period. One of its causes is, along with others, primary and/or secondary damage to the brainstem structures with elevated ICP and progressive brain dislocation. The determination of ICP, unlike CPP, is crucial in the diagnosis and treatment of primary/secondary brain injuries and in prognosis. Key words: acute cerebral circulatory disorder, extravascular lung fluid, pulmonary vascular permeability, intracranial pressure, cerebral perfusion pressure, acute respiratory distress syndrome.

  3. Post Traumatic Cerebral Oedema in Severe Head Injury is Related to Intracranial Pressure and Cerebral Perfusion Pressure but not to Cerebral Compliance

    Directory of Open Access Journals (Sweden)

    U Nujaimin

    2009-07-01

    Full Text Available This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP as well as cerebral perfusion pressure (CPP with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure

  4. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    OBJECT: Cerebral ischemia remains the key cause of disability and death in the late phase after subarachnoid hemorrhage (SAH), and its pathogenesis is still poorly understood. The purpose of this study was to examine whether the change in intracranial pressure or the extravasated blood causes the...

  5. Fifty shades of gradients: does the pressure gradient in venous sinus stenting for idiopathic intracranial hypertension matter? A systematic review.

    Science.gov (United States)

    McDougall, Cameron M; Ban, Vin Shen; Beecher, Jeffrey; Pride, Lee; Welch, Babu G

    2018-03-02

    OBJECTIVE The role of venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) is not well understood. The aim of this systematic review is to attempt to identify subsets of patients with IIH who will benefit from VSS based on the pressure gradients of their venous sinus stenosis. METHODS MEDLINE/PubMed was searched for studies reporting venous pressure gradients across the stenotic segment of the venous sinus, pre- and post-stent pressure gradients, and clinical outcomes after VSS. Findings are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS From 32 eligible studies, a total of 186 patients were included in the analysis. Patients who had favorable outcomes had higher mean pressure gradients (22.8 ± 11.5 mm Hg vs 17.4 ± 8.0 mm Hg, p = 0.033) and higher changes in pressure gradients after stent placement (19.4 ± 10.0 mm Hg vs 12.0 ± 6.0 mm Hg, p = 0.006) compared with those with unfavorable outcomes. The post-stent pressure gradients between the 2 groups were not significantly different (2.8 ± 4.0 mm Hg vs 2.7 ± 2.0 mm Hg, p = 0.934). In a multivariate stepwise logistic regression controlling for age, sex, body mass index, CSF opening pressure, pre-stent pressure gradient, and post-stent pressure gradient, the change in pressure gradient with stent placement was found to be an independent predictor of favorable outcome (p = 0.028). Using a pressure gradient of 21 as a cutoff, 81/86 (94.2%) of patients with a gradient > 21 achieved favorable outcomes, compared with 82/100 (82.0%) of patients with a gradient ≤ 21 (p = 0.022). CONCLUSIONS There appears to be a relationship between the pressure gradient of venous sinus stenosis and the success of VSS in IIH. A randomized controlled trial would help elucidate this relationship and potentially guide patient selection.

  6. [Special artificial respiration procedures and intracranial pressure. Animal experiment studies, development and use of a new pressure measuring technic, clinical aspects].

    Science.gov (United States)

    Schedl, R

    1985-01-01

    We investigated the influence of Forced Diffusion Ventilation (FDV), a special form of High Frequency Ventilation (HFV), on elevated intracranial pressure (ICP) in 5 dogs. Elevation of ICP was standardized by inflation of an epidural balloon. A typical finding with FDV is a reduced intrapleural pressure and therefore one could expect a better cerebrovenous drainage influencing ICP. Nevertheless, we found no changes in mean ICP under conditions of FDV compared with IPPV. Respirator-synchronous fluctuations of ICP, cisternal cerebrospinal fluid pressure and intrapleural pressure were drastically reduced with FDV. This phenomenon has been already reported by other groups as a typical effect of HFV with rates of 100/min. One can speculate, that this immediate impact of HFV on ICP-curves might be of some advantage in patients with critically reduced intracranial compliance requiring long-term artificial ventilation, because peaks and amplitudes of ICP are reduced. Our clinical experience with High Frequency Pulsation (HFP) includes 11 patients with severe brain trauma. In clinical routine this method of HFV is more facile to applicate than FDV, because there is no need of a special endotracheal tube and sufficient CO2-elimination is not strongly dependent on precise position of the tube. But HFP, as FDV, includes all advantages of respiratory systems, that are open against atmosphere (coughing and simultaneous breathing, without drastically increasing airway pressure, suction during respiration, etc.). However, we could find no special advantages or disadvantages in ICP-course during long-term application of HFP (up to 10 days). Because application of HFV is dependent on special technical equipment, we investigated in 6 patients the influence of respiratory frequency, tidal volume and inspiratory flow on ICP-fluctuations using conventional ventilators. ICP was recorded by a new, self constructed pneumatic epidural pressure sensor. Ventilator-related ICP

  7. An evaluation and comparison of intraventricular, intraparenchymal, and fluid-coupled techniques for intracranial pressure monitoring in patients with severe traumatic brain injury.

    Science.gov (United States)

    Vender, John; Waller, Jennifer; Dhandapani, Krishnan; McDonnell, Dennis

    2011-08-01

    Intracranial pressure measurements have become one of the mainstays of traumatic brain injury management. Various technologies exist to monitor intracranial pressure from a variety of locations. Transducers are usually placed to assess pressure in the brain parenchyma and the intra-ventricular fluid, which are the two most widely accepted compartmental monitoring sites. The individual reliability and inter-reliability of these devices with and without cerebrospinal fluid diversion is not clear. The predictive capability of monitors in both of these sites to local, regional, and global changes also needs further clarification. The technique of monitoring intraventricular pressure with a fluid-coupled transducer system is also reviewed. There has been little investigation into the relationship among pressure measurements obtained from these two sources using these three techniques. Eleven consecutive patients with severe, closed traumatic brain injury not requiring intracranial mass lesion evacuation were admitted into this prospective study. Each patient underwent placement of a parenchymal and intraventricular pressure monitor. The ventricular catheter tubing was also connected to a sensor for fluid-coupled measurement. Pressure from all three sources was measured hourly with and without ventricular drainage. Statistically significant correlation within each monitoring site was seen. No monitoring location was more predictive of global pressure changes or more responsive to pressure changes related to patient stimulation. However, the intraventricular pressure measurements were not reliable in the presence of cerebrospinal fluid drainage whereas the parenchymal measurements remained unaffected. Intraparenchymal pressure monitoring provides equivalent, statistically similar pressure measurements when compared to intraventricular monitors in all care and clinical settings. This is particularly valuable when uninterrupted cerebrospinal fluid drainage is desirable.

  8. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension.

    Science.gov (United States)

    Oudeman, Eline A; Nandoe Tewarie, Rishi D S; Jöbsis, G Joost; Arts, Mark P; Kruyt, Nyika D

    2015-01-01

    Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior stenosis. The postoperative course was complicated by severe intracranial hypotension attributed to the erroneous placement of a low-pressure drain placed in the pleural cavity instead of a lumbar drain; this resulted in subdural hematoma's necessitating subsequent surgery. Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 3-5 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas.

  9. Development of a real-time monitoring system for intra-fractional motion in intracranial treatment using pressure sensors.

    Science.gov (United States)

    Inata, Hiroki; Araki, Fujio; Kuribayashi, Yuta; Hamamoto, Yasushi; Nakayama, Shigeki; Sodeoka, Noritaka; Kiriyama, Tetsukazu; Nishizaki, Osamu

    2015-09-21

    This study developed a dedicated real-time monitoring system to detect intra-fractional head motion in intracranial radiotherapy using pressure sensors. The dedicated real-time monitoring system consists of pressure sensors with a thickness of 0.6 mm and a radius of 9.1 mm, a thermoplastic mask, a vacuum pillow, and a baseplate. The four sensors were positioned at superior-inferior and right-left sides under the occipital area. The sampling rate of pressure sensors was set to 5 Hz. First, we confirmed that the relationship between the force and the displacement of the vacuum pillow follows Hook's law. Next, the spring constant for the vacuum pillow was determined from the relationship between the force given to the vacuum pillow and the displacement of the head, detected by Cyberknife target locating system (TLS) acquisitions in clinical application. Finally, the accuracy of our system was evaluated by using the 2  ×  2 confusion matrix. The regression lines between the force, y, and the displacement, x, of the vacuum pillow were given by y = 3.8x, y = 4.4x, and y = 5.0x when the degree of inner pressure was  -12 kPa,-20 kPa, and  -27 kPa, respectively. The spring constant of the vacuum pillow was 1.6 N mm(-1) from the 6D positioning data of a total of 2999 TLS acquisitions in 19 patients. Head motions of 1 mm, 1.5 mm, and 2 mm were detected in real-time with the accuracies of 67%, 84%, and 89%, respectively. Our system can detect displacement of the head continuously during every interval of TLS with a resolution of 1-2 mm without any radiation exposure.

  10. Immune pressure analysis of protease and reverse transcriptase ...

    African Journals Online (AJOL)

    /dn) were analyzed for 33 HIV-1 subtype C protease (PR) and reverse transcriptase (RT) nucleotide sequences each from antiretroviral naïve South African chronically infected individuals. The ds/dn ratios were calculated using the ...

  11. Increased intracranial pressure in a case of spinal cervical glioblastoma multiforme: analysis of these two rare conditions

    Directory of Open Access Journals (Sweden)

    C.M. de Castro-Costa

    1994-03-01

    Full Text Available The authors describe a rare case of increased intracranial hypertension consequent to a spinal cervical glioblastoma multiforme in a young patient. They analyse the physiopathology of intracranial hypertension in spinal tumors and the rarity of such kind of tumor in this location, and its clinico-pathological aspects.

  12. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    International Nuclear Information System (INIS)

    Nogueira, Raul G.; Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J.; Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A.

    2008-01-01

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66±17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb

  13. A novel method for long-term monitoring of intracranial pressure in rats

    DEFF Research Database (Denmark)

    Uldall, Maria; Juhler, Marianne; Skjolding, Anders Daehli

    2014-01-01

    and in the epidural space. The two pressures were recorded twice a week for 59 days and the correlation was studied. RESULTS: The two pressure recordings correlated exceptionally well and the R(2) values on each recording day ranged between 0.99 and 1.00. However, the ventricular probes caused a number...... of complications including loss of patency and tissue damage probably due to cerebral infection, whereas the epidural probes were safe and reliable throughout the entire study. COMPARISON WITH EXISTING METHODS: Epidural probes are much easier to implant than ventricular probes. In addition, these new probes...

  14. Ultrasonographic Optic Nerve Sheath Diameter as a Surrogate Measure of Raised Intracranial Pressure in Severe Pregnancy-induced Hypertension Patients.

    Science.gov (United States)

    Singh, Shiv Kumar; Bhatia, Kiran

    2018-01-01

    It is a well-known fact that severe pregnancy-induced hypertension (PIH) can be disastrous at times as it can cause a lot of complications to both pregnant women and her baby. Hence, it is always desirable to know the extent of severity by a real-time and easily accessible modality like ultrasound. The aim of the study was to evaluate the incidence of raised intracranial pressure (ICP) in severe preeclampsia and eclampsia patients using ocular ultrasonography with optic nerve sheath diameter (ONSD) measurement. This study design was a prospective and clinically controlled blinded observational study. After taking necessary permissions from the Institution Ethical Committee, 75 patients were enrolled for the study. However, finally, 25 patients in severe preeclampsia and 24 in eclampsia group were compared with 25 normal term antenatal women. Demographic profiles, hemodynamic parameters, laboratory markers for severity of PIH, and ultrasonographic OSND were measured. They were statistically analyzed and compared using one-way ANOVA and Tukey's test. Value of P surrogate marker for raised ICP in severe PIH patients. It is a rapid, bedside, noninvasive, and readily accessible tool and could be a part of a holistic approach for managing such patients.

  15. Association of Inter-arm Blood Pressure Difference with Asymptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients.

    Science.gov (United States)

    Wang, Yan; Zhang, Jin; Qian, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

    2016-07-14

    Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites. We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by Vascular Profiler-1000 device. In the continuous study, ICAS was significantly associated with age, male, average brachial SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, subjects with the top quartile of inter-arm DBP difference (≥4 mmHg) showed significantly higher risk of ICAS (OR = 2.109; 95% CI, 1.24-3.587). And the participants with the top quartile of inter-arm SBP difference (≥6 mmHg) showed significantly higher risk of ECAS (OR = 2.288; 95% CI, 1.309-3.998). In conclusion, we reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study.

  16. Enterprise stenting for intracranial aneurysm treatment induces dynamic and reversible age-dependent stenosis in cerebral arteries.

    Science.gov (United States)

    Gao, Bulang; Safain, Mina G; Malek, Adel M

    2015-04-01

    Although intracranial stenting has been associated with in-stent stenosis, the vascular response of cerebral vessels to the deployment of the Enterprise vascular reconstruction device is poorly defined. To evaluate the change in parent vessel caliber that ensues after Enterprise stent placement. Seventy-seven patients with 88 aneurysms were treated using Enterprise stent-assisted coil embolization and underwent high-resolution three-dimensional rotational angiography followed by three-dimensional edge-detection filtering to remove windowing-dependence measurement artifact. Orthogonal diameters and cross-sectional areas (CSAs) were measured proximal and distal on either side of the leading stent edge (points A, B), trailing stent edge (points D, E), and at mid-stent (point C). Enterprise stent deployment caused an instant increase in the parent artery CSA by 8.98% at D, which was followed 4-6 months later by significant in-stent stenosis (15.78% at A, 27.24% at B, 10.68% at C, 32.12% at D, and 28.28% at E) in the stented artery. This time-dependent phenomenon showed resolution which was complete by 12-24 months after treatment. This target vessel stenosis showed significant age dependence with greater response in the young. No flow-limiting stenosis requiring treatment was observed in this series. Use of the Enterprise stent is associated with a significant dynamic and spontaneously resolvable age-dependent in-stent stenosis. Further study is warranted on the clinical impact, if any, of this occurrence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Headache attributed to intracranial pressure alterations: applicability of the International Classification of Headache Disorders ICHD-3 beta version versus ICHD-2.

    Science.gov (United States)

    Curone, M; Peccarisi, C; Bussone, G

    2015-05-01

    The association between headache and changes in intracranial pressure is strong in clinical practice. Syndromes associated with abnormalities of cerebrospinal fluid (CSF) pressure include spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH). In 2013, the Headache Classification Committee of the International Headache Society (IHS) published the third International Classification of Headache Disorders (ICHD-3 beta version). The aim of this study was to investigate applicability of the new ICHD-3 versus ICHD-2 criteria in a clinical sample of patients with intracranial pressure (ICP) alterations. Patients admitted at our Headache Center for headache evaluation in whom a diagnosis of ICP alterations was performed were reviewed. 71 consecutive patients were studied. 40 patients (Group A) were diagnosed as IIH, 22 (Group B) as SIH, 7 (Group C) and 2 (Group D), respectively, as symptomatic intracranial hypertension and symptomatic intracranial hypotension. Main headache features were: in Group A, daily or nearly-daily headache (100 %) with diffuse/non-pulsating pain (73 %), aggravated by coughing/straining (54 %) and migrainous-associated symptoms (43 %). In Group B, an orthostatic headache (100 %) with nausea (29 %), vomiting (24 %), hearing disturbance (33 %), neck pain (48 %), hypacusia (24 %), photophobia (22 %) was reported. In Group C, a diffuse non-pulsating headache was present in 95 % with vomiting (25 %), sixth nerve palsy (14 %) and tinnitus (29 %). In Group D, an orthostatic headache with neck stiffness was reported by 100 %. Regarding applicability of ICHD-2 criteria in Group A, 73 % of the patients fitted criterion A; 100 %, criterion B; 100 %, criterion C; and 75 %, criterion D; while applying ICHD-3 beta version criteria, 100 % fitted criterion A; 97.5 %, criterion B; 100 %, criterion C; and 100 %, criterion D. In Group B, application of ICHD-2 showed 91 % patients fitting criterion A; 100 %, criterion B; 100

  18. The effect of hydrostatic pressure on the anomalous sign reversal of the Hall coefficient in tellurium

    International Nuclear Information System (INIS)

    Balynas, V.; Dobrovolskis, Z.; Krotkus, A.; Hoerstel, W.

    1981-01-01

    In order to obtain information about the pressure behaviour of the higher lying second conduction band the dependences of the Hall coefficient of single crystalline tellurium on temperature (300 to 500 K) have been measured at atmospheric pressure and hydrostatic pressures of 500 and 800 MPa. The separation between the two conduction bands in Te decreases with increasing pressure. The anomalous sign reversal of the Hall coefficient can be well explained by a double-conduction band model

  19. Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods.

    Science.gov (United States)

    Cardim, Danilo; Robba, Chiara; Donnelly, Joseph; Bohdanowicz, Michal; Schmidt, Bernhard; Damian, Maxwell; Varsos, Georgios V; Liu, Xiuyun; Cabeleira, Manuel; Frigieri, Gustavo; Cabella, Brenno; Smielewski, Peter; Mascarenhas, Sergio; Czosnyka, Marek

    2016-04-15

    Elevation of intracranial pressure (ICP) may occur in many diseases, and therefore the ability to measure it noninvasively would be useful. Flow velocity signals from transcranial Doppler (TCD) have been used to estimate ICP; however, the relative accuracy of these methods is unclear. This study aimed to compare four previously described TCD-based methods with directly measured ICP in a prospective cohort of traumatic brain-injured patients. Noninvasive ICP (nICP) was obtained using the following methods: 1) a mathematical "black-box" model based on interaction between TCD and arterial blood pressure (nICP_BB); 2) based on diastolic flow velocity (nICP_FVd); 3) based on critical closing pressure (nICP_CrCP); and 4) based on TCD-derived pulsatility index (nICP_PI). In time domain, for recordings including spontaneous changes in ICP greater than 7 mm Hg, nICP_PI showed the best correlation with measured ICP (R = 0.61). Considering every TCD recording as an independent event, nICP_BB generally showed to be the best estimator of measured ICP (R = 0.39; p area under the curve [AUC] = 0.66; p AUC (0.70; p AUC = 0.64; p > 0.05). nICP_PI was not related to measured ICP using any of the above statistical indicators. We also introduced a new estimator (nICP_Av) based on the average of three methods (nICP_BB, nICP_FVd, and nICP_CrCP), which overall presented improved statistical indicators (R = 0.47; p AUC = 0.73; p < 0.05). nICP_PI appeared to reflect changes in ICP in time most accurately. nICP_BB was the best estimator for ICP "as a number." nICP_Av demonstrated to improve the accuracy of measured ICP estimation.

  20. Método para registro continuo da pressão intracraniana A method for continuous monitoring of the intracranial pressure

    Directory of Open Access Journals (Sweden)

    Henrique S. Ivamoto

    1975-06-01

    Full Text Available Pacientes com hipertensão intracraniana aguda podem ser melhor manipulados se a pressão intracraniana for constantemente medida. Uma série de 91 pacientes com traumatismos cranio-encefálicos agudos, hemorragia subaracnóidea, encefalite, hemorragia intracerebral, ou intoxicação por monóxido de carbono foi acompanhada usando o interruptor a pressão de Numoto por um método aqui descrito. O principal benefício tem sido o conhecimento do valor da pressão intracraniana a todo momento e a detecção rápida de elevações da pressão. Complicações se limitaram a 3 casos de infecção. Dois deles foram pequenas coleções purulentas no ponto de saída do tubo no couro cabeludo. Um paciente com uma fratura craniana exposta, laceração cerebral e hematoma intracerebral desenvolveu uma infecção da ferida operatoria e abscesso cerebral que requereu drenagem.Patients suffering acute intracranial pressure increases can be more advantageously handled if the intracranial pressure is constantly monitored. 91 patients with acute head injuries, hydrocephalus, cerebral infarction, subarachnoid hemorrhage, encephalitis, intracerebral hemorrhage, or carbon monoxide intoxication have been so monitored by using the Numoto pressure switch by a method herein described. The main advantage has been the knowledge of the level of intracranial pressure at any given time and the early detection of a rising pressure when this phenomenon occurred. There were no complications except for 3 cases of infection. Two of these cases were minor purulent collections only at the site of exit of the tube in the scalp. One patient with a compound wound, cerebral laceration, and intracerebral hematoma developed a wound infection and brain abscess which required drainage.

  1. Intracranial Pressure Elevation 24 Hours after Ischemic Stroke in Aged Rats is Prevented by Early, Short Hypothermia Treatment

    Directory of Open Access Journals (Sweden)

    Lucy Anne Murtha

    2016-05-01

    Full Text Available Stroke is predominantly a senescent disease, yet most preclinical studies investigate treatment in young animals. We recently demonstrated that short-duration hypothermia-treatment completely prevented the dramatic intracranial pressure (ICP rise seen post-stroke in young rats. Here, our aim was to investigate whether a similar ICP rise occurs in aged rats and to determine whether short-duration hypothermia is an effective treatment in aged animals. Experimental Middle Cerebral Artery occlusion (MCAo - 3 hour occlusion was performed on male Wistar rats aged 19-20 months. At one hour after stroke-onset, rats were randomized to 2.5 hours hypothermia-treatment (32.5 °C or normothermia (37 °C. ICP was monitored at baseline, for 3.5 hours post-occlusion, and at 24 hours post-stroke. Infarct and edema volumes were calculated from histology. Baseline pre-stroke ICP was 11.2 ± 3.3 mmHg across all animals. Twenty-four hours post-stroke, ICP was significantly higher in normothermic animals compared to hypothermia-treated animals (27.4 ± 18.2 mmHg vs. 8.0 ± 5.0 mmHg, p = 0.03. Infarct and edema volumes were not significantly different between groups. These data demonstrate ICP may also increase 24 hours post-stroke in aged rats, and that short-duration hypothermia treatment has a profound and sustained preventative effect. These findings may have important implications for the use of hypothermia in clinical trials of aged stroke patients.

  2. Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome.

    Science.gov (United States)

    Joswig, Holger; Epprecht, Lorenz; Valmaggia, Christophe; Leschka, Sebastian; Hildebrandt, Gerhard; Fournier, Jean-Yves; Stienen, Martin Nikolaus

    2016-06-01

    A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH). Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer. Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH2O, p = .003); all patients with TS had pathological ICP values of >20 cmH2O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03-97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86-524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4-6; 100 vs. 17 %; p = .001). Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.

  3. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype or a...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

  4. Pediatric Idiopathic Intracranial Hypertension Presenting With Sensorineural Hearing Loss.

    Science.gov (United States)

    Reitsma, Sietze; Stokroos, Robert; Weber, Jacobiene W; van Tongeren, Joost

    2015-12-01

    To present the rare case of a young boy with idiopathic intracranial hypertension presenting with bilateral sensorineural hearing loss developing over several months. This was accompanied by headaches, otalgia, tinnitus, and vertigo. Furthermore, we aim to provide a concise review on this matter, as this report represents the second case in literature of pediatric idiopathic intracranial hypertension presenting with hearing loss. Workup of a 9-year-old boy with bilateral sensorineural hearing loss, including (among others) physical examination, audiometry, diagnostic imaging, and lumbar puncture. Physical examination including fundoscopy as well as imaging showed no abnormalities. At presentation, pure tone audiometry revealed bone conduction thresholds of about 30 dB HL in both ears. Two months later, this declined to about 35 dB HL in both ears. Lumbar puncture revealed an increased intracranial pressure. The boy was thus diagnosed with idiopathic intracranial hypertension. After the lumbar puncture, the otological complaints gradually resolved, and the hearing normalized (bone conduction thresholds of 0-5 dB HL). Although rare, sensorineural hearing loss in the pediatric population together with otalgia, tinnitus, and vertigo can be due to idiopathic intracranial hypertension and as such can be reversible. © The Author(s) 2015.

  5. Location of the internal carotid artery and ophthalmic artery segments for non-invasive intracranial pressure measurement by multi-depth TCD.

    Science.gov (United States)

    Hamarat, Yasin; Deimantavicius, Mantas; Kalvaitis, Evaldas; Siaudvytyte, Lina; Januleviciene, Ingrida; Zakelis, Rolandas; Bartusis, Laimonas

    2017-12-01

    The aim of the present study was to locate the ophthalmic artery by using the edge of the internal carotid artery (ICA) as the reference depth to perform a reliable non-invasive intracranial pressure measurement via a multi-depth transcranial Doppler device and to then determine the positions and angles of an ultrasonic transducer (UT) on the closed eyelid in the case of located segments. High tension glaucoma (HTG) patients and healthy volunteers (HVs) undergoing non-invasive intracranial pressure measurement were selected for this prospective study. The depth of the edge of the ICA was identified, followed by a selection of the depths of the IOA and EOA segments. The positions and angles of the UT on the closed eyelid were measured. The mean depth of the identified ICA edge for HTG patients was 64.3 mm and was 63.0 mm for HVs (p = 0.21). The mean depth of the selected IOA segment for HTG patients was 59.2 mm and 59.3 mm for HVs (p = 0.91). The mean depth of the selected EOA segment for HTG patients was 48.5 mm and 49.8 mm for HVs (p = 0.14). The difference in the located depths of the segments between groups was not statistically significant. The results showed a significant difference in the measured UT angles in the case of the identified edge of the ICA and selected ophthalmic artery segments (p = 0.0002). We demonstrated that locating the IOA and EOA segments can be achieved using the edge of the ICA as a reference point. OA: ophthalmic artery; IOA: intracranial segments of the ophthalmic artery; EOA: extracranial segments of the ophthalmic artery; ICA: internal carotid artery; UT: ultrasonic transducer; HTG: high tension glaucoma; SD: standard deviation; ICP: intracranial pressure; TCD: transcranial Doppler.

  6. Negative Pressure Pulmonary Edema after Reversing Rocuronium-Induced Neuromuscular Blockade by Sugammadex

    Directory of Open Access Journals (Sweden)

    Manzo Suzuki

    2014-01-01

    Full Text Available Negative pressure pulmonary edema (NPPE is a rare complication that accompanies general anesthesia, especially after extubation. We experienced a case of negative pressure pulmonary edema after tracheal extubation following reversal of rocuronium-induced neuromuscular blockade by sugammadex. In this case, the contribution of residual muscular block on the upper airway muscle as well as large inspiratory forces created by the respiratory muscle which has a low response to muscle relaxants, is suspected as the cause.

  7. Hybrid membrane system for desalination and wastewater treatment: Integrating forward osmosis and low pressure reverse osmosis

    OpenAIRE

    Valladares Linares, R.

    2014-01-01

    Since more than 97% of the water in the world is seawater, desalination technologies have the potential to solve the fresh water crisis. The most used desalination technology nowadays is seawater reverse osmosis (SWRO), where a membrane is used as a physical barrier to separate the salts from the water, using high hydraulic pressure as the driving force. However, the use of high hydraulic pressure imposes a high cost on operation of these systems, in addition to the known persistent fouling p...

  8. Standardized Application of Laxatives and Physical Measures in Neurosurgical Intensive Care Patients Improves Defecation Pattern but Is Not Associated with Lower Intracranial Pressure

    Directory of Open Access Journals (Sweden)

    Martin Kieninger

    2014-01-01

    Full Text Available Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP on bowel movement, intracranial pressure (ICP, and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

  9. Standardized application of laxatives and physical measures in neurosurgical intensive care patients improves defecation pattern but is not associated with lower intracranial pressure.

    Science.gov (United States)

    Kieninger, Martin; Sinner, Barbara; Graf, Bernhard; Grassold, Astrid; Bele, Sylvia; Seemann, Milena; Künzig, Holger; Zech, Nina

    2014-01-01

    Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

  10. Gray water recycle: Effect of pretreatment technologies on low pressure reverse osmosis treatment

    Science.gov (United States)

    Gray water can be a valuable source of water when properly treated to reduce the risks associated with chemical and microbial contamination to acceptable levels for the intended reuse application. In this study, the treatment of gray water using low pressure reverse osmosis (RO) filtration after pre...

  11. Salinity-gradient power: Evaluation of pressure-retarded osmosis and reverse electrodialysis

    NARCIS (Netherlands)

    Post, J.W.; Veerman, J.; Hamelers, H.V.M.; Euverink, G.J.W.; Metz, S.J.; Nymeijer, K.; Buisman, C.J.N.

    2007-01-01

    A huge potential to obtain clean energy exists from mixing water streams with different salt concentrations. Two membrane-based energy conversion techniques are evaluated: pressure-retarded osmosis and reverse electrodialysis. From the literature, a comparison is not possible since the reported

  12. Two-step optimization of pressure and recovery of reverse osmosis desalination process.

    Science.gov (United States)

    Liang, Shuang; Liu, Cui; Song, Lianfa

    2009-05-01

    Driving pressure and recovery are two primary design variables of a reverse osmosis process that largely determine the total cost of seawater and brackish water desalination. A two-step optimization procedure was developed in this paper to determine the values of driving pressure and recovery that minimize the total cost of RO desalination. It was demonstrated that the optimal net driving pressure is solely determined by the electricity price and the membrane price index, which is a lumped parameter to collectively reflect membrane price, resistance, and service time. On the other hand, the optimal recovery is determined by the electricity price, initial osmotic pressure, and costs for pretreatment of raw water and handling of retentate. Concise equations were derived for the optimal net driving pressure and recovery. The dependences of the optimal net driving pressure and recovery on the electricity price, membrane price, and costs for raw water pretreatment and retentate handling were discussed.

  13. INVESTIGATION RESULTS PERTAINING TO DETERMINATION OF REVERSE FLOW PRESSURE ON TREATED FLAT SURFACE

    Directory of Open Access Journals (Sweden)

    A. N. Zhuk

    2018-01-01

    Full Text Available The executed investigations have shown that it is possible to prepare sheet-like material for laser cutting economically viable and with small amount of power expenditure while using reverse jet cleaning for surface treatment. As compared to conventional jet cleaning technologies efficiency of the reverse jet cleaning is attributed to significant pressure increase (by 25–50 % when the jet is interacting with the treated surface. The paper proposes a mathematical model on the basis of approximate energy method (upper-bound method and the model is used for calculation of fracture pressure due to action of the reverse jet on the treated surface which consists of a corrosion deposit layer. A variational problem was solved within a framework of the developed model and the problem solution has made it possible to obtain a theoretical dependence for calculation of minimum fracture pressure value pmin in the point reverse jet impact with a barrier oretical dependence and it has taken into account yielding point of the deformed material ss, density of fractured material med material r, jet velocity uстр and parameter of reverse flowing – jet reduction ratio l. Comparison theoretical data and experimental ones (experimental data have been obtained while using a differential pressure transducer ЭДП-30 and a spring dynamometer with measuring limits 25 and 80 MPa, respectively has shown difference by 4–15 %. Determined insignificant difference between a theory and an experiment demonstrates that the obtained theoretical dependence is considered as a quite correct one and it can be used in engineering practice for prediction of power and kinematics parameters which are necessary for selection of the required pump equipment designed for realization of reverse-jet cleaning process.

  14. Characterization of Rare Reverse Flow Events in Adverse Pressure Gradient Turbulent Boundary Layers

    Science.gov (United States)

    Kaehler, Christian J.; Bross, Matthew; Fuchs, Thomas

    2017-11-01

    Time-resolved tomographic flow fields measured in the viscous sublayer region of a turbulent boundary layer subjected to an adverse pressure gradient (APG) are examined with the aim to resolve and characterize reverse flow events at Reτ = 5000. The fields were measured using a novel high resolution tomographic particle tracking technique. It is shown that this technique is able to fully resolve mean and time dependent features of the complex three-dimensional flow with high accuracy down to very near-wall distances ( 10 μm). From time resolved Lagrangian particle trajectories, statistical information as well as instantaneous topological features of near-wall flow events are deduced. Similar to the zero pressure gradient case (ZPG), it was found that individual events with reverse flow components still occur relatively rarely under the action of the pressure gradient investigated here. However, reverse flow events comprised of many individual events, are shown to appear in relatively organized groupings in both spanwise and streamise directions. Furthermore, instantaneous measurements of reverse flow events show that these events are associated with the motion of low-momentum streaks in the near-wall region. This work is supported by the Priority Programme SPP 1881 Turbulent Superstructures and the individual project Grant KA1808/8-2 of the Deutsche Forschungsgemeinschaft.

  15. Experimental and numerical studies on pressure drop in reverse electrodialysis: Effect of unit cell configuration

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Sung Kook; Choi, Kyung Soo [Advanced Combustion Laboratory, Korea Institute of Energy Research, Daejeon (Korea, Republic of); Kim, Chan Soo; Hwang, Kyo Sik; Han, Ji Hyung; Kim, Han Ki; Jeong, Nam Jo [Jeju Global Research Center, Korea Institute of Energy Research, Jeju (Korea, Republic of)

    2016-11-15

    Experimental and numerical studies on pressure drop in Reverse electrodialysis (RED) were performed. In this study, a module with 200 unit cells is considered for the demonstration of bench-scale RED module and two different unit cell configurations are utilized. Pressure drop through the module is measured by varying flow rates. For evaluating the hydrodynamic characteristics in the unit cell, a numerical simulation is also conducted and the simplified method using a porous media model is employed to simulate the channel filled with spacer. Due to the insertion of spacer and narrow channel, great pressure loss occurs along the unit cell. Based on estimated pressure data, high pressure difference between seawater and fresh water channel takes place locally in the unit cell configuration with crossflow direction, leading to a leakage problem through the membrane and finally degradation in the output power. Consequently, it is confirmed that the unit cell configuration is one of the important design parameters in a RED module.

  16. Intracranial sarcoidosis

    International Nuclear Information System (INIS)

    Seltzer, S.; Mark, A.S.; Atlas, S.W.

    1989-01-01

    The appearance of intracranial sarcoidosis on Gd-DTPA-enhanced MR imaging has not been previously reported. The authors have studied five patients with T1-and T2-weighted pre-GD and T1-weighted post-GD sequences. Images showed diffuse meningeal involvement suspected on the unenhanced scans in only one patient, enhancing extraaxial masses mimicking meningiomas, and enhancing and nonenhancing intraaxial lesions. In four of five patients, the diagnosis of intracranial sarcoidosis was suggested only after Gd-DTPA administration. The addition of Gd-DTPA greatly enhanced the sensitivity of MR imaging to the extraaxial and meningeal manifestations of central nervous system sarcoidosis

  17. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases

    DEFF Research Database (Denmark)

    Markey, Keira A; Uldall, Maria; Botfield, Hannah

    2016-01-01

    Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provi...

  18. Unlocking High-Salinity Desalination with Cascading Osmotically Mediated Reverse Osmosis: Energy and Operating Pressure Analysis.

    Science.gov (United States)

    Chen, Xi; Yip, Ngai Yin

    2018-02-20

    Current practice of using thermally driven methods to treat hypersaline brines is highly energy-intensive and costly. While conventional reverse osmosis (RO) is the most efficient desalination technique, it is confined to purifying seawater and lower salinity sources. Hydraulic pressure restrictions and elevated energy demand render RO unsuitable for high-salinity streams. Here, we propose an innovative cascading osmotically mediated reverse osmosis (COMRO) technology to overcome the limitations of conventional RO. The innovation utilizes the novel design of bilateral countercurrent reverse osmosis stages to depress the hydraulic pressure needed by lessening the osmotic pressure difference across the membrane, and simultaneously achieve energy savings. Instead of the 137 bar required by conventional RO to desalinate 70 000 ppm TDS hypersaline feed, the highest operating pressure in COMRO is only 68.3 bar (-50%). Furthermore, up to ≈17% energy saving is attained by COMRO (3.16 kWh/m 3 , compared to 3.79 kWh/m 3 with conventional RO). When COMRO is employed to boost the recovery of seawater desalination to 70% from the typical 35-50%, energy savings of up to ≈33% is achieved (2.11 kWh/m 3 , compared to 3.16 kWh/m 3 with conventional RO). Again, COMRO can operate at a moderate hydraulic pressure of 80 bar (25% lower than 113 bar of conventional RO). This study highlights the encouraging potential of energy-efficient COMRO to access unprecedented high recovery rates and treat hypersaline brines at moderate hydraulic pressures, thus extending the capabilities of membrane-based technologies for high-salinity desalination.

  19. Second law analysis of reverse osmosis desalination plants: An alternative design using pressure retarded osmosis

    International Nuclear Information System (INIS)

    Sharqawy, Mostafa H.; Zubair, Syed M.; Lienhard, John H.

    2011-01-01

    A second law analysis of a reverse osmosis desalination plant is carried out using reliable seawater exergy formulation instead of a common model in literature that represents seawater as an ideal mixture of liquid water and solid sodium chloride. The analysis is performed using reverse osmosis desalination plant data and compared with results previously published using the ideal mixture model. It is demonstrated that the previous model has serious shortcomings, particularly with regard to calculation of the seawater flow exergy, the minimum work of separation, and the second law efficiency. The most up-to-date thermodynamic properties of seawater, as needed to conduct an exergy analysis, are given as correlations in this paper. From this new analysis, it is found that the studied reverse osmosis desalination plant has very low second law efficiency (<2%) even when using the available energy recovery systems. Therefore, an energy recovery system is proposed using the (PRO) pressure retarded osmotic method. The proposed alternative design has a second law efficiency of 20%, and the input power is reduced by 38% relative to original reverse osmosis system. -- Highlights: ► A previously proposed model for the calculation of seawater flow exergy gives incorrect values. ► Reverse osmosis desalination plants have very low second law efficiency (<2%) even when using the available energy recovery systems. ► A PRO energy recovery device increases the RO plant’s second law efficiency to 20% and reduces the input power.

  20. Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students: Nursing Care With Increased Intracranial Pressure Patient.

    Science.gov (United States)

    Lee, Myung-Nam; Nam, Kyung-Dong; Kim, Hyeon-Young

    2017-03-01

    Nursing care for patients with central nervous system problems requires advanced professional knowledge and care skills. Nursing students are more likely to have difficulty in dealing with adult patients who have severe neurological problems in clinical practice. This study investigated the effect on the metacognition, team efficacy, and learning attitude of nursing students after an integrated simulation and problem-based learning program. A real scenario of a patient with increased intracranial pressure was simulated for the students. The results showed that this method was effective in improving the metacognitive ability of the students. Furthermore, we used this comprehensive model of simulation with problem-based learning in order to assess the consequences of student satisfaction with the nursing major, interpersonal relationships, and importance of simulation-based education in relation to the effectiveness of the integrated simulation with problem-based learning. The results can be used to improve the design of clinical practicum and nursing education.

  1. Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study

    International Nuclear Information System (INIS)

    Sangani, Shruti V; Parikh, Samira

    2015-01-01

    CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED). We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients. The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001). The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME

  2. What Is IH (Intracranial Hypertension)?

    Science.gov (United States)

    ... Store What is IH? What is IH? Intracranial hypertension literally means that the pressure of cerebrospinal fluid ( ... is too high. “Intracranial” means “within the skull.” “Hypertension” means “high fluid pressure.” To understand how this ...

  3. Water permeability of nanoporous graphene at realistic pressures for reverse osmosis desalination

    Energy Technology Data Exchange (ETDEWEB)

    Cohen-Tanugi, David; Grossman, Jeffrey C. [Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States)

    2014-08-21

    Nanoporous graphene (NPG) shows tremendous promise as an ultra-permeable membrane for water desalination thanks to its atomic thickness and precise sieving properties. However, a significant gap exists in the literature between the ideal conditions assumed for NPG desalination and the physical environment inherent to reverse osmosis (RO) systems. In particular, the water permeability of NPG has been calculated previously based on very high pressures (1000–2000 bars). Does NPG maintain its ultrahigh water permeability under real-world RO pressures (<100 bars)? Here, we answer this question by drawing results from molecular dynamics simulations. Our results indicate that NPG maintains its ultrahigh permeability even at low pressures, allowing a permeate water flux of 6.0 l/h-bar per pore, or equivalently 1041 ± 20 l/m{sup 2}-h-bar assuming a nanopore density of 1.7 × 10{sup 13} cm{sup −2}.

  4. Intracranial Hypertension Research Foundation

    Science.gov (United States)

    ... PARTNERSHIPS Meet our Fundraising Partners Tweet Welcome Intracranial hypertension (IH) is the general term for the neurological ... high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). The Intracranial Hypertension Research Foundation ...

  5. Acute surgical management in idiopathic intracranial hypertension.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  6. Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

    Directory of Open Access Journals (Sweden)

    Ljubisavljević Srdjan

    2016-09-01

    Full Text Available According to the definition, idiopathic intracranial hypertension (IIH is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.

  7. Comparison of Intracranial Pressure and Pressure Reactivity Index Obtained Through Pressure Measurements in the Ventricle and in the Parenchyma During and Outside Cerebrospinal Fluid Drainage Episodes in a Manipulation-Free Patient Setting.

    Science.gov (United States)

    Klein, Samuel Patrick; Bruyninckx, Dominike; Callebaut, Ina; Depreitere, Bart

    2018-01-01

    We investigated the effect of cerebrospinal fluid (CSF) drainage on the intracranial pressure (ICP) signal measured in the parenchyma and the ventricle as well as the effect on the pressure reactivity index (PRx) calculated from both signals.  Ten patients were included in this prospective study. All patients received a parenchymal ICP sensor and an external ventricular drain (EVD) for CSF drainage. ICP signals (ICP-p and ICP-evd) were captured. Part of the study was a period of 90 min during which the patient was free from any manipulation, consisting of 30 min of drainage (O1), 30 min EVD closed (C) and 30 min of drainage (O2).  Mean ICP-evd and mean AMP-evd increased (3.03 and 0.46 mmHg) from O1 to C and decreased (2.12 and 0.43 mmHg) from C to O2. ICP-p and AMP-p changes were less pronounced (closing EVD: +0.81 mmHg/+0.22 mmHg; opening EVD: -0.22 mmHg/-0.05 mmHg). Mean difference between PRx-evd and PRx-p was 0.12 for O1, 0.02 for C and -0.02 for O2. The intraclass correlation coefficient for absolute agreement of single measures was 0.66 for O1, 0.77 for C and 0.69 for O2. Mean PRx differences demonstrated a significant difference between O1 versus C and O1 versus O2 but not between C versus O2.  Drainage of CSF reduces ICP magnitude and amplitude through the EVD. This effect was only marginal in parenchymal ICP measurements. In manipulation-free circumstances, agreement of PRx obtained through parenchymal and ventricular measurements was moderate to good, depending on the statistical method, and was not necessarily influenced by drainage.

  8. Pressure-induced reversal between thermal contraction and expansion in ferroelectric PbTiO3.

    Science.gov (United States)

    Zhu, Jinlong; Zhang, Jianzhong; Xu, Hongwu; Vogel, Sven C; Jin, Changqing; Frantti, Johannes; Zhao, Yusheng

    2014-01-15

    Materials with zero/near zero thermal expansion coefficients are technologically important for applications in thermal management and engineering. To date, this class of materials can only be produced by chemical routes, either by changing chemical compositions or by composting materials with positive and negative thermal expansion. Here, we report for the first time a physical route to achieve near zero thermal expansion through application of pressure. In the stability field of tetragonal PbTiO3 we observed pressure-induced reversals between thermal contraction and expansion between ambient pressure and 0.9 GPa. This hybrid behavior leads to a mathematically infinite number of crossover points in the pressure-volume-temperature space and near-zero thermal expansion coefficients comparable to or even smaller than those attained by chemical routes. The observed pressures for this unusual phenomenon are within a small range of 0.1-0.9 GPa, potentially feasible for designing stress-engineered materials, such as thin films and nano-crystals, for thermal management applications.

  9. Reversible pressure-induced crystal-amorphous structural transformation in ice Ih

    Science.gov (United States)

    English, Niall J.; Tse, John S.

    2014-08-01

    Molecular dynamics (MD) simulation of depressurised high-density amorphous ice (HDA) at 80 K and at negative pressures has been performed. Over several attempts, HDA recrystallised to a form close to hexagonal ice Ih, albeit with some defects. The results support the hypothesis that compression of ice-Ih to HDA is a reversible first-order phase transition, with a large hysteresis. Therefore, it would appear that LDA is not truly amorphous. The elastic energy estimated from the area of the hysteresis loop is ca. 4.5 kJ/mol, in some way consistent with experimentally-determined accumulated successive heats of transformations from recovered HDA → ice Ih.

  10. Reversible Morphological Control of Tubulin-Encapsulating Giant Liposomes by Hydrostatic Pressure.

    Science.gov (United States)

    Hayashi, Masahito; Nishiyama, Masayoshi; Kazayama, Yuki; Toyota, Taro; Harada, Yoshie; Takiguchi, Kingo

    2016-04-19

    Liposomes encapsulating cytoskeletons have drawn much recent attention to develop an artificial cell-like chemical-machinery; however, as far as we know, there has been no report showing isothermally reversible morphological changes of liposomes containing cytoskeletons because the sets of various regulatory factors, that is, their interacting proteins, are required to control the state of every reaction system of cytoskeletons. Here we focused on hydrostatic pressure to control the polymerization state of microtubules (MTs) within cell-sized giant liposomes (diameters ∼10 μm). MT is the cytoskeleton formed by the polymerization of tubulin, and cytoskeletal systems consisting of MTs are very dynamic and play many important roles in living cells, such as the morphogenesis of nerve cells and formation of the spindle apparatus during mitosis. Using real-time imaging with a high-pressure microscope, we examined the effects of hydrostatic pressure on the morphology of tubulin-encapsulating giant liposomes. At ambient pressure (0.1 MPa), many liposomes formed protrusions due to tubulin polymerization within them. When high pressure (60 MPa) was applied, the protrusions shrank within several tens of seconds. This process was repeatedly inducible (around three times), and after the pressure was released, the protrusions regenerated within several minutes. These deformation rates of the liposomes are close to the velocities of migrating or shape-changing living cells rather than the shortening and elongation rates of the single MTs, which have been previously measured. These results demonstrate that the elongation and shortening of protrusions of giant liposomes is repeatedly controllable by regulating the polymerization state of MTs within them by applying and releasing hydrostatic pressure.

  11. The Conceptual Design of High Pressure Reversible Axial Tunnel Ventilation Fans

    Directory of Open Access Journals (Sweden)

    A. G. Sheard

    2012-01-01

    Full Text Available Tunnel ventilation fans, classically, must have the ability to both supply and extract air from a tunnel system, with the operator's choice dependent on the tunnel ventilation system's operating mode most appropriate at any given point in time. Consequently, tunnel ventilation fans must incorporate a reversible aerodynamic design which limits the maximum fan pressure rise. This paper presents three high pressure reversible fan concepts. These comprise a two-stage counter rotating fan, a single-stage high speed fan, and a two-stage fan with a single motor and impeller on each end of the motor shaft. The authors consider the relative merits of each concept. The third concept offers the most compact fan, transform, silencer, and damper package size. The authors discuss the mechanical design challenges that occur with a two-stage fan with a single motor and impeller on each end of the motor shaft. They present and consider a selected motor bearing arrangement and casing design for maintainability. Finally, the authors present both prototype fan and full-scale package aerodynamic and acoustic performance, before discussing the challenges presented by high temperature certification in accordance with the requirements of EN 12101-3: 2012.

  12. Pressure-induced Polarization Reversal in Z-type Hexaferrite Single Crystal

    Science.gov (United States)

    Jeon, Byung-Gu; Chun, Sae Hwan; Kim, Kee Hoon

    2012-02-01

    Multiferroic materials with a gigantic magnetoelectric (ME) coupling at room temperature have been searched for applications to novel devices. Recently, large direct and converse ME effects were realized at room temperature in the so-called Z-type hexaferrite (Ba,Sr)3Co2Fe24O41 single crystals [1,2]. To obtain a new control parameter for realizing a sensitive ME tuning, we studied ME properties of the crystals under uniaxial pressure. Upon applying a tiny uniaxial pressure of about 0.6 GPa, magnetic field-driven electric polarization reversal and anomaly in a M-H loop start to appear at 10 K and gradually disappear at higher temperature above 130 K. By comparing those results with longitudinal magnetostriction at ambient pressure, we propose the pressure-dependent variations of transverse conical spin configuration as well as its domain structure under small magnetic field bias, and point out the possibility of having two different physical origins of the ME coupling in this system. [1] Y. Kitagawa et al., Nat. Mater. 9, 797 (2010) [2] S. H. Chun et al., submitted.

  13. The effect of acetazolamide on cerebral blood volume and intracranial pressure in patients with hydrocephalus. Theoretical background of the acetazolamide challenge test

    International Nuclear Information System (INIS)

    Ogawa, Daiji

    2000-01-01

    The acetazolamide challenge test is one of the useful tests for diagnosing normal pressure hydrocephalus (NPH). It has the advantage of being less invasive than other tests. However, the manner of increment in cerebral blood volume (CBV) has not been well clarified. Therefore, the theoretical background of the test is also unclear. The aims of this study were to evaluate the effect of acetazolamide on CBV and intracranial pressure (ICP) and elucidate the theoretical background of the test. Thirteen patients with NPH were studied. CBV and ICP were measured before and after the intravenous injection of acetazolamide (1000 mg). CBV was evaluated by means of cerebral pool SPECT; ICP was evaluated by OSAKA telesensor or a pressure transducer via ventricular catheter. Immediately after the injection, CBV increased rapidly, reaching its maximum (15% increase) at 6 minutes. Then CBV gradually decreased. ICP also elevated rapidly, reaching its maximum (12.6 mmHg elevation) at 4 minutes. A gradual decrement ICP was observed, and 26 minutes after injection, the ICP became lower than the pre-injection level. The rapid increase in CBV caused the ICP elevation, and the increment ratio reflected the cerebral compliance. Therefore, we concluded that the acetazolamide challenge test is based on the alteration of cerebral compliance seen in NPH patients. The decrement ratio of ICP is affected not only by the resistance cerebrospinal fluid (CSF) absorption but also by decrease in the CBV and CSF production induced by acetazolamide. Consequently, it is difficult to evaluate the resistance of CSF absorption by this test. Because CBV increased in all cases, it is assumed that acetazolamide administration can be used to reliably load the volume. (author)

  14. Invasive and Ultrasound Based Monitoring of the Intracranial Pressure in an Experimental Model of Epidural Hematoma Progressing towards Brain Tamponade on Rabbits

    Directory of Open Access Journals (Sweden)

    Konstantinos Kasapas

    2014-01-01

    Full Text Available Introduction. An experimental epidural hematoma model was used to study the relation of ultrasound indices, namely, transcranial color-coded-Doppler (TCCD derived pulsatility index (PI, optic nerve sheath diameter (ONSD, and pupil constriction velocity (V which was derived from a consensual sonographic pupillary light reflex (PLR test with invasive intracranial pressure (ICP measurements. Material and Methods. Twenty rabbits participated in the study. An intraparenchymal ICP catheter and a 5F Swan-Ganz catheter (SG for the hematoma reproduction were used. We successively introduced 0.1 mL increments of autologous blood into the SG until the Cushing reaction occurred. Synchronous ICP and ultrasound measurements were performed accordingly. Results. A constant increase of PI and ONSD and a decrease of V values were observed with increased ICP values. The relationship between the ultrasound variables and ICP was exponential; thus curved prediction equations of ICP were used. PI, ONSD, and V were significantly correlated with ICP (r2=0.84±0.076, r2=0.62±0.119, and r2=0.78±0.09, resp. (all P<0.001. Conclusion. Although statistically significant prediction models of ICP were derived from ultrasound indices, the exponential relationship between the parameters underpins that results should be interpreted with caution and in the current experimental context.

  15. High-Pressure-Driven Reversible Dissociation of α-Synuclein Fibrils Reveals Structural Hierarchy.

    Science.gov (United States)

    Piccirilli, Federica; Plotegher, Nicoletta; Ortore, Maria Grazia; Tessari, Isabella; Brucale, Marco; Spinozzi, Francesco; Beltramini, Mariano; Mariani, Paolo; Militello, Valeria; Lupi, Stefano; Perucchi, Andrea; Bubacco, Luigi

    2017-10-17

    The analysis of the α-synuclein (aS) aggregation process, which is involved in Parkinson's disease etiopathogenesis, and of the structural feature of the resulting amyloid fibrils may shed light on the relationship between the structure of aS aggregates and their toxicity. This may be considered a paradigm of the ground work needed to tackle the molecular basis of all the protein-aggregation-related diseases. With this aim, we used chemical and physical dissociation methods to explore the structural organization of wild-type aS fibrils. High pressure (in the kbar range) and alkaline pH were used to disassemble fibrils to collect information on the hierarchic pathway by which distinct β-sheets sequentially unfold using the unique possibility offered by high-pressure Fourier transform infrared spectroscopy. The results point toward the formation of kinetic traps in the energy landscape of aS fibril disassembly and the presence of transient partially folded species during the process. Since we found that the dissociation of wild-type aS fibrils by high pressure is reversible upon pressure release, the disassembled molecules likely retain structural information that favors fibril reformation. To deconstruct the role of the different regions of aS sequence in this process, we measured the high-pressure dissociation of amyloids formed by covalent chimeric dimers of aS (syn-syn) and by the aS deletion mutant that lacks the C-terminus, i.e., aS (1-99). The results allowed us to single out the role of dimerization and that of the C-terminus in the complete maturation of fibrillar aS. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  16. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...

  17. Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients.

    Science.gov (United States)

    Sæhle, Terje; Eide, Per Kristian

    2015-05-01

    OBJECT In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. METHODS The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms. RESULTS The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%). Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than -5 to -10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any

  18. Performances of nanofiltration and low pressure reverse osmosis membranes for desalination: characterization and modelling

    Science.gov (United States)

    Boussouga, Y. A.; Lhassani, A.

    2017-03-01

    The nanofiltration and the reverse osmosis processes are the most common techniques for the desalination of water contaminated by an excess of salts. In this present study, we were interested in the characterization of commercial, composite and asymmetric membranes of nanofiltration (NF90, NF270) and low pressure reverse osmosis (BW30LE). The two types of characterization that we opted for our study: (i) characterization of electrical proprieties, in terms of the surface charge of various membranes studied by the measurement of the streaming potential, (ii) hydrodynamic characterization in terms of hydraulic permeability with pure water, mass transfer and phenomenological parameters for each system membrane/salt using hydrodynamic approaches. The irreversible thermodynamics allowed us to model the observed retention Robs of salts (NaCl and Na2SO4) for the different membranes studied, to understand and to predict a good filtration with a membrane. A study was conducted on the type of mass transfer for each system membrane/salt: convection and diffusion. The results showed that all tested membranes are negatively charged for the solutions at neutral pH, this is explained by their material composition. The results also showed competitiveness between the different types of membranes. In view of that the NF remains effective in terms of selective retention with less energy consumption than LPRO.

  19. Reverse Trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver.

    Science.gov (United States)

    Yoneda, Godai; Katagiri, Satoshi; Yamamoto, Masakazu

    2015-06-01

    Bleeding remains an important intraoperative complication in patients who undergo hepatectomy. It is generally believed that a reduction in central venous pressure will decrease bleeding from the hepatic venous system. To our knowledge, however, no study has compared the effectiveness of these techniques for controlling bleeding. So we compared the effectiveness of central venous pressure control techniques, such as infrahepatic inferior vena cava clamping, changes in surgical position of the patient, and hypoventilation anesthesia, for lowering central venous pressure. The study group comprised 50 patients who underwent hepatectomy in our department from 2012 through 2013. A central venous catheter was inserted into the right internal jugular vein, and the tip was placed in the superior vena cava. A transducer was placed along the mid-axillary line of the left side of the chest. After opening the abdomen, changes in central venous pressure were measured during inferior vena cava clamping, the reverse Trendelenburg position, the Trendelenburg position, and hypoventilation anesthesia. The inclination relative to the transducer, as measured with an inclinometer, was -10 degrees for the Trendelenburg position and +10 degrees for the reverse Trendelenburg position. The tidal volume was set at 10 mL/kg during conventional anesthesia and 5 mL/kg during hypoventilation anesthesia. The mean central venous pressure was 8.0 cm H(2)O in the supine position during conventional anesthesia, 5.0 cm H(2)O during inferior vena cava clamping, 5.6 cm H(2)O during reverse Trendelenburg position, 10.6 cm H(2)O during Trendelenburg position, and 7.6 cm H(2)O during hypoventilation anesthesia. The mean central venous pressure during inferior vena cava clamping and reverse Trendelenburg position was significantly lower than that during supine position (P = 0.0017 and P = 0.0231, respectively). The mean central venous pressure during hypoventilation

  20. Simultaneous monitoring of static and dynamic intracranial pressure parameters from two separate sensors in patients with cerebral bleeds: comparison of findings.

    Science.gov (United States)

    Eide, Per Kristian; Holm, Sverre; Sorteberg, Wilhelm

    2012-09-07

    We recently reported that in an experimental setting the zero pressure level of solid intracranial pressure (ICP) sensors can be altered by electrostatics discharges. Changes in the zero pressure level would alter the ICP level (mean ICP); whether spontaneous changes in mean ICP happen in clinical settings is not known. This can be addressed by comparing the ICP parameters level and waveform of simultaneous ICP signals. To this end, we retrieved our recordings in patients with cerebral bleeds wherein the ICP had been recorded simultaneously from two different sensors. During a time period of 10 years, 17 patients with cerebral bleeds were monitored with two ICP sensors simultaneously; sensor 1 was always a solid sensor while Sensor 2 was a solid -, a fluid - or an air-pouch sensor. The simultaneous signals were analyzed with automatic identification of the cardiac induced ICP waves. The output was determined in consecutive 6-s time windows, both with regard to the static parameter mean ICP and the dynamic parameters (mean wave amplitude, MWA, and mean wave rise time, MWRT). Differences in mean ICP, MWA and MWRT between the two sensors were determined. Transfer functions between the sensors were determined to evaluate how sensors reproduce the ICP waveform. Comparing findings in two solid sensors disclosed major differences in mean ICP in 2 of 5 patients (40%), despite marginal differences in MWA, MWRT, and linear phase magnitude and phase. Qualitative assessment of trend plots of mean ICP and MWA revealed shifts and drifts of mean ICP in the clinical setting. The transfer function analysis comparing the solid sensor with either the fluid or air-pouch sensors revealed more variable transfer function magnitude and greater differences in the ICP waveform derived indices. Simultaneous monitoring of ICP using two solid sensors may show marked differences in static ICP but close to identity in dynamic ICP waveforms. This indicates that shifts in ICP baseline pressure

  1. Simultaneous monitoring of static and dynamic intracranial pressure parameters from two separate sensors in patients with cerebral bleeds: comparison of findings

    Directory of Open Access Journals (Sweden)

    Eide Per

    2012-09-01

    Full Text Available Abstract Background We recently reported that in an experimental setting the zero pressure level of solid intracranial pressure (ICP sensors can be altered by electrostatics discharges. Changes in the zero pressure level would alter the ICP level (mean ICP; whether spontaneous changes in mean ICP happen in clinical settings is not known. This can be addressed by comparing the ICP parameters level and waveform of simultaneous ICP signals. To this end, we retrieved our recordings in patients with cerebral bleeds wherein the ICP had been recorded simultaneously from two different sensors. Materials and Methods: During a time period of 10 years, 17 patients with cerebral bleeds were monitored with two ICP sensors simultaneously; sensor 1 was always a solid sensor while Sensor 2 was a solid -, a fluid - or an air-pouch sensor. The simultaneous signals were analyzed with automatic identification of the cardiac induced ICP waves. The output was determined in consecutive 6-s time windows, both with regard to the static parameter mean ICP and the dynamic parameters (mean wave amplitude, MWA, and mean wave rise time, MWRT. Differences in mean ICP, MWA and MWRT between the two sensors were determined. Transfer functions between the sensors were determined to evaluate how sensors reproduce the ICP waveform. Results Comparing findings in two solid sensors disclosed major differences in mean ICP in 2 of 5 patients (40%, despite marginal differences in MWA, MWRT, and linear phase magnitude and phase. Qualitative assessment of trend plots of mean ICP and MWA revealed shifts and drifts of mean ICP in the clinical setting. The transfer function analysis comparing the solid sensor with either the fluid or air-pouch sensors revealed more variable transfer function magnitude and greater differences in the ICP waveform derived indices. Conclusions Simultaneous monitoring of ICP using two solid sensors may show marked differences in static ICP but close to identity

  2. Development of ultra-low pressure reverse osmosis membranes; Choteiatsu gyakushintomaku no kaihatsu

    Energy Technology Data Exchange (ETDEWEB)

    Hirose, M.; Ito, H.; Ohara, T. [Nitto Denko Corp., Osaka (Japan)

    1998-06-05

    Described herein is development of ultra-low pressure reverse osmosis (RO) membranes. The composite RO membrane, which is now widely used, has a cross-sectional structure consisting of an ultrafilter membrane as the support and a very thin skin layer responsible for filtration. It is confirmed that the skin layer is of a pleated structure. Growing this structure can greatly accelerate permeation of water without damaging arresting and durability characteristics of the membrane, and hence is a desired approach. Utilization of molecular structure simulation of the skin layer materials is investigated by the molecular dynamics. The results show that the stable structure of the material for the skin layer in the RO membrane is a network structure with regularly arranged honeycombs, when it should arrest at least 99% of salt. These techniques serve as the bases for development of the ultra-low pressure RO membranes (ES Series), where the skin layer is made of cross-linked, totally aromatic polyamide. The membrane passes twice as large a quantity of water as the conventional one, is highly resistant to chemicals, and arrests 99.7% of salt. 3 refs., 4 figs.

  3. Non-invasive estimation of intracranial pressure. MR-based evaluation in children with hydrocephalus; Nichtinvasive Bestimmung des intrakraniellen Drucks. MR-basierte Untersuchung bei Kindern mit Hydrozephalus

    Energy Technology Data Exchange (ETDEWEB)

    Muehlmann, M.; Steffinger, D.; Ertl-Wagner, B.; Koerte, I.K. [Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Peraud, A. [Ludwig-Maximilians-Universitaet Muenchen, Abteilung fuer Neurochirurgie, Muenchen (Germany); Lehner, M. [Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universitaet Muenchen, Abteilung fuer Kinderchirurgie, Muenchen (Germany); Heinen, F.; Alperin, N. [University Miami, Department of Radiology, Miller School of Medicine, Miami (United States)

    2012-09-15

    The intracranial pressure (ICP) is a crucially important parameter for diagnostic and therapeutic decision-making in patients with hydrocephalus. So far there is no standard method to non-invasively assess the ICP. Various approaches to obtain the ICP semi-invasively or non-invasively are discussed and the clinical application of a magnetic resonance imaging (MRI)-based method to estimate ICP (MR-ICP) is demonstrated in a group of pediatric patients with hydrocephalus. Arterial inflow, venous drainage and craniospinal cerebrospinal fluid (CSF) flow were quantified using phase-contrast imaging to derive the MR-ICP. A total of 15 patients with hydrocephalus (n=9 treated with shunt placement or ventriculostomy) underwent MRI on a 3 T scanner applying retrospectively-gated cine phase contrast sequences. Of the patients six had clinical symptoms indicating increased ICP (age 2.5-14.61 years, mean 7.4 years) and nine patients had no clinical signs of elevated ICP (age 2.1-15.9 years; mean 9.8 years; all treated with shunt or ventriculostomy). Median MR-ICP in symptomatic patients was 24.5 mmHg (25th percentile 20.4 mmHg; 75th percentile 44.6 mmHg). Median MR-ICP in patients without acute signs of increased ICP was 9.8 mmHg (25th percentile 8.6 mmHg; 75th percentile 11.4 mmHg). Group differences were significant (p < 0.001; Mann-Whitney U-test). The MR-ICP technique is a promising non-invasive tool for estimating ICP. Further studies in larger patient cohorts are warranted to investigate its application in children with hydrocephalus. (orig.) [German] Der intrakranielle Druck (''intracranial pressure'' - ICP) ist ein entscheidender Parameter bei der Diagnostik, Therapie und Verlaufsbeurteilung von Patienten mit Hydrozephalus. Derzeit gibt es keine radiologische Standardmethode, um den intrakraniellen Druck quantitativ zu bestimmen. Methoden zur invasiven und nichtinvasiven Einschaetzung des ICP werden diskutiert und die Anwendung eines MR

  4. Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study.

    Science.gov (United States)

    Honda, Mitsuru; Ichibayashi, Ryo; Suzuki, Ginga; Yokomuro, Hiroki; Seiki, Yoshikatsu; Sase, Shigeru; Kishi, Taichi

    2017-12-01

    Monitoring of intracranial pressure (ICP) is considered to be fundamental for the care of patients with severe traumatic brain injury (TBI) and is routinely used to direct medical and surgical therapy. Accordingly, some guidelines for the management of severe TBI recommend that treatment be initiated for ICP values >20 mmHg. However, it remained to be accounted whether there is a scientific basis to this instruction. The purpose of the present study was to clarify whether the basis of ICP values >20 mmHg is appropriate. We retrospectively reviewed 25 patients with severe TBI who underwent neuroimaging during ICP monitoring within the first 7 days. We measured cerebral blood flow (CBF), mean transit time (MTT), cerebral blood volume (CBV), and ICP 71 times within the first 7 days. Although the CBF, MTT, and CBV values were not correlated with the ICP value at ICP values ≤20 mmHg, the CBF value was significantly negatively correlated with the ICP value (r = -0.381, P values >20 mmHg. The MTT value was also significantly positively correlated with the ICP value (r = 0.638, P values >20 mmHg. The cerebral circulation disturbance increased with the ICP value. We demonstrated the cerebral circulation disturbance at ICP values >20 mmHg. This study suggests that an ICP >20 mmHg is the threshold to initiate treatments. An active treatment intervention would be required for severe TBI when the ICP was >20 mmHg.

  5. Mannitol-induced rebleeding from intracranial aneurysm. Case report

    DEFF Research Database (Denmark)

    Rosenørn, J; Westergaard, L; Hansen, P H

    1983-01-01

    A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across...

  6. Mannitol-induced rebleeding from intracranial aneurysm. Case report

    DEFF Research Database (Denmark)

    Rosenørn, J; Westergaard, L; Hansen, P H

    1983-01-01

    A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across ...

  7. Effects of feed solution chemistry on low pressure reverse osmosis filtration of cesium and strontium

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Shiyuan, E-mail: dingshiyuan@bnu.edu.cn [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875 (China); Yang, Yu, E-mail: yangyu@bnu.edu.cn [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875 (China); Huang, Haiou, E-mail: huanghaiou@bnu.edu.cn [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875 (China); Liu, Hengchen, E-mail: 799599501@qq.com [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875 (China); Hou, Li-an, E-mail: houlian678@hotmail.com [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875 (China); Xi’an High-Tech Institute, No. 2, Tongxin Street, Baqiao District, Xi’an 710025 (China)

    2015-08-30

    Highlights: • A low pressure spiral wound RO membrane can reject Cs and Sr efficiently. • The rejection of Cs and Sr is dependent on feed pH and co-existing ions. • Donnan exclusion and electrostatic interaction govern the rejection of Cs and Sr. • The differences of filtration mechanism were influenced by the size of ions. • Sr could strengthen the irreversible membrane fouling resistance with HA. - Abstract: The objective of this study was to identify the removal mechanisms of radionuclides by reverse osmosis (RO) membranes under conditions relevant to full-scale water treatment. For this purpose, the effects of feed solution chemistry on the removal of Cs and Sr by a low pressure RO system was investigated by systematically varying membrane surface charge, ionic composition, and organic matter concentrations. The results showed that the effects of solution chemistry on the filtration of Cs and Sr were related to their hydrated ionic radius, resulting in the predominance of the Donnan’s effect and electrostatic interactions, respectively. Consequently, the rejection of Cs increased more pronouncedly than Sr with the increases of feed concentration. Due to the Donnan’s effect, different anions decreased the rejection of Cs to different extents in accordance to the order of anions’ radii as SO{sub 4}{sup 2−} > Cl{sup −} > NO{sub 3}{sup −} > F{sup −}. The variations in Sr rejection were influenced by the electrostatic interactions between Sr{sup 2+} and the membrane. In addition, humic acid (HA) lowered the rejection of Cs and caused significant membrane flux decline, but did not change the rejection of Sr. Sr also aggravated HA fouling of the membrane.

  8. An Update on Idiopathic Intracranial Hypertension

    OpenAIRE

    Thurtell, Matthew J.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

    2010-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology often encountered in neurologic practice. It produces non-localizing symptoms and signs of raised intracranial pressure and, when left untreated, can result in severe irreversible visual loss. It most commonly occurs in obese women of childbearing age, but it can also occur in children, men, non-obese adults, and older adults. While it is frequently associated with obesity, it can be associated with other conditions...

  9. Graves' disease and idiopathic intracranial hypertension

    OpenAIRE

    Manish Gutch; Annesh Bhattacharjee; Sukriti Kumar; Durgesh Pushkar

    2017-01-01

    Idiopathic intracranial hypertension (IIH) is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in assoc...

  10. A reverse depletion method for pressurized water reactor core reload design

    International Nuclear Information System (INIS)

    Downar, T.J.; Kin, Y.J.

    1986-01-01

    Low-leakage fuel management is currently practiced in over half of all pressurized water reactor (PWR) cores. The large numbers of burnable poison pins used to control the power peaking at the in-board fresh fuel positions have introduced an additional complexity to the core reload design problem. In addition to determining the best location of each assembly in the core, the designer must concurrently determine the distribution of burnable poison pins in the fresh fuel. A new method for performing core design more suitable for low-leakage fuel management is reported. A procedure was developed that uses the wellknown ''Haling depletion'' to achieve an end-of-cycle (EOC) core state where the assembly pattern is configured in the absence of all control poison. This effectively separates the assembly assignment and burnable poison distribution problems. Once an acceptable pattern at EOC is configured, the burnable and soluble poison required to control the power and core excess reactivity are solved for as unknown variables while depleting the cycle in reverse from the EOC exposure distribution to the beginning of cycle. The methods developed were implemented in an approved light water reactor licensing code to ensure the validity of the results obtained and provided for the maximum utility to PWR core reload design

  11. Influence of periodic heartbeat reversal and abdominal movements on hemocoelic and tracheal pressure in resting blowflies Calliphora vicina.

    Science.gov (United States)

    Wasserthal, Lutz Thilo

    2012-01-15

    In Calliphoridae and Drosophilidae, the dorsal vessel (heart and aorta with associated venous channels) is the only connection between the thorax and the abdomen. Hemolymph oscillates between the compartments by periodic heartbeat reversal, but both the mechanism and its influence on hemocoelic and tracheal pressure have remained unclear. The pumping direction of the heart regularly reverses, with a higher pulse rate during backward compared with forward pumping. A sequence of forward and backward pulse periods lasts approximately 34 s. Pulse rate, direction, velocity and the duration of heartbeat periods were determined by thermistor and electrophysiological measurements. For the first time, heartbeat-induced pressure changes were measured in the hemocoel and in the tracheal system of the thorax and the abdomen. The tracheal pressure changed from sub-atmospheric during backward heartbeat to supra-atmospheric during forward heartbeat in the thorax and inversely in the abdomen. The heartbeat reversals were coordinated with slow abdominal movements with a pumping stroke at the beginning of the forward pulse period. The pressure effect of the pumping stroke was visible only in the abdomen. Periodic hemolymph shift and abdominal movements resulted in pressure changes in the hemocoel and tracheal system alternating in the thorax and abdomen, suggesting an effect on respiratory gas exchange.

  12. Spaceflight-Induced Intracranial Hypertension.

    Science.gov (United States)

    Michael, Alex P; Marshall-Bowman, Karina

    2015-06-01

    Although once a widely speculated about and largely theoretical topic, spaceflight-induced intracranial hypertension has gained acceptance as a distinct clinical phenomenon, yet the underlying physiological mechanisms are still poorly understood. In the past, many terms were used to describe the symptoms of malaise, nausea, vomiting, and vertigo, though longer duration spaceflights have increased the prevalence of overlapping symptoms of headache and visual disturbance. Spaceflight-induced visual pathology is thought to be a manifestation of increased intracranial pressure (ICP) because of its similar presentation to cases of known intracranial hypertension on Earth as well as the documentation of increased ICP by lumbar puncture in symptomatic astronauts upon return to gravity. The most likely mechanisms of spaceflight-induced increased ICP include a cephalad shift of body fluids, venous outflow obstruction, blood-brain barrier breakdown, and disruption to CSF flow. The relative contribution of increased ICP to the symptoms experienced during spaceflight is currently unknown, though other factors recently posited to contribute include local effects on ocular structures, individual differences in metabolism, and the vasodilator effects of carbon dioxide. This review article attempts to consolidate the literature regarding spaceflight-induced intracranial hypertension and distinguish it from other pathologies with similar symptomatology. It discusses the proposed physiological causes and the pathological manifestations of increased ICP in the spaceflight environment and provides considerations for future long-term space travel. In the future, it will be critical to develop countermeasures so that astronauts can participate at their peak potential and return safely to Earth.

  13. Intraparenchymal intracranial pressure monitoring in patients with acute liver failure Monitoreo intraparenquimatoso de presión intracraneana en pacientes con falla hepática aguda

    Directory of Open Access Journals (Sweden)

    Alejandra T. Rabadán

    2008-06-01

    Full Text Available BACKGROUND: Elevated intracranial pressure (ICP is a common cause of death in acute liver failure (ALF and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. METHOD: Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patients had ICP monitoring because of grade III-IV encephalopathy. All patients received fresh plasma (2-3 units before and during placing the intraparenchymal device. RESULTS: Eleven cases (64.7% had elevated ICP, and 6 patients (35.2% had normal values. One patient (5.9% had an asymptomatic small intraparenchymal haemorrhage ANTECEDENTES: La presión intracraneana elevada (PIC es una causa frecuente de muerte en la falla hepática aguda (FHA y es determinante para la toma de decisiones respecto del momento del transplante hepático. El tipo de dispositivo para el monitoreo de OIC es controversial em los pacientes em FHA. Los dispositivos epidurales tienen menos riesgo de complicaciones hemorrágicas, pero son menos confiables que los intraparenquimatosos. MÉTODO: Veintitrés pacientes con FHA fueron tratados, y 19 de ellos recibieron un transplante hepático. diecisiete pacientes tuvieron monitoreo de PIC debido a encefalopatía grado III-IV. Todos los pacientes recibieron plasma fresco (2-3 unidades antes y durante la colocación de la fibra intraparenquimatosa. RESULTADOS: Once casos (64.7% tuvieron PIC elevada, y 6 pacientes (35.2% tuvieron valores normales. Un paciente (5.9% tuvo una pequeña hemorragia intraparenquimatosa asintomática <1cm³ en TAC, la cual no impidió el transplante hepático. CONCLUSIÓN: En nuestra experiencia, el monitoreo intraparenquimatoso de presión intracraneana en pacientes con FHA parece ser un método preciso y con bajo riesgo

  14. Comparison of energy efficiency and power density in pressure retarded osmosis and reverse electrodialysis.

    Science.gov (United States)

    Yip, Ngai Yin; Elimelech, Menachem

    2014-09-16

    Pressure retarded osmosis (PRO) and reverse electrodialysis (RED) are emerging membrane-based technologies that can convert chemical energy in salinity gradients to useful work. The two processes have intrinsically different working principles: controlled mixing in PRO is achieved by water permeation across salt-rejecting membranes, whereas RED is driven by ion flux across charged membranes. This study compares the energy efficiency and power density performance of PRO and RED with simulated technologically available membranes for natural, anthropogenic, and engineered salinity gradients (seawater-river water, desalination brine-wastewater, and synthetic hypersaline solutions, respectively). The analysis shows that PRO can achieve both greater efficiencies (54-56%) and higher power densities (2.4-38 W/m(2)) than RED (18-38% and 0.77-1.2 W/m(2)). The superior efficiency is attributed to the ability of PRO membranes to more effectively utilize the salinity difference to drive water permeation and better suppress the detrimental leakage of salts. On the other hand, the low conductivity of currently available ion exchange membranes impedes RED ion flux and, thus, constrains the power density. Both technologies exhibit a trade-off between efficiency and power density: employing more permeable but less selective membranes can enhance the power density, but undesired entropy production due to uncontrolled mixing increases and some efficiency is sacrificed. When the concentration difference is increased (i.e., natural → anthropogenic → engineered salinity gradients), PRO osmotic pressure difference rises proportionally but not so for RED Nernst potential, which has logarithmic dependence on the solution concentration. Because of this inherently different characteristic, RED is unable to take advantage of larger salinity gradients, whereas PRO power density is considerably enhanced. Additionally, high solution concentrations suppress the Donnan exclusion effect of the

  15. Multiaxial fatigue strength of type 316 stainless steel under push–pull, reversed torsion, cyclic inner and outer pressure loading

    International Nuclear Information System (INIS)

    Morishita, Takahiro; Itoh, Takamoto; Bao, Zhenlong

    2016-01-01

    Multiaxial fatigue tests under non-proportional loading in which principal directions of stress and strain are changed in a cycle were carried out using a developed multiaxial fatigue testing machine which can load a push–pull and reversed torsion loading with cyclic inner and outer pressure. This paper presents the developed testing machine and experimental results under several multiaxial loading conditions including non-proportional loading. In strain control tests, the failure life is reduced in accordance with increasing inner pressure at each strain path. The failure life can be correlated by von Mises' equivalent stress amplitude relatively well independent of not only inner pressure but also loading path. In load control tests, the failure life is reduced largely by non-proportional loading but the influence of inner and outer pressure on the failure life is relative small.

  16. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    OpenAIRE

    Oudeman, Eline A.; Tewarie, Rishi D. S. Nandoe; J?bsis, G. Joost; Arts, Mark P.; Kruyt, Nyika D.

    2015-01-01

    Background: Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. Case Description: We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior...

  17. Intracranial hypotension and hypertension in children and adolescents.

    Science.gov (United States)

    Ozge, Aynur; Bolay, Hayrunnisa

    2014-07-01

    The specific aim of this review is to report the features of intracranial pressure changes [spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents, with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with intracranial pressure changes are relatively rare and less known in children and adolescents. SIH is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently encountered connective tissue disorders, and a good prognosis with medical management, initial epidural blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in children and different from the disease in adults, not only with respect to clinical features (likely to present with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome. Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis and entire management.

  18. Genus Zero Graph Segmentation: Estimation of Intracranial Volume

    DEFF Research Database (Denmark)

    Jensen, Rasmus Ramsbøl; Thorup, Signe Strann; Paulsen, Rasmus Reinhold

    2013-01-01

    The intracranial volume (ICV) in children with premature fusion of one or more sutures in the calvaria is of interest due to the risk of increased intracranial pressure. Challenges for automatic estimation of ICV include holes in the skull e.g. the foramen magnum and fontanelles. In this paper, we...

  19. Idiopathic intracranial hypertension with altered consciousness in a ...

    African Journals Online (AJOL)

    Idiopathic intracranial hypertension (IIH) is a clinical condition of increased intracranial pressure (ICP) without an obvious underlying pathological brain lesion. It is usually characterized by headache, neck pain, vomiting, visual disturbances, papilledema, cranial nerve palsy or a combination of these signs and symptoms.

  20. Genus zero graph segmentation: Estimation of intracranial volume

    DEFF Research Database (Denmark)

    Jensen, Rasmus Ramsbøl; Thorup, Signe Strann; Paulsen, Rasmus Reinhold

    2014-01-01

    The intracranial volume (ICV) in children with premature fusion of one or more sutures in the calvaria is of interest due to the risk of increased intracranial pressure. Challenges for automatic estimation of ICV include holes in the skull e.g. the foramen magnum and fontanelles. In this paper, w...

  1. Pressure effects on enzyme reactions in mainly organic media: alpha-chymotrypsin in reversed micelles of Aerosol OT in octane.

    Science.gov (United States)

    Mozhaev, V V; Bec, N; Balny, C

    1994-08-01

    Biocatalytic transformations in reversed micelles formed by anionic surfactant Aerosol OT in octane have been studied at high pressures by an example of alpha-chymotrypsin-catalyzed hydrolysis of N-carbobenzoxy-L-tyrosine p-nitrophenyl ester and N-succinyl-L-phenylalanine p-nitroanilide. For the first time it has been found that the enzyme retains high activity in these water-in-oil microemulsions up to a pressure of 2 kbar. The value of the activation volume (delta V*) for the enzyme reactions shows a dependence on the water content in the system. When the size of the micellar aqueous inner cavity (as evaluated at 1 atm) approaches the molecular size of alpha-chymotrypsin, delta V* becomes significantly different from the value in aqueous solution and in the micelles with a larger size. Possibilities of regulating the enzyme activity by pressure in systems with a low content of water are discussed.

  2. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  3. NOISY INTRACRANIAL TUMORS

    NARCIS (Netherlands)

    VANDOOREN, BTH; VANBRUGGEN, AC; MOOIJ, JJA; HEW, JM; JOURNEE, HL

    1994-01-01

    Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9

  4. Intracranial atherosclerosis: current concepts.

    Science.gov (United States)

    Arenillas, Juan F

    2011-01-01

    The most relevant ideas discussed in this article are described here. Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Its importance in whites may have been underestimated. New technical developments, such as high-resolution MRI, allow direct assessment of the intracranial atherosclerotic plaque, which may have a profound impact on ICAD diagnosis and therapy in the near future. Early detection of ICAD may allow therapeutic intervention while the disease is still asymptomatic. The Barcelonès Nord and Maresme Asymptomatic Intracranial Atherosclerosis Study is presented here. The main prognostic factors that characterize the patients who are at a higher risk for ICAD recurrence are classified and discussed. The best treatment for ICAD remains to be established. The Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study is currently ongoing to address this crucial issue. These and other topics will be discussed at the Fifth International Intracranial Atherosclerosis Conference (Valladolid, Spain, autumn 2011).

  5. Hybrid membrane system for desalination and wastewater treatment : Integrating forward osmosis and low pressure reverse osmosis

    NARCIS (Netherlands)

    Valladares Linares, R.

    2014-01-01

    Since more than 97% of the water in the world is seawater, desalination technologies have the potential to solve the fresh water crisis. The most used desalination technology nowadays is seawater reverse osmosis (SWRO), where a membrane is used as a physical barrier to separate the salts from the

  6. Life cycle cost of a hybrid forward osmosis – low pressure reverse osmosis system for seawater desalination and wastewater recovery

    KAUST Repository

    Valladares Linares, Rodrigo

    2015-10-19

    In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis – low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor – reverse osmosis – advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m3 d−1 of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m3 produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and

  7. Reverse water-in-fluorocarbon emulsions for use in pressurized metered-dose inhalers containing hydrofluoroalkane propellants.

    Science.gov (United States)

    Butz, N; Porté, C; Courrier, H; Krafft, M P; Vandamme, Th F

    2002-05-15

    Pulmonary administration of drugs has demonstrated numerous advantages in the treatment of pulmonary diseases due to direct targeting to the respiratory tract. It enables avoiding the first pass effect, reduces the amount of drugs administered, targets drugs to specific sites and reduces their side effects. Reverse water-in-fluorocarbon (FC) emulsions are potential drug delivery systems for pulmonary administration using pressurized metered-dose inhalers (pMDI). The external phase of these emulsions consists of perfluorooctyl bromide (PFOB, perflubron), whereas their internal phase contains the drugs solubilized or dispersed in water. These emulsions are stabilized by a perfluoroalkylated dimorpholinophosphate (F8H11DMP), i.e. a fluorinated surfactant. This study demonstrates the possibility of delivering a reverse fluorocarbon emulsion via the pulmonary route using a CFC-free pMDI. Two hydrofluoroalkanes (HFAs) (Solkane(R) 134a and Solkane(R) 227) were used as propellants, and various solution (or emulsion)/propellant ratios (1/3, 1/2, 2/3, 1/1, 3/2, 3/1 v/v) were investigated. The insolubility of water (with or without the fluorinated surfactant F8H11DMP) in both HFA 227 and HFA 134a was demonstrated. PFOB and the reverse emulsion were totally soluble or dispersible in all proportions in both propellants. This study demonstrated also that the reverse FC emulsion can be successfully used to deliver caffeine in a homogeneous and reproducible way. The mean diameter of the emulsion water droplets in the pressured canister was investigated immediately after packaging and after 1 week of storage at room temperature. Best results were obtained with emulsion/propellant ratios comprised between 2/3 and 3/2, and with HFA 227 as propellant.

  8. Idiopathic intracranial hypertension and transverse sinus stenoses

    DEFF Research Database (Denmark)

    Skyrman, Simon; Fytagoridis, Anders; Andresen, Morten

    2013-01-01

    An 18-year-old woman was diagnosed with idiopathic intracranial hypertension (IIH) and bilateral transverse sinus stenoses (TSS), after presenting with papilledema and decreased visual acuity. Lumbar puncture revealed an opening pressure of >60 cm H2O. MRI showed bilateral TSS believed to be asso...

  9. Intracranial hypertension in 2 children with marfan syndrome

    NARCIS (Netherlands)

    Hilhorst-Hofstee, Yvonne; Kroft, Lucia J. M.; Pals, Gerard; van Vugt, Jeroen P. P.; Overweg-Plandsoen, Wouterina C. G.

    2008-01-01

    Two unrelated children with Marfan syndrome presented with recurrent intracranial hypertension. Both children complained of headache, nausea, and vomiting and one of them had papilledema. Both had increased cerebrospinal fluid pressure, and their complaints disappeared after lumbar puncture.

  10. ICP curve morphology and intracranial flow-volume changes

    DEFF Research Database (Denmark)

    Unnerbäck, Mårten; Ottesen, Johnny T.; Reinstrup, Peter

    2018-01-01

    proposed to shape the ICP curve. This study tested the hypothesis that the ICP curve correlates to intracranial volume changes. METHODS: Cine phase contrast magnetic resonance imaging (MRI) examinations were performed in neuro-intensive care patients with simultaneous ICP monitoring. The MRI was set......BACKGROUND: The intracranial pressure (ICP) curve with its different peaks has been extensively studied, but the exact physiological mechanisms behind its morphology are still not fully understood. Both intracranial volume change (ΔICV) and transmission of the arterial blood pressure have been...

  11. Graves' disease and idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Manish Gutch

    2017-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in association with this disorder. We present a rare case of a 25-year-old man with Graves' disease with intractable headache that was later investigated and attributed to development of IIH.

  12. Renal rescue of dopamine D2 receptor function reverses renal injury and high blood pressure

    Science.gov (United States)

    Konkalmatt, Prasad R.; Asico, Laureano D.; Zhang, Yanrong; Yang, Yu; Drachenberg, Cinthia; Zheng, Xiaoxu; Han, Fei; Jose, Pedro A.; Armando, Ines

    2016-01-01

    Dopamine D2 receptor (DRD2) deficiency increases renal inflammation and blood pressure in mice. We show here that long-term renal-selective silencing of Drd2 using siRNA increases renal expression of proinflammatory and profibrotic factors and blood pressure in mice. To determine the effects of renal-selective rescue of Drd2 expression in mice, the renal expression of DRD2 was first silenced using siRNA and 14 days later rescued by retrograde renal infusion of adeno-associated virus (AAV) vector with DRD2. Renal Drd2 siRNA treatment decreased the renal expression of DRD2 protein by 55%, and DRD2 AAV treatment increased the renal expression of DRD2 protein by 7.5- to 10-fold. Renal-selective DRD2 rescue reduced the expression of proinflammatory factors and kidney injury, preserved renal function, and normalized systolic and diastolic blood pressure. These results demonstrate that the deleterious effects of renal-selective Drd2 silencing on renal function and blood pressure were rescued by renal-selective overexpression of DRD2. Moreover, the deleterious effects of 45-minute bilateral ischemia/reperfusion on renal function and blood pressure in mice were ameliorated by a renal-selective increase in DRD2 expression by the retrograde ureteral infusion of DRD2 AAV immediately after the induction of ischemia/reperfusion injury. Thus, 14 days after ischemia/reperfusion injury, the renal expression of profibrotic factors, serum creatinine, and blood pressure were lower in mice infused with DRD2 AAV than in those infused with control AAV. These results indicate an important role of renal DRD2 in limiting renal injury and preserving normal renal function and blood pressure. PMID:27358912

  13. Plasma brain-derived neurotrophic factor and reverse dipping pattern of nocturnal blood pressure in patients with cardiovascular risk factors.

    Directory of Open Access Journals (Sweden)

    Manabu Kadoya

    Full Text Available Basic studies have shown that brain-derived neurotrophic factor (BDNF has critical roles in the survival, growth, maintenance, and death of central and peripheral neurons, while it is also involved in regulation of the autonomic nervous system. Furthermore, recent clinical studies have suggested potential role of plasma BDNF in the circulatory system.We investigated the mutual relationships among plasma BDNF, patterns of nocturnal blood pressure changes (dippers, non-dippers, extra-dippers, and reverse-dippers, and cardiac autonomic function as determined by heart rate variability (HRV.This was a cross-sectional study of patients registered in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA Study from October 2010 to November 2012.Two-hundred fifty patients with 1 or more cardiovascular risk factor(s (obesity, smoking, presence of cardiovascular event history, hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease were enrolled.Plasma BDNF levels (natural logarithm transformed were significantly (p = 0.001 lower in reverse-dipper patients (7.18±0.69 pg/ml, mean ± SD, n = 36 as compared to dippers (7.86±0.86 pg/ml, n = 100. Multiple logistic regression analysis showed that BDNF (odds ratios: 0.417, 95% confidence interval: 0.228-0.762, P = 0.004 was the sole factor significantly and independently associated with the reverse-dippers as compared with dippers. Furthermore, plasma BDNF level was significantly and positively correlated with the time-domain (SDNN, SDANN5, CVRR and frequency-domain (LF of HRV parameters. Finally, multiple logistic regression analyses showed that the relationship between plasma BDNF and the reverse-dippers was weakened, yet remained significant or borderline significant even after adjusting for HRV parameters.Low plasma BDNF was independently associated with patients showing a reverse-dipper pattern of nocturnal blood pressure, in which an imbalance of cardiac autonomic function

  14. Intracranial capillary hemangioma mimicking a dissociative disorder

    Directory of Open Access Journals (Sweden)

    Alexander Lacasse

    2012-01-01

    Full Text Available Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS. Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser’s syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms.

  15. SEPARATION OF HAZARDOUS ORGANICS BY LOW PRESSURE REVERSE OSMOSIS MEMBRANES - PHASE II FINAL REPORT

    Science.gov (United States)

    Extensive experimental studies showed that thin-film, composite membranes can be used effectively for the separation of selected hazardous organic compounds. This waste treatment technique offers definite advantages in terms of high solute separations at low pressures (<2MPa) and...

  16. Intracranial hypertension prediction using extremely randomized decision trees.

    Science.gov (United States)

    Scalzo, Fabien; Hamilton, Robert; Asgari, Shadnaz; Kim, Sunghan; Hu, Xiao

    2012-10-01

    Intracranial pressure (ICP) elevation (intracranial hypertension, IH) in neurocritical care is typically treated in a reactive fashion; it is only delivered after bedside clinicians notice prolonged ICP elevation. A proactive solution is desirable to improve the treatment of intracranial hypertension. Several studies have shown that the waveform morphology of the intracranial pressure pulse holds predictors about future intracranial hypertension and could therefore be used to alert the bedside clinician of a likely occurrence of the elevation in the immediate future. In this paper, a computational framework is proposed to predict prolonged intracranial hypertension based on morphological waveform features computed from the ICP. A key contribution of this work is to exploit an ensemble classifier method based on extremely randomized decision trees (Extra-Trees). Experiments on a representative set of 30 patients admitted for various intracranial pressure related conditions demonstrate the effectiveness of the predicting framework on ICP pulses acquired under clinical conditions and the superior results of the proposed approach in comparison to linear and AdaBoost classifiers. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  17. Pressure-induced reversal between thermal contraction and expansion in ferroelectric PbTiO3

    OpenAIRE

    Jinlong Zhu; Jianzhong Zhang; Hongwu Xu; Sven C. Vogel; Changqing Jin; Johannes Frantti; Yusheng Zhao

    2014-01-01

    Materials with zero/near zero thermal expansion coefficients are technologically important for applications in thermal management and engineering. To date, this class of materials can only be produced by chemical routes, either by changing chemical compositions or by composting materials with positive and negative thermal expansion. Here, we report for the first time a physical route to achieve near zero thermal expansion through application of pressure. In the stability field of tetragonal P...

  18. Pressure reversal of the action of octanol on postsynaptic membranes from Torpedo.

    OpenAIRE

    Braswell, L. M.; Miller, K. W.; Sauter, J. F.

    1984-01-01

    Octanol increases the binding of [3H]-acetylcholine to the desensitized state of the nicotinic receptor in postsynaptic membranes prepared from Torpedo californica. This increase in binding results from an increase in the affinity of [3H]-acetylcholine for its receptor without any change in the number of sites or the shape of the acetylcholine binding curve. High pressures of helium (300 atm) decrease [3H]-acetylcholine binding by a mechanism that changes only the affinity of acetylcholine bi...

  19. Idiopathic intracranial hypertension: case report

    Directory of Open Access Journals (Sweden)

    Iacob G.

    2015-12-01

    Full Text Available Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9, was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right > left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox, corticosteroid, antidepressants (Amitriptyline, anticonvulsivants (Topiramate three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP. A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and

  20. MRI findings of cerebral parenchyma along a ventricular catheter under various intracranial conditions

    International Nuclear Information System (INIS)

    Yamamoto, Yoshisuke; Hoshino, Tamotsu; Suzuki, Hidenori

    1993-01-01

    We have experienced 4 cases of cerebral parenchymas in which high intensity was sustained by MRI T 2 WI, though a low density disappeared in CT, among the cases in which an expansion of the low density was observed in the cerebral parenchyma along a ventricular catheter by a CT scan after ventricular drainage and a shunt operation designed to combat increased intracranial pressure due to meningitis and a brain tumor. The cases were classified on the basis of morbidity into 1 case of cryptococcus meningitis, 1 case complicated by cerebellar hemorrhage and meningitis, and two cases of acute increased intracranial pressue due to a thalamic tumor and cerebellar astrocytoma. If a ventricular catheter or drainage tube is inserted, cerebral fluid penetrates into the cerebral parenchyma to cause a change in the tissue which can be explained, on the basis of CT findings, as a reversible change. However, this histological change is not always reversible according to our present MRI finding; rather, it becomes strong if the results of an inflammation such as meningitis are added to the cerebral fluid; in such a case, the reversibility is considered to disappear completely. (author)

  1. Life cycle cost of a hybrid forward osmosis - low pressure reverse osmosis system for seawater desalination and wastewater recovery.

    Science.gov (United States)

    Valladares Linares, R; Li, Z; Yangali-Quintanilla, V; Ghaffour, N; Amy, G; Leiknes, T; Vrouwenvelder, J S

    2016-01-01

    In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis - low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor - reverse osmosis - advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m(3) d(-1) of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m(3) produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and

  2. Blood Pressure Is the Determinant for the Increased Risk for Intracranial Arterial Stenosis in Subjects with Elevated Glycated Hemoglobin Levels: The Kangbuk Samsung Health Study.

    Science.gov (United States)

    Oh, Hyung-Geun; Rhee, Eun-Jung

    2016-11-01

    Ischemic stroke is known to be an important vascular complication of diabetes. Intracranial arterial stenosis (ICAS) is considered as an important cause of stroke in Asians. We aimed to analyze the risk for ICAS assessed by transcranial Doppler (TCD) ultrasonography in different groups of young Korean subjects divided by glycated hemoglobin (HbA1c) levels. This study included 10,437 participants without history of cardiovascular diseases (81.3% men, mean age 43 years) from a health screening program, in whom TCD ultrasonography was used to detect greater than 50% ICAS based on criteria modified from the SONIA (Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis) trial. The subjects were divided into 3 groups according to HbA1c levels: HbA1c < 5.7%, 5.7 ≤ HbA1c < 6.5%, and HbA1c ≥ 6.5% or under medication for diabetes. Among the participants, 3.0% of the subjects had ICAS. The subjects with ICAS tended to have higher mean HbA1c level compared with those without ICAS (5.8 ± .8 versus 5.7 ± .6, P = .063). The proportion of subjects with ICAS significantly increased as the HbA1c increased from the first to the third group (2.8%, 3.0%, 4.6%, P for linear trend = .022). In logistic regression analysis with ICAS as the dependent variable, the group with HbA1c ≥ 6.5% showed significantly increased odds ratio for ICAS with subjects with HbA1c < 5.7% as the reference after adjustment for confounding variables (1.575, 95% confidence interval 1.056-2.347). However, this significance disappeared with inclusion of presence of hypertension in the model. The risk for ICAS assessed by TCD was increased in young Korean subjects with HbA1c ≥ 6.5%. However, this significance was attenuated after adjustment for presence of hypertension, suggesting the importance of hypertension in ICAS. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Influence of preliminary deformation and phase strengthening on γ reversible α transformation kinetics in cerium under pressure

    International Nuclear Information System (INIS)

    Larionov, L.V.; Livshits, L.D.; Peresada, G.I.; AN SSSR, Moscow. Inst. Fiziki Zemli)

    1985-01-01

    Using the methods of piezo- and resistometry the influence of preliminary plastic deformation, phase transformation induced strengthening and heat treatment on kinetics of γ reversible α transformation in cerium is studied. It is shown, that the used methods of preliminary treatment of sample material do not change pressure value of γ → α and α →γ transformation initiation and do not affect hysteresis value, but affect considerably its kinetics. Preliminary plastic deformation and structural strengthening increase the average formation rate of a new phase. According to the data of tensile tests, structural strengthening, apprearing as a result of one cycle of γ → α → γ transformation, increases cerium strength characteristics 6y 30-50% with simultaneous decrease in plasticity. Metallographic studies confirm martensitic character of γ → α → γ transformations in cerium

  4. Arterial blood pressure but not serum albumin concentration correlates with ADC ratio values in pediatric posterior reversible encephalopathy syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Furtado, Andre; Zuccoli, Giulio [Section of Neuroradiology Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Hsu, Ariel [University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); La Colla, Luca [University of Parma, Department of Anesthesiology, Parma (Italy)

    2015-07-15

    Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity affecting both adults and children characterized by neurotoxicity often in setting of hypertension coupled with distinct brain magnetic resonance imaging features. Decreased serum albumin level has been suggested to correlate with the presence of vasogenic brain edema in adult PRES. Serum albumin has thus been hypothesized to protect against neurotoxicity in PRES by reducing vasogenic brain edema through its role in maintaining plasma osmotic pressure and endothelial integrity. The purpose of our study was to investigate if such correlation between decreased serum albumin level and PRES-related vasogenic edema could be found in children. We conducted a retrospective study of 25 pediatric patients diagnosed with PRES. Underlying clinical conditions, presenting symptoms, blood pressures, and serum albumin levels at onset of symptoms were collected. Brain MR imaging studies were reviewed. We used a quantitative method to evaluate the degree of vasogenic edema by measuring apparent diffusion coefficient (ADC) values of the T2-FLAIR hyperintense brain lesions. No significant correlation was found between serum albumin level and degree of PRES-related vasogenic edema. A significant correlation was found between elevated blood pressure and degree of vasogenic edema in the temporal lobes (p = 0.02 and 0.04, respectively) but not in the other cerebral lobes or cerebellum. Our initial results suggest blood pressure, not serum albumin level, as a main biomarker for brain edema in children with PRES. Thus, our study does not suggest a protective role of serum albumin against PRES-related neurotoxicity in children. (orig.)

  5. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    Science.gov (United States)

    ... cause is determined and is referred to as “secondary” intracranial hypertension. What are the risk factors for idiopathic intracranial ... clotting disorders, anemia and malnutrition. Can idiopathic intracranial ... to be “secondary” which affects males and females equally. The second ...

  6. Idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne M; Jensen, Rigmor H

    2015-01-01

    AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected but u...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....

  7. Two-fluid and nonlinear effects of tearing and pressure-driven resistive modes in reversed field pinches

    International Nuclear Information System (INIS)

    Mirnov, V.V.

    2002-01-01

    Large-scale tearing instabilities have long been considered to underlie transport and dynamo processes in the reversed field pinch (RFP). The vast majority of theoretical and computational RFP work has focused on pressureless, single-fluid MHD in cylindrical plasmas driven solely by a toroidal electric field. We report results of five investigations covering two-fluid dynamos, toroidal nonlinear MHD computation, nonlinear computation of Oscillating Field Current Drive (OFCD), the effect of shear flow on tearing instability, and the effect of pressure on resistive instability. The key findings are: (1) two-fluid dynamo arising from the Hall term is much larger than the standard MHD dynamo present in a single-fluid treatment, (2) geometric coupling from toroidicity precludes the occurrence of laminar single helicity states, except for nonreversed plasmas, (3) OFCD, a form of AC helicity injection, can sustain the RFP plasma current, although magnetic fluctuations are enhanced, (4) edge shear flow can destabilize the edge resonant m=0 modes, which occur as spikes in experiment, and (5) pressure driven modes are resistive at low beta, only becoming ideal at extremely high beta. (author)

  8. Indirect desalination of Red Sea water with forward osmosis and low pressure reverse osmosis for water reuse

    KAUST Repository

    Yangali-Quintanilla, Victor; Li, Zhenyu; Valladares Linares, Rodrigo; Li, Qingyu; Amy, Gary L.

    2011-01-01

    The use of energy still remains the main component of the costs of desalting water. Forward osmosis (FO) can help to reduce the costs of desalination, and extracting water from impaired sources can be beneficial in this regard. Experiments with FO membranes using a secondary wastewater effluent as a feed water and Red Sea water as a draw solution demonstrated that the technology is promising. FO coupled with low pressure reverse osmosis (LPRO) was implemented for indirect desalination. The system consumes only 50% (~1.5 kWh/m3) of the energy used for high pressure seawater RO (SWRO) desalination (2.5-4 kWh/m3), and produces a good quality water extracted from the impaired feed water. Fouling of the FO membranes was not a major issue during long-term experiments over 14 days. After 10 days of continuous FO operation, the initial flux declined by 28%. Cleaning the FO membranes with air scouring and clean water recovered the initial flux by 98.8%. A cost analysis revealed FO per se as viable technology. However, a minimum average FO flux of 10.5 L/m2-h is needed to compete with water reuse using UF-LPRO, and 5.5 L/m2-h is needed to recover and desalinate water at less cost than SWRO. © 2011 Elsevier B.V.

  9. Indirect desalination of Red Sea water with forward osmosis and low pressure reverse osmosis for water reuse

    KAUST Repository

    Yangali-Quintanilla, Victor

    2011-10-01

    The use of energy still remains the main component of the costs of desalting water. Forward osmosis (FO) can help to reduce the costs of desalination, and extracting water from impaired sources can be beneficial in this regard. Experiments with FO membranes using a secondary wastewater effluent as a feed water and Red Sea water as a draw solution demonstrated that the technology is promising. FO coupled with low pressure reverse osmosis (LPRO) was implemented for indirect desalination. The system consumes only 50% (~1.5 kWh/m3) of the energy used for high pressure seawater RO (SWRO) desalination (2.5-4 kWh/m3), and produces a good quality water extracted from the impaired feed water. Fouling of the FO membranes was not a major issue during long-term experiments over 14 days. After 10 days of continuous FO operation, the initial flux declined by 28%. Cleaning the FO membranes with air scouring and clean water recovered the initial flux by 98.8%. A cost analysis revealed FO per se as viable technology. However, a minimum average FO flux of 10.5 L/m2-h is needed to compete with water reuse using UF-LPRO, and 5.5 L/m2-h is needed to recover and desalinate water at less cost than SWRO. © 2011 Elsevier B.V.

  10. Application of pressure assisted forward osmosis for water purification and reuse of reverse osmosis concentrate from a water reclamation plant

    KAUST Repository

    Jamil, Shazad

    2016-07-26

    The use of forward osmosis (FO) is growing among the researchers for water desalination and wastewater treatment due to use of natural osmotic pressure of draw solute. In this study pressure assisted forward osmosis (PAFO) was used instead of FO to increase the water production rate. In this study a low concentration of draw solution (0.25 M KCl) was applied so that diluted KCl after PAFO operation can directly be used for fertigation. The performance of PAFO was investigated for the treatment of reverse osmosis concentrate (ROC) from a water reclamation plant. The water production in PAFO was increased by 9% and 29% at applied pressure of 2 and 4 bars, respectively, to feed side based on 90 h of experiments. Granular activated carbon (GAC) pretreatment and HCl softening were used to reduce organic fouling and scaling prior to application of PAFO. It reduced total organic carbon (TOC) and total inorganic carbon (TIC) by around 90% and 85%, respectively from untreated ROC. Subsequently, this led to an increase in permeate flux. In addition, GAC pretreatment adsorbed 12 out of 14 organic micropollutants tested from ROC to below detection limit. This application enabled to minimise the ROC volume with a sustainable operation and produced high quality and safe water for discharge or reuse. The draw solution (0.25 M KCl) used in this study was diluted to 0.14 M KCl, which is a suitable concentration (10 kg/m3) for fertigation, due to water transport from feed solution. © 2016 Elsevier B.V.

  11. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

    NARCIS (Netherlands)

    M.C. Cnossen (Maryse); Huijben, J.A. (Jilske A.); van der Jagt, M. (Mathieu); Volovici, V. (Victor); van Essen, T. (Thomas); S. Polinder (Suzanne); D. Nelson (David); Ercole, A. (Ari); Stocchetti, N. (Nino); Citerio, G. (Giuseppe); W.C. Peul (Wilco); A.I.R. Maas (Andrew I.R.); D.K. Menon (David ); E.W. Steyerberg (Ewout W.); Lingsma, H.F. (Hester F.); Adams, H. (Hadie); Alessandro, M. (Masala); J.E. Allanson (Judith); Amrein, K. (Krisztina); Andaluz, N. (Norberto); N. Andelic (Nada); Andrea, N. (Nanni); L. Andreassen (Lasse); Anke, A. (Audny); Antoni, A. (Anna); Ardon, H. (Hilko); Audibert, G. (Gérard); Auslands, K. (Kaspars); Azouvi, P. (Philippe); Baciu, C. (Camelia); Bacon, A. (Andrew); Badenes, R. (Rafael); Baglin, T. (Trevor); R.H.M.A. Bartels (Ronald); P. Barzo (P.); Bauerfeind, U. (Ursula); R. Beer (Ronny); Belda, F.J. (Francisco Javier); B.-M. Bellander (Bo-Michael); A. Belli (Antonio); Bellier, R. (Rémy); H. Benali (Habib); Benard, T. (Thierry); M. Berardino (Maurizio); L. Beretta (Luigi); Beynon, C. (Christopher); Bilotta, F. (Federico); H. Binder (Harald); Biqiri, E. (Erta); Blaabjerg, M. (Morten); Lund, S.B. (Stine Borgen); Bouzat, P. (Pierre); Bragge, P. (Peter); Brazinova, A. (Alexandra); F. Brehar (Felix); Brorsson, C. (Camilla); Buki, A. (Andras); M. Bullinger (Monika); Bucková, V. (Veronika); Calappi, E. (Emiliana); P. Cameron (Peter); Carbayo, L.G. (Lozano Guillermo); Carise, E. (Elsa); K.L.H. Carpenter (Keri L.H.); Castaño-León, A.M. (Ana M.); Causin, F. (Francesco); Chevallard, G. (Giorgio); A. Chieregato (Arturo); G. Citerio (Giuseppe); Cnossen, M. (Maryse); M. Coburn (Mark); J.P. Coles (Jonathan P.); Cooper, J.D. (Jamie D.); Correia, M. (Marta); A. Covic (Amra); N. Curry (Nicola); E. Czeiter (Endre); M. Czosnyka (Marek); Dahyot-Fizelier, C. (Claire); F. Damas (François); P. Damas (Pierre); H. Dawes (Helen); De Keyser, V. (Véronique); F.D. Corte (Francesco); B. Depreitere (Bart); Ding, S. (Shenghao); D.W.J. Dippel (Diederik); K. Dizdarevic (Kemal); Dulière, G.-L. (Guy-Loup); Dzeko, A. (Adelaida); G. Eapen (George); Engemann, H. (Heiko); A. Ercole (Ari); P. Esser (Patrick); Ezer, E. (Erzsébet); M. Fabricius (Martin); V.L. Feigin (V.); Feng, J. (Junfeng); Foks, K. (Kelly); F. Fossi (Francesca); Francony, G. (Gilles); J. Frantzén (Janek); Freo, U. (Ulderico); S.K. Frisvold (Shirin Kordasti); Furmanov, A. (Alex); Gagliardo, P. (Pablo); D. Galanaud (Damien); G. Gao (Guoyi); K. Geleijns (Karin); A. Ghuysen (Alexandre); Giraud, B. (Benoit); Glocker, B. (Ben); Gomez, P.A. (Pedro A.); Grossi, F. (Francesca); R.L. Gruen (Russell); Gupta, D. (Deepak); J.A. Haagsma (Juanita); E. Hadzic (Ermin); I. Haitsma (Iain); J.A. Hartings (Jed); R. Helbok (Raimund); E. Helseth (Eirik); Hertle, D. (Daniel); S. Hill (Sean); Hoedemaekers, A. (Astrid); S. Hoefer (Stefan); P.J. Hutchinson (Peter J.); Håberg, K.A. (Kristine Asta); B.C. Jacobs (Bart); Janciak, I. (Ivan); K. Janssens (Koen); Jiang, J.-Y. (Ji-Yao); Jones, K. (Kelly); Kalala, J.-P. (Jean-Pierre); Kamnitsas, K. (Konstantinos); Karan, M. (Mladen); Karau, J. (Jana); A. Katila (Ari); M. Kaukonen (Maija); Keeling, D. (David); Kerforne, T. (Thomas); N. Ketharanathan (Naomi); Kettunen, J. (Johannes); Kivisaari, R. (Riku); A.G. Kolias (Angelos G.); Kolumbán, B. (Bálint); E.J.O. Kompanje (Erwin); D. Kondziella (Daniel); L.-O. Koskinen (Lars-Owe); Kovács, N. (Noémi); F. Kalovits (Ferenc); A. Lagares (Alfonso); L. Lanyon (Linda); S. Laureys (Steven); Lauritzen, M. (Martin); F.E. Lecky (Fiona); C. Ledig (Christian); R. Lefering; V. Legrand (Valerie); Lei, J. (Jin); L. Levi (Leon); R. Lightfoot (Roger); H.F. Lingsma (Hester); D. Loeckx (Dirk); Lozano, A. (Angels); Luddington, R. (Roger); Luijten-Arts, C. (Chantal); Maas, A.I.R. (Andrew I.R.); MacDonald, S. (Stephen); MacFayden, C. (Charles); M. Maegele (Marc); M. Majdan (Marek); Major, S. (Sebastian); A. Manara (Alex); Manhes, P. (Pauline); G. Manley (Geoffrey); Martin, D. (Didier); C. Martino (Costanza); Maruenda, A. (Armando); H. Maréchal (Hugues); Mastelova, D. (Dagmara); Mattern, J. (Julia); McMahon, C. (Catherine); Melegh, B. (Béla); Menon, D. (David); T. Menovsky (Tomas); Morganti-Kossmann, C. (Cristina); Mulazzi, D. (Davide); Mutschler, M. (Manuel); H. Mühlan (Holger); Negru, A. (Ancuta); Nelson, D. (David); E. Neugebauer (Eddy); V.F. Newcombe (Virginia F.); Noirhomme, Q. (Quentin); Nyirádi, J. (József); M. Oddo (Mauro); A.W. Oldenbeuving; M. Oresic (Matej); Ortolano, F. (Fabrizio); A. Palotie (Aarno); P.M. Parizel; Patruno, A. (Adriana); J.-F. Payen (Jean-François); Perera, N. (Natascha); V. Perlbarg (Vincent); Persona, P. (Paolo); Peul, W. (Wilco); N. Pichon (Nicolas); Piilgaard, H. (Henning); A. Piippo (Anna); S.P. Floury (Sébastien Pili); M. Pirinen (Matti); H. Ples (Horia); Polinder, S. (Suzanne); Pomposo, I. (Inigo); M. Psota (Marek); P. Pullens (Pim); L. Puybasset (Louis); A. Ragauskas (Arminas); R. Raj (Rahul); Rambadagalla, M. (Malinka); Rehorcíková, V. (Veronika); J.K.J. Rhodes (Jonathan K.J.); S. Richardson (Sylvia); S. Ripatti (Samuli); S. Rocka (Saulius); Rodier, N. (Nicolas); Roe, C. (Cecilie); Roise, O. (Olav); C.M.A.A. Roks (Gerwin); Romegoux, P. (Pauline); J. Rosand (Jonathan); Rosenfeld, J. (Jeffrey); C. Rosenlund (Christina); G. Rosenthal (Guy); R. Rossaint (Rolf); S. Rossi (Sandra); Rostalski, T. (Tim); D. Rueckert (Daniel); de Ruiz, A.F. (Arcaute Felix); M. Rusnák (Martin); Sacchi, M. (Marco); Sahakian, B. (Barbara); J. Sahuquillo (Juan); O. Sakowitz (Oliver); Sala, F. (Francesca); Sanchez-Pena, P. (Paola); Sanchez-Porras, R. (Renan); Sandor, J. (Janos); Santos, E. (Edgar); N. Sasse (Nadine); Sasu, L. (Luminita); Savo, D. (Davide); I.B. Schipper (Inger); Schlößer, B. (Barbara); S. Schmidt (Silke); Schneider, A. (Annette); H. Schoechl (Herbert); G.G. Schoonman; Rico, F.S. (Frederik Schou); E. Schwendenwein (Elisabeth); Schöll, M. (Michael); Sir, O. (özcan); T. Skandsen (Toril); Smakman, L. (Lidwien); D. Smeets (Dominique); Smielewski, P. (Peter); Sorinola, A. (Abayomi); E. Stamatakis (Emmanuel); S. Stanworth (Simon); Stegemann, K. (Katrin); Steinbüchel, N. (Nicole); R. Stevens (Robert); W. Stewart (William); E.W. Steyerberg (Ewout); N. Stocchetti (Nino); Sundström, N. (Nina); Synnot, A. (Anneliese); J. Szabó (József); J. Söderberg (Jeannette); F.S. Taccone (Fabio); Tamás, V. (Viktória); Tanskanen, P. (Päivi); A. Tascu (Alexandru); Taylor, M.S. (Mark Steven); Te, A.B. (Ao Braden); O. Tenovuo (Olli); Teodorani, G. (Guido); A. Theadom (Alice); Thomas, M. (Matt); D. Tibboel (Dick); C.M. Tolias (Christos M.); Tshibanda, J.-F.L. (Jean-Flory Luaba); Tudora, C.M. (Cristina Maria); P. Vajkoczy (Peter); Valeinis, E. (Egils); Hecke, W.V. (Wim Van); Praag, D.V. (Dominique Van); Dirk, V.R. (Van Roost); Vlierberghe, E.V. (Eline Van); Vyvere, T.V. (Thijs vande); Vanhaudenhuyse, A. (Audrey); A. Vargiolu (Alessia); E. Vega (Emmanuel); J. Verheyden (Jan); Vespa, P.M. (Paul M.); A. Vik (Anne); R. Vilcinis (Rimantas); Vizzino, G. (Giacinta); C.L.A.M. Vleggeert-Lankamp (Carmen); V. Volovici (Victor); P. Vulekovic (Peter); Vámos, Z. (Zoltán); Wade, D. (Derick); Wang, K.K.W. (Kevin K.W.); Wang, L. (Lei); E.D. Wildschut (Enno); G. Williams (Guy); Willumsen, L. (Lisette); Wilson, A. (Adam); Wilson, L. (Lindsay); Winkler, M.K.L. (Maren K.L.); P. Ylén (Peter); Younsi, A. (Alexander); M. Zaaroor (Menashe); Zhang, Z. (Zhiqun); Zheng, Z. (Zelong); Zumbo, F. (Fabrizio); de Lange, S. (Stefanie); G.C.W. De Ruiter (Godard C.W.); den Boogert, H. (Hugo); van Dijck, J. (Jeroen); T.A. van Essen (T.); C.M. van Heugten (Caroline M.); M. van der Jagt (Mathieu); J. van der Naalt (Joukje)

    2017-01-01

    textabstractBackground: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP)

  12. Sinogenic intracranial complications

    DEFF Research Database (Denmark)

    Kofoed, Mikkel Seremet; Fisker, Niels; Christensen, Anne Estmann

    2018-01-01

    We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, ...

  13. Intracranial tuberculoma: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Salgado, P; Zenteno, M A; Rodriguez-Carbajal, J; Brutto, O.H. del; Talamas, O

    1989-09-01

    MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.).

  14. Intracranial tuberculoma: MR imaging

    International Nuclear Information System (INIS)

    Salgado, P.; Zenteno, M.A.; Rodriguez-Carbajal, J.; Brutto, O.H. del; Talamas, O.

    1989-01-01

    MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.)

  15. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Xu Shubin; Liang Zhihui; Cui Jinguo; Tian Huiqin; Li Liang; Chen Feng

    2009-01-01

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  16. Forward Osmosis/Low Pressure Reverse Osmosis for Water Reuse: Removal of Organic Micropollutants, Fouling and Cleaning

    KAUST Repository

    Linares, Rodrigo

    2011-07-01

    Forward osmosis (FO) is a natural process in which a solution with high concentration of solutes is diluted when being in contact, through a semipermeable membrane, with a low concentration solution. This osmotic process has been demonstrated to be efficient to recover wastewater effluents while diluting a saline draw solution. Nevertheless, the study of the removal of micropollutants by FO is barely described in the literature. This research focuses on the removal of these substances spiked in a secondary wastewater effluent, while diluting water from the Red Sea, generating feed water that can be desalinated with a low pressure reverse osmosis (LPRO) system. Another goal of this work is to characterize the fouling of the FO membrane, and its effect on micropollutants rejection, as well as the membrane cleaning efficiency of different methods. When considering only FO with a clean membrane, the rejection of the hydrophilic neutral compounds was between 48.6% and 84.7%, for the hydrophobic neutrals the rejection ranged from 40.0% to 87.5%, and for the ionic compounds the rejections were between 92.9% and 96.5%. With a fouled membrane, the rejections were between 44.6% to 95.2%, 48.7% to 91.5% and 96.9% to 98.6%, respectively. These results suggest that, except for the hydrophilic neutral compounds, the rejection of the micropollutants is increased by the fouling layer, possibly due to the higher hydrophilicity of the FO fouled membrane compared to the clean one, the increased adsorption capacity and reduced mass transport capacity, membrane swelling, and the higher negative charge of the surface, related to the foulants. However, when coupled with low pressure reverse osmosis, the rejections for both, the clean and fouled membrane, increased above 98%. The fouling layer, after characterizing the wastewater effluent and the concentrated wastewater after the FO process, proved to be composed of biopolymers, which can be removed with air scouring during short periods

  17. Diffusion imaging of reversible and irreversible microstructural changes within the corticospinal tract in idiopathic normal pressure hydrocephalus

    Directory of Open Access Journals (Sweden)

    Kouhei Kamiya

    2017-01-01

    Full Text Available The symptoms of idiopathic normal pressure hydrocephalus (iNPH can be improved by shunt surgery, but prediction of treatment outcome is not established. We investigated changes of the corticospinal tract (CST in iNPH before and after shunt surgery by using diffusion microstructural imaging, which infers more specific tissue properties than conventional diffusion tensor imaging. Two biophysical models were used: neurite orientation dispersion and density imaging (NODDI and white matter tract integrity (WMTI. In both methods, the orientational coherence within the CSTs was higher in patients than in controls, and some normalization occurred after the surgery in patients, indicating axon stretching and recovery. The estimated axon density was lower in patients than in controls but remained unchanged after the surgery, suggesting its potential as a marker for irreversible neuronal damage. In a Monte-Carlo simulation that represented model axons as undulating cylinders, both NODDI and WMTI separated the effects of axon density and undulation. Thus, diffusion MRI may distinguish between reversible and irreversible microstructural changes in iNPH. Our findings constitute a step towards a quantitative image biomarker that reflects pathological process and treatment outcomes of iNPH.

  18. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  19. Intracranial cavernous angioma

    International Nuclear Information System (INIS)

    Yuhi, Fumiaki; Gondou, Masazumi; Sasahira, Masahiro; Ichitsubo, Hidenori; Asakura, Tetsuhiko.

    1986-01-01

    The present authors have experienced 2 cases of intracranial cavernous angioma. Of these cases, one was admitted because of generalized convulsions, while the other was admitted because of headache. In both cases, neither plain X-ray films nor carotid angiography showed any abnormality, but computerized tomography (CT) revealed a slightly high-density area which was not enhanced with contrast media. Histologically, the tumors had many vascular cavities with walls lined with a single layer of endothelial cells and had no neural tissue between the vascular cavities; therefore, they were diagnosed as cases of cavernous angioma. The authors discussed the radiological findings of the intracranial cavernous angioma with a review of the literature and stressed the role of computerized tomography in the diagnosis of cavernous angioma. (author)

  20. Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Sinha S

    2005-01-01

    Full Text Available We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs′ had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.

  1. Intracranial Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Maria Khan

    2011-01-01

    Full Text Available Intracranial atherosclerotic disease (ICAD is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%–99% stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. Among Asians, cilostazol has shown a favorable effect on symptomatic stenosis and is of benefit in terms of fewer bleeds. Moreover, aggressive risk factor management alone and in combination with dual antiplatelets been shown to be most effective in this group of patients. Interventional trials on intracranial atherosclerotic stenosis have so far only been carried out among Caucasians and have not yielded consistent results. Since the Asian population is known to be preferentially effected, focused trials need to be performed to establish treatment modalities that are most effective in this population.

  2. Intracranial MR angiography

    International Nuclear Information System (INIS)

    Davis, W.L.; Blatter, D.D.; Parker, D.L.; Robison, R.O.; Harnsberger, H.R.

    1991-01-01

    This paper compares the more traditional three-dimensional (3D) time-of-flight MR angiography with a novel new technique, MOTSA, in the evaluation of both normal and abnormal intracranial anatomy. The authors performed sequential, location-matched 3D TOF and MOTSA MR angiography in 10 subjects with normal and 25 with abnormal intracranial anatomy. Images were evaluated for visualization of specific vessels and depiction of pathologic anatomy. All images were subjected to an objective scoring system. Digital angiography was available in 15 of 25 abnormal cases. In the normal cases, large- and small-vessel visualization was improved. Significant improvement in visualization of venous anatomy was also observed. In the abnormal cases, pathologic anatomy was better visualized, providing important diagnostic information. Multiple overlapping thin-slab-acquisition MR angiography demonstrates vessel visualization that is increased over that of 3D TOF MR angiography in both normal and abnormal cases. Because of the decrease in saturation effects and phase dispersion, MOTSA is especially useful in the evaluation of complex intracranial vascular abnormalities

  3. Spaceflight-Induced Intracranial Hypertension: An Overview

    Science.gov (United States)

    Traver, William J.

    2011-01-01

    This slide presentation is an overview of the some of the known results of spaceflight induced intracranial hypertension. Historical information from Gemini 5, Apollo, and the space shuttle programs indicated that some vision impairment was reported and a comparison between these historical missions and present missions is included. Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight. Views illustrate the occurrence of Optic Disc Edema, Globe Flattening, and Choroidal Folds. There are views of the Arachnoid Granulations and Venous return, and the question of spinal or venous compliance issues is discussed. The question of increased blood flow and its relation to increased Cerebrospinal fluid (CSF) is raised. Most observed on-orbit papilledema does not progress, and this might be a function of plateau homeostasis for the higher level of intracranial pressure. There are seven cases of astronauts experiencing in flight and post flight symptoms, which are summarized and follow-up is reviewed along with a comparison of the treatment options. The question is "is there other involvement besides vision," and other Clinical implications are raised,

  4. Intracranial chondroma: a rare entity.

    Science.gov (United States)

    Maheshwari, Veena; Mehdi, Ghazala; Varshney, Manoranjan; Jain, Anshu; Vashishtha, Sonal; Gaur, Kavita; Srivastava, Vinod Kumar

    2011-05-12

    Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination.

  5. Three cases of intracranial lipoma

    Energy Technology Data Exchange (ETDEWEB)

    Kurokawa, Hiroyuki; Kikuchi, Kenji; Yanagida, Noritaka; Fujii, Satoshi; Watanabe, Kazuo; Miyauchi, Takaharu

    1987-12-01

    Intracranial lipoma is an uncommon lesion that can be found in both symptomatic and asymptomatic patients. Because of CT (computerized tomography), the tumors can now be easily diagnosed in asymptomatic individuals. Three cases of intracranial lipoma in asymptomatic patients are presented, along with a review of the literature, and the value of CT, especially coronal section, in the diagnosis of intracranial lipomas and associated anomalies, such as the agenesis of corpus callosum, is discussed.

  6. The contemporary management of intracranial atherosclerotic disease.

    Science.gov (United States)

    Leng, Xinyi; Wong, Ka Sing; Leung, Thomas W

    2016-06-01

    Intracranial atherosclerotic disease is the most common cause of cerebral vasculopathy and an important stroke etiology worldwide, with a higher prevalence in Asian, Hispanic and African ethnicities. Symptomatic intracranial atherosclerotic disease portends a recurrent stroke risk as high as 18% at one year. The key to secondary prevention is an understanding of the underlying stroke mechanism and aggressive control of conventional cardiovascular risks. Contemporary treatment includes antiplatelet therapy, optimal glycemic and blood pressure control, statin therapy and lifestyle modifications. For patients with high-grade (70-99%) symptomatic steno-occlusion, short-term dual antiplatelet therapy with aspirin and clopidogrel followed by life-long single antiplatelet therapy may reduce the recurrent risk. Current evidence does not advocate percutaneous transluminal angioplasty and stenting as an initial treatment. External counterpulsation, encephaloduroarteriosynangiosis and remote limb ischemic preconditioning are treatments under investigation. Future studies should aim at predicting patients prone to recurrence despite of medical therapies and testing the efficacy of emerging therapies.

  7. Dietary sodium restriction reverses vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure

    Science.gov (United States)

    Jablonski, Kristen L.; Racine, Matthew L.; Geolfos, Candace J.; Gates, Phillip E.; Chonchol, Michel; McQueen, Matthew B.; Seals, Douglas R.

    2013-01-01

    Objectives We determined the efficacy of dietary sodium restriction (DSR) for improving vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure (SBP; 130–159 mmHg) and the associated physiological mechanisms. Background Vascular endothelial dysfunction develops with advancing age and elevated SBP, contributing to increased cardiovascular risk. DSR lowers BP, but its effect on vascular endothelial function and mechanisms involved are unknown. Methods Seventeen subjects (11M/6F; 62±7 yrs, mean±S.D.) completed a randomized, crossover study of 4 weeks of both low and normal sodium intake. Vascular endothelial function (endothelium-dependent dilation; EDD), nitric oxide (NO)/tetrahydrobiopterin (BH4) bioavailability and oxidative stress-associated mechanisms were assessed following each condition. Results Urinary sodium excretion was reduced by ~50% (to 70±30 mmol/day), and conduit (brachial artery flow-mediated dilation [FMDBA]) and resistance (forearm blood flow responses to acetylcholine [FBFACh]) artery EDD were 68% and 42% (peak FBFACh) higher following the low sodium diet (psodium markedly enhanced NO- mediated EDD (greater ΔFBFACh with endothelial NO synthase [eNOS] inhibition) without changing eNOS expression/activation (Ser1177 phosphorylation), restored BH4 bioactivity (less ΔFMDBA with acute BH4), abolished tonic superoxide suppression of EDD (less ΔFMDBA and ΔFBFACh with ascorbic acid infusion), and increased circulating superoxide dismutase activity (p<0.05). These effects were independent of ΔSBP. Other subject characteristics/dietary factors and endothelium-independent dilation were unchanged. Conclusions DSR largely reverses both macro- and microvascular endothelial dysfunction by enhancing NO and BH4 bioavailability and reducing oxidative stress. Our findings support the emerging concept that DSR induces “vascular protection” beyond that attributable to its BP-lowering effects. PMID

  8. Primary intracranial malignant lymphoma

    International Nuclear Information System (INIS)

    Matsumoto, Mikiro; Ohtsuka, Takatsugu; Kuroki, Takao; Shibata, Iekado; Terao, Hideo; Kudo, Motoshige

    1988-01-01

    Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3 % of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found. (author)

  9. Intracranial Hemorrhage in Pregnancy

    Directory of Open Access Journals (Sweden)

    Afshan B. Hameed

    2012-11-01

    Full Text Available A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications. Cranial imaging demonstrated a large subdural hematoma with midline shift. She delivered a healthy baby girl by cesarean section. Eventually, symptoms and intracranial abnormalities resolved over time. In conclusion, subdural hematoma is a relatively rare complication that requires multidisciplinary management plan.

  10. Idiopathic intracranial hypertension in pediatric patients

    Directory of Open Access Journals (Sweden)

    Nada Jirásková

    2008-11-01

    Full Text Available Nada Jirásková, Pavel RozsívalDepartment of Ophthalmology, University Hospital, Hradec Králové, Czech RepublicPurpose: To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH in children.Methods: Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy.Results: Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients. Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients.Conclusions: Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.Keywords: idiopathic intracranial hypertension, pediatric, treatment

  11. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Cardwell, C.; Cox, I.; Baldey, A.

    2002-01-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  12. Spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C; Cox, I; Baldey, A [St. F.X. Cabrini Hospital, VIC (Australia). Departments of Nuclear Medicine and Magnetic Resonance Imaging

    2002-07-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc.

  13. Reversible effects of oxygen partial pressure on genes associated with placental angiogenesis and differentiation in primary-term cytotrophoblast cell culture.

    Science.gov (United States)

    Debiève, F; Depoix, C; Gruson, D; Hubinont, C

    2013-09-01

    Timely regulated changes in oxygen partial pressure are important for placental formation. Disturbances could be responsible for pregnancy-related diseases like preeclampsia and intrauterine growth restriction. We aimed to (i) determine the effect of oxygen partial pressure on cytotrophoblast differentiation; (ii) measure mRNA expression and protein secretion from genes associated with placental angiogenesis; and (iii) determine the reversibility of these effects at different oxygen partial pressures. Term cytotrophoblasts were incubated at 21% and 2.5% O2 for 96 hr, or were switched between the two oxygen concentrations after 48 hr. Real-time PCR and enzyme-linked immunosorbent assays (ELISAs) were used to evaluate cell fusion and differentiation, measuring transcript levels for those genes involved in cell fusion and placental angiogenesis, including VEGF, PlGF, VEGFR1, sVEGFR1, sENG, INHA, and GCM1. Cytotrophoblasts underwent fusion and differentiation in 2.5% O2 . PlGF expression was inhibited while sVEGFR1 expression increased. VEGF and sENG mRNA expressions increased in 2.5% compared to 21% O2 , but no protein was detected in the cell supernatants. Finally, GCM1 mRNA expression increased during trophoblast differentiation at 21% O2 , but was inhibited at 2.5% O2 . These mRNA expression effects were reversed by returning the cells to 21% O2 . Thus, low-oxygen partial pressure does not inhibit term-cytotrophoblast cell fusion and differentiation in vitro. Lowering the oxygen partial pressure from 21% to 2.5% caused normal-term trophoblasts to reversibly modify their expression of genes associated with placental angiogenesis. This suggests that modifications observed in pregnancy diseases such as preeclampsia or growth retardation are probably due to an extrinsic effect on trophoblasts. Copyright © 2013 Wiley Periodicals, Inc.

  14. IDIOPATHIC INTRACRANIAL HYPERTENSION IN A WOMAN WITH SCHIZOPHRENIA

    Directory of Open Access Journals (Sweden)

    Ivan N. Dimitrov

    2012-02-01

    Full Text Available Idiopathic intracranial hypertension (IIH or benign intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure. This uncommon disorder occurs primarily in obese women aged 10 to 50 years, sometimes in association with endocrine and metabolic dysfunction, with systemic diseases or when treated with multiple medications. We describe a case of IIH in a 43-year-old woman with schizophrenia treated with risperidone, demonstrating a typical clinical picture of benign intracranial hypertension. For the 5 years of treatment with risperidone she put on 35 kg in total (BMI> 35; for the last 2-3 months she began to complain of visual obscurations, nausea with vomiting. Ophthalmoscopy revealed bilateral asymmetric papilledema (OD>OS. Magnetic resonance imaging was normal, intracranial pressure was elevated IIH was diagnosed. Risperidone was discontinued and replaced with Seroquel 200 mg daily. Treatment with furosemide and mannitol 10 % was initiated. Papilledema resolved completely over the next 2 months. The patient was followed-up for four years after risperidone withdrawal. Weight loss of 28 kg was noted for four years. There were no relapses of headache, nausea, visual obscuration. Ophthalmologic examination revealed no papilledema.We suggest that prolonged use of antipsychotics, such as risperidone, should require proper surveillance for possible development of IIH and routine ophthalmologic examinations should be performed.

  15. Secondary Intracranial Hypotension: A Case Report

    Directory of Open Access Journals (Sweden)

    Pinar Gundogan Bozdag

    2014-04-01

    Full Text Available Intracranial hypotension is a clinical condition that characterized by postural (orthostatic headache and low pressure. It apperas with cerebrospinal fluid leak which occurs spontaneous or depending on the secondary attempts. 31 years old female patient which has diagnosis of acute appendicitis and underwent appendectomy under spinal anesthesia. postoperative 5.day she admitted with a postural headache, diplopia. Patient was treated with conservative methods after diagnosed with magnetic resonance imaging. We aim to asses an encountered complication after spinal anesthesia which widely applied for surgical procedures with imaging findings and literature.

  16. The "Skull Flap" a new conceived device for decompressive craniectomy experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion.

    Science.gov (United States)

    Salvatore, Chibbaro; Fabrice, Vallee; Marco, Marsella; Leonardo, Tigan; Thomas, Lilin; Benoit, Lecuelle; Bernard, George; Pierre, Kehrli; Eric, Vicaut; Paolo, Diemidio

    2013-10-01

    Decompressive craniectomy (DC) is a procedure performed increasingly often in current neurosurgical practice. Significant perioperative morbidity may be associated to this procedure because of the large skull defect; also, later closure of the skull defect (cranioplasty) may be associated to post-operative morbidity as much as any other reconstructive operation. The authors present a newly conceived/developed device: The "Skull Flap" (SF). This system, placed at the time of the craniectomy, offers the possibility to provide cranial reconstruction sparing patients a second operation. In other words, DC and cranioplasty essentially take place at the same time and in addition, patients retain their own bone flap. The current study conducted on animal models, represents the logical continuation of a prior recent study, realized on cadaver specimens, to assess the efficacy and safety of this recently developed device. This is an experimental pilot study on dogs to assess both safety and efficacy of the SF device. Two groups of experimental raised intracranial pressure animal models underwent DC; in the first group of dogs, the bone flap was left in raised position above the skull defect using the SF device; on the second group the flap was discarded. All dogs underwent transcranial Doppler (TCD) to assess brain perfusion. Head computed tomography (CT) scan to determine flap position was also obtained in the group in which the SF device was placed. SF has proved to be a strong fixation device that allows satisfactory brain decompression by keeping the bone flap elevated from the swollen brain; later on, the SF allows cranial reconstruction in a simple way without requiring a second staged operation. In addition, it is relevant to note that brain perfusion was measured and found to be better in the group receiving the SF (while the flap being in a raised as well as in its natural position) comparing to the other group. The SF device has proved to be very easy to place

  17. The "Skull Flap" a new conceived device for decompressive craniectomy experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion

    Directory of Open Access Journals (Sweden)

    Chibbaro Salvatore

    2013-01-01

    Full Text Available Background: Decompressive craniectomy (DC is a procedure performed increasingly often in current neurosurgical practice. Significant perioperative morbidity may be associated to this procedure because of the large skull defect; also, later closure of the skull defect (cranioplasty may be associated to post-operative morbidity as much as any other reconstructive operation. The authors present a newly conceived/developed device: The "Skull Flap" (SF. This system, placed at the time of the craniectomy, offers the possibility to provide cranial reconstruction sparing patients a second operation. In other words, DC and cranioplasty essentially take place at the same time and in addition, patients retain their own bone flap. The current study conducted on animal models, represents the logical continuation of a prior recent study, realized on cadaver specimens, to assess the efficacy and safety of this recently developed device. Materials and Methods: This is an experimental pilot study on dogs to assess both safety and efficacy of the SF device. Two groups of experimental raised intracranial pressure animal models underwent DC; in the first group of dogs, the bone flap was left in raised position above the skull defect using the SF device; on the second group the flap was discarded. All dogs underwent transcranial Doppler (TCD to assess brain perfusion. Head computed tomography (CT scan to determine flap position was also obtained in the group in which the SF device was placed. Results: SF has proved to be a strong fixation device that allows satisfactory brain decompression by keeping the bone flap elevated from the swollen brain; later on, the SF allows cranial reconstruction in a simple way without requiring a second staged operation. In addition, it is relevant to note that brain perfusion was measured and found to be better in the group receiving the SF (while the flap being in a raised as well as in its natural position comparing to the other

  18. Biomarkers Prognostic for Elevated Intracranial Pressure

    Science.gov (United States)

    2016-03-01

    Orthopedic injury (n=20) iii) Exclusion of patients with polytrauma . It has been reported that serum ceruloplasmin (as well as copper) levels...inclusion of polytrauma patients in our results. We therefore identified the TBI patients with isolated head trauma, and compared the recorded...ceruloplasmin values between those with elevated ICP and those without. Figure 13 shows that when the patients with polytrauma were excluded from the

  19. Modeling Cyclic Variation of Intracranial Pressure

    National Research Council Canada - National Science Library

    Daley, M

    2001-01-01

    ...) recording during mechanical ventilation are due to cyclic extravascular compressional modulation primarily of the cerebral venous bed, an established isovolumetric model of cerebrospinal fluid...

  20. Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension.

    Science.gov (United States)

    Choi, Hanna; Lee, Mi Ji; Choi, Hyun Ah; Cha, Jihoon; Chung, Chin-Sang

    2018-02-01

    Background Intracranial structural dislocation in spontaneous intracranial hypotension (SIH) can be measured by various intracranial angles and distances. We aimed to identify the clinical significance of structural dislocation in relation to treatment outcome in patients with SIH. Methods In this retrospective analysis, we identified patients with SIH who received an epidural blood patch (EBP) at Samsung Medical Center from January 2005 to March 2015. Structural dislocation in pretreatment MRIs of SIH patients was assessed by measuring tonsillar herniation, mamillopontine distance, the angle between the vein of Galen and straight sinus (vG/SS angle), the pontomesencephalic angle, and the lateral ventricular angle. After the first EBP, poor response was defined as the persistence of symptoms that prompted a repeat EBP. Results Out of the 95 patients included, 31 (32.6%) showed poor response. Among the radiological markers of structural dislocation, the vG/SS angle was associated with poor response (49.82 ± 16.40° vs 66.58 ± 26.08°, p = 0.002). Among clinical variables, premorbid migraine ( p = 0.036) was related to poor response. In multivariate analysis, reduced vG/SS angle was independently associated with poor response (OR 1.04 [95% CI 1.01 - 1.07] per 1° decrease, p = 0.006). In 23 patients who underwent MRI after successful treatment, the vG/SS angle significantly increased after the EBP ( p < 0.001, by paired t-test), while two patients with aggravation or recurrence showed a further reduction of their vG/SS angles. Conclusions Intracranial structural dislocation, measured by the vG/SS angle, is associated with poor response to the first EBP in patients with SIH. Successful treatment can reverse the structural dislocation.

  1. Intracranial Hypertension: Medication and Surgery

    Science.gov (United States)

    ... fallen out of favor, unless there is a secondary inflammatory process caused by an underlying disease like ... have little effect on headaches caused by intracranial hypertension, they may temporarily affect the intensity of a ...

  2. Intracranial hypotension - a look beyond “bilateral subdural hematomas”

    International Nuclear Information System (INIS)

    Penev, B.

    2015-01-01

    Full text: The intracranial hypotension (ICH) is a disorder due to spontaneous or iatrogenic CSF leak and a low intracranial pressure. The clinical presentation is characterized by drug resistant orthostatic headache, nausea, vomiting, dizziness, neck pain and etc. The intracranial hypotension is defined as a benign disorder and the treatment is predominantly conservative. Due to this fact it is very important to differentiate this entity from subdural hematomas and hygromas which are treated surgically. Magnetic resonance imaging has revolutionized the diagnosis of ICH. Nowadays there are a lot of clinical and imaging features of this disorder. Regardless of clinical varieties and atypical forms, MRI gives enough information for the correct or probable diagnosis in the vast majority of the cases. The initial imaging resemblance with posttraumatic subdural hematomas and hygromas can result in giving the wrong diagnosis and therefore performing unneeded surgical interventions. the aim of this presentation is to discuss the contemporary criteria, algorithm and imaging features of ICH

  3. The syndrome of pseudotumour cerebri and idiopathic intracranial hypertension.

    Science.gov (United States)

    Fraser, Clare; Plant, Gordon T

    2011-02-01

    Idiopathic intracranial hypertension (IIH) is a condition in which raised intracranial pressure is associated with a high body mass index, and in those societies in which the prevalence of obesity is increasing the disorder is of increasing importance. It is one cause of the syndrome of pseudotumour cerebri but the cause and the link with a rise in body weight are not understood. Furthermore the treatment of the more severe, sight-threatening cases is controversial. A major theme in recent years has been an attempt to identify the underlying mechanism of IIH. Some theories - such as the dural sinus stenosis theory - seem to ignore the relationship with weight gain; others have proposed a direct link between obesity and raised intracranial pressure through a specific fat distribution in the body; others through the production of lipokines; and yet others have suggested a converse causation with raised intracranial pressure giving rise to obesity. Uncontrolled case series continue to demonstrate the success of interventions such as cerebrospinal fluid diversion procedures, venous sinus stenting and bariatric surgery but there are no level 1 clinical trials. Interest in IIH is increasing and currently generating numerous studies but there is no consensus view on either cause or management.

  4. Reverse spin-crossover and high-pressure kinetics of the heme iron center relevant for the operation of heme proteins under deep-sea conditions.

    Science.gov (United States)

    Troeppner, Oliver; Lippert, Rainer; Shubina, Tatyana E; Zahl, Achim; Jux, Norbert; Ivanović-Burmazović, Ivana

    2014-10-20

    By design of a heme model complex with a binding pocket of appropriate size and flexibility, and by elucidating its kinetics and thermodynamics under elevated pressures, some of the pressure effects are demonstrated relevant for operation of heme-proteins under deep-sea conditions. Opposite from classical paradigms of the spin-crossover and reaction kinetics, a pressure increase can cause deceleration of the small-molecule binding to the vacant coordination site of the heme-center in a confined space and stabilize a high-spin state of its Fe center. This reverse high-pressure behavior can be achieved only if the volume changes related to the conformational transformation of the cavity can offset the volume changes caused by the substrate binding. It is speculated that based on these criteria nature could make a selection of structures of heme pockets that assist in reducing metabolic activity and enzymatic side reactions under extreme pressure conditions. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Nonlocal Intracranial Cavity Extraction

    Science.gov (United States)

    Manjón, José V.; Eskildsen, Simon F.; Coupé, Pierrick; Romero, José E.; Collins, D. Louis; Robles, Montserrat

    2014-01-01

    Automatic and accurate methods to estimate normalized regional brain volumes from MRI data are valuable tools which may help to obtain an objective diagnosis and followup of many neurological diseases. To estimate such regional brain volumes, the intracranial cavity volume (ICV) is often used for normalization. However, the high variability of brain shape and size due to normal intersubject variability, normal changes occurring over the lifespan, and abnormal changes due to disease makes the ICV estimation problem challenging. In this paper, we present a new approach to perform ICV extraction based on the use of a library of prelabeled brain images to capture the large variability of brain shapes. To this end, an improved nonlocal label fusion scheme based on BEaST technique is proposed to increase the accuracy of the ICV estimation. The proposed method is compared with recent state-of-the-art methods and the results demonstrate an improved performance both in terms of accuracy and reproducibility while maintaining a reduced computational burden. PMID:25328511

  6. Nonlocal Intracranial Cavity Extraction

    Directory of Open Access Journals (Sweden)

    José V. Manjón

    2014-01-01

    Full Text Available Automatic and accurate methods to estimate normalized regional brain volumes from MRI data are valuable tools which may help to obtain an objective diagnosis and followup of many neurological diseases. To estimate such regional brain volumes, the intracranial cavity volume (ICV is often used for normalization. However, the high variability of brain shape and size due to normal intersubject variability, normal changes occurring over the lifespan, and abnormal changes due to disease makes the ICV estimation problem challenging. In this paper, we present a new approach to perform ICV extraction based on the use of a library of prelabeled brain images to capture the large variability of brain shapes. To this end, an improved nonlocal label fusion scheme based on BEaST technique is proposed to increase the accuracy of the ICV estimation. The proposed method is compared with recent state-of-the-art methods and the results demonstrate an improved performance both in terms of accuracy and reproducibility while maintaining a reduced computational burden.

  7. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  8. Multi-objective optimization of a pressurized solid oxide fuel cell – gas turbine hybrid system integrated with seawater reverse osmosis

    International Nuclear Information System (INIS)

    Eveloy, Valerie; Rodgers, Peter; Al Alili, Ali

    2017-01-01

    To improve the capacity and efficiency of distributed power and fresh water generation in coastal industrial facilities affected by regional water scarcity, a natural gas-fueled, pressurized solid oxide fuel cell-gas turbine (SOFC-GT) hybrid is integrated with a bottoming organic Rankine cycle (ORC) and seawater reverse osmosis (RO) desalination plant. This power and water co-generation system is optimized in terms of two objectives, maximum exergy efficiency and minimum cost rate, using a genetic algorithm. The exergetic and economic performance of three solutions representing maximum exergy efficiency, minimum cost rate, and a compromise between efficiency and cost rate, are compared. When imposing a water production requirement (reference case), the selected compromise multi-objective optimization solution delivers a net power output of 2.4 MWe and 636 m"3/day of permeate, at a co-generation exergy efficiency and cost rate of 71.3% and 0.0256 USD/s, respectively. The system payback time is estimated to be less than six years for typical economic parameters, but would become unprofitable in the most unfavorable economic scenario considered. Overall, the results indicate the thermodynamic and economic benefits of reverse osmosis over thermal desalination processes for integration with high-efficiency power generation systems in coastal regions impacted by domestic gas shortages and water scarcity. - Highlights: • Integration of a pressurized SOFC-GT hybrid system with a reverse osmosis unit. • Multi-objective, exergetic and economic optimization using a genetic algorithm. • Optimum solution delivers 2.4 MWe and 636 m"3/day of desalinated water. • Overall exergy efficiency and cost rate of 71.3% and 0.0256 USD/s, respectively. • System payback time estimated at less than six years for typical economic conditions.

  9. Is the obesity epidemic reversing favorable trends in blood pressure? Evidence from cohorts born between 1890 and 1990 in the United States.

    Science.gov (United States)

    Goff, David C; Gillespie, Cathleen; Howard, George; Labarthe, Darwin R

    2012-08-01

    Previous reports have described favorable changes in the relationship between systolic blood pressure and age in recent birth cohorts. The obesity epidemic might threaten that pattern. To update analyses of differences between birth cohorts in the relationship between systolic blood pressure and age and to determine whether increases in obesity have had adverse effects. We examined the systolic blood pressure distributions across birth cohorts born between 1890 and 1990 in 68,070 participants, aged 18-74 years, in the National Health (and Nutrition) Examination Surveys between 1960 and 2008. We postulated that age-adjusted 10th, 25th, 50th, 75th, and 90th percentiles of systolic blood pressure had decreased in more recent versus earlier cohorts, and that this pattern had slowed or reversed recently due, at least in part, to obesity. After adjusting for gender, race, age and age(2), the 10th, 25th, 50th, 75th, and 90th percentiles of systolic blood pressure were 1.1, 1.4, 1.9, 2.5, and 3.4 mmHg lower for each decade more recently born (all P birth cohort were positive and significant (P distributions are shifted lower relative to earlier cohorts. Decreases of 1.9 mmHg in the median systolic blood pressure per decade translates into 11.4-13.3 mmHg over 6-7 decades, a shift that would contribute importantly to lower rates of cardiovascular diseases. These favorable changes are slowing, perhaps owing, at least in part, to the obesity epidemic. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Pressure effects on .alpha.-synuclein amyloid fibrils: an experimental investigation on their dissociation and reversible nature

    Czech Academy of Sciences Publication Activity Database

    Piccirilli, F.; Plotegher, N.; Spinozzi, F.; Bubacco, L.; Mariani, P.; Beltramini, M.; Tessari, I.; Militello, V.; Perucchi, A.; Amenitsch, H.; Baldassarri Jr., E.; Steinhart, Miloš; Lupi, S.; Ortore, M. G.

    2017-01-01

    Roč. 627, 1 August (2017), s. 46-55 ISSN 0003-9861 Institutional support: RVO:61389013 Keywords : amyloid * high-pressure * SAXS Subject RIV: CD - Macromolecular Chemistry OBOR OECD: Polymer science Impact factor: 3.165, year: 2016

  11. Intracranial arterial stenosis.

    Science.gov (United States)

    Carvalho, Marta; Oliveira, Ana; Azevedo, Elsa; Bastos-Leite, António J

    2014-04-01

    Intracranial arterial stenosis (IAS) is usually attributable to atherosclerosis and corresponds to the most common cause of stroke worldwide. It is very prevalent among African, Asian, and Hispanic populations. Advancing age, systolic hypertension, diabetes mellitus, high levels of low-density lipoprotein cholesterol, and metabolic syndrome are some of its major risk factors. IAS may be associated with transient or definite neurological symptoms or can be clinically asymptomatic. Transcranial Doppler and magnetic resonance angiography are the most frequently used ancillary examinations for screening and follow-up. Computed tomography angiography can either serve as a screening tool for the detection of IAS or increasingly as a confirmatory test approaching the diagnostic accuracy of catheter digital subtraction angiography, which is still considered the gold (confirmation) standard. The risk of stroke in patients with asymptomatic atherosclerotic IAS is low (up to 6% over a mean follow-up period of approximately 2 years), but the annual risk of stroke recurrence in the presence of a symptomatic stenosis may exceed 20% when the degree of luminal narrowing is 70% or more, recently after an ischemic event, and in women. It is a matter of controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with symptomatic IAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone, but recent data contradict such expectation. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Multiple intracranial hydatid cysts: MR findings

    International Nuclear Information System (INIS)

    Pumar, J.; Alvarez, M.; Leira, R.; Prieto, J.M.; Arrojo, L.; Pereira, J.; Vidal, J.

    1992-01-01

    Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular. (orig.)

  13. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    . The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  14. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  15. Intracranial calcification in central diabetes insipidus

    International Nuclear Information System (INIS)

    Al-Kandari, Salwa R.; Pandey, Tarun; Badawi, Mona H.

    2008-01-01

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

  16. Intracranial calcification in central diabetes insipidus

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kandari, Salwa R. [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); Pandey, Tarun [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); University of Arkansas for Medical Sciences, Radiology Department, Little Rock, AR (United States); Badawi, Mona H. [Al-Adan Hospital, Department of Paediatrics, Kuwait (Kuwait)

    2008-01-15

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

  17. Analysis of multi-factors affecting symptomatic intracranial hemorrhage in intraarterial thrombolysis with urokinase for acute ischemic stroke

    International Nuclear Information System (INIS)

    Qiao Qianlin; Zhou Shi; Wang Xuejian; Wu Qinghua; Song Jie

    2005-01-01

    Objective: To explore the causes and preventive measures of symptomatic intracranial hemorrhage in 217 patients with acute cerebral ischemic stroke treated with local intra-arterial urokinase. Methods: From February 1999 to June 2004, 217 patients were treated for acute ischemic stroke with local intra-arterial urokinase in our hospital. Factors associated with symptomatic intracranial hemorrhage of intra-arterial thrombolysis were analyzed by Stepwise logistic regression to identify some factors relating the prediction symptomatic intracranial hemorrhage. Results: Symptomatic intracranial hemorrhage occurred in 8 cases (3.7%). Predictors of the symptomatic intracranial hemorrhage were the elevated systolic blood pressure before therapy (odds ratio, 1.096; 95% CI, 1.006 to 1.194) and urokinase (UK) treatment (odds ratio, 1.068 ; 95% CL, 1.053 to 1.247). Risk of secondary symptomatic intracranial hemorrhage was increased with elevated systolic blood pressure. Other factors like age, initial treating time, NIHSS, diabetes and collateral circulation did not predict the symptomatic intracranial hemorrhage respectively. Conclusions: Predictors of symptomatic intracranial hemorrhage after local intra-arterial infusion of urokinase for acute ischemic stroke were the elevated systolic blood pressure before therapy and urokinase (UK) treatment. (authors)

  18. Recovery of iron after Fenton-like secondary treatment of olive mill wastewater by nano-filtration and low-pressure reverse osmosis membranes

    International Nuclear Information System (INIS)

    Ochando-Pulido, J.M.; Victor-Ortega, M.D.; Martinez-Ferez, A.

    2016-01-01

    In this work, the performances of novel nano-filtration (NF) and low-pressure reverse osmosis (RO) polymeric membranes were examined with the aim of recovering the iron used as catalyst in former secondary treatment based on the Fenton-like advanced oxidation of olive mill wastewater (OMW). Results highlight that both membranes exhibit a good performance towards the rejection of iron (99.1% for the NF membrane vs. 100% for the low-pressure RO membrane) in the secondary-treated OMW effluent, thus permitting the recovery of iron in the concentrate stream in order to recycle it back into the oxidation reactor to reduce catalyst consumption. Finally, the permeate streams could be re-used for irrigation. Major productivity was observed by the selected NF membrane, about 47.4 L/hm2 upon 9 bar, whereas 30.9 L/hm2 could be yielded with the RO membrane under an operating pressure of 8 bar. Moreover, a sensibly lower fouling index was measured on the NF membrane (0.0072 in contrast with 0.065), which ensures major steady-state performance on this membrane and a longer service lifetime. This also results in lower required membrane area and membrane plant over dimension (4 modules in case of RO operation whereas only 2 modules for NF). [es

  19. Impact characteristics for high-pressure large-flow water-based emulsion pilot operated check valve reverse opening

    Science.gov (United States)

    Liu, Lei; Huang, Chuanhui; Yu, Ping; Zhang, Lei

    2017-10-01

    To improve the dynamic characteristics and cavitation characteristics of large-flow pilot operated check valve, consider the pilot poppet as the research object, analyses working principle and design three different kinds of pilot poppets. The vibration characteristics and impact characteristics are analyzed. The simulation model is established through flow field simulation software. The cavitation characteristics of large-flow pilot operated check valve are studied and discussed. On this basis, high-pressure large-flow impact experimental system is used for impact experiment, and the cavitation index is discussed. Then optimal structure is obtained. Simulation results indicate that the increase of pilot poppet half cone angle can effectively reduce the cavitation area, reducing the generation of cavitation. Experimental results show that the pressure impact is not decreasing with increasing of pilot poppet half cone angle in process of unloading, but the unloading capacity, response speed and pilot poppet half cone angle are positively correlated. The impact characteristics of 60° pilot poppet, and its cavitation index is lesser, which indicates 60° pilot poppet is the optimal structure, with the theory results are basically identical.

  20. Reversible hydrogen storage using CO2 and a proton-switchable iridium catalyst in aqueous media under mild temperatures and pressures.

    Science.gov (United States)

    Hull, Jonathan F; Himeda, Yuichiro; Wang, Wan-Hui; Hashiguchi, Brian; Periana, Roy; Szalda, David J; Muckerman, James T; Fujita, Etsuko

    2012-03-18

    Green plants convert CO(2) to sugar for energy storage via photosynthesis. We report a novel catalyst that uses CO(2) and hydrogen to store energy in formic acid. Using a homogeneous iridium catalyst with a proton-responsive ligand, we show the first reversible and recyclable hydrogen storage system that operates under mild conditions using CO(2), formate and formic acid. This system is energy-efficient and green because it operates near ambient conditions, uses water as a solvent, produces high-pressure CO-free hydrogen, and uses pH to control hydrogen production or consumption. The extraordinary and switchable catalytic activity is attributed to the multifunctional ligand, which acts as a proton-relay and strong π-donor, and is rationalized by theoretical and experimental studies.

  1. Primary intracranial leiomyoma: case report

    Energy Technology Data Exchange (ETDEWEB)

    Lai, P.H.; Yang, C.F.; Yeh, L.R.; Pan, H.B. [Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, 386 Ta-Chung First Rd., Kaohsiung 813, Taiwan (Taiwan, Province of China); Huang, C.H. [Department of Neurosurgery, Veterans General Hospital-Kashsiung, National Yang Ming University, National Defence Medical Centre, Kashsiung, Taiwan (Taiwan, Province of China); Lin, S.L. [Department of Pathology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, Taiwan (Taiwan, Province of China)

    1998-04-01

    We present a case of intracranial parenchymal leiomyoma in a 20-year-old woman with a chief complaint of numbness and a painful sensation over the right limbs for several years. CT and MRI revealed an intensely enhancing calcified mass. The patient was well, without recurrence, 2 years after surgery. (orig.) With 2 figs., 13 refs.

  2. Haemorrhage in intracranial tuber- culosis

    African Journals Online (AJOL)

    CASE REPORT. 16. SA JOURNAL OF RADIOLOGY • July 2005. Haemorrhage in intracranial tuber- culosis. M Modi. FCRad (SA), MMed. Department of Radiation Sciences ... wall where granulomatous inflamma- tion (Fig. 2, arrow) was present in the adventitia. A specific site of origin for the subarachnoid haemorrhage was.

  3. Canine Intracranial Meningioma: Case report

    Directory of Open Access Journals (Sweden)

    José Ricardo Gomes de Carvalho

    2016-11-01

    Full Text Available ABSTRACT. Carvalho J.R.G., Vasconcellos C.H.C., Bastos I. P.B., Trajano F.L.C., Costa T.S. & Fernandes J.I [Canine Intracranial Meningioma: Case report.] Meningioma intracraniano canino: Relato de caso. Revista Brasileira de Medicina Veterinária, 38(supl. 3:1- 7, 2016. Programa de Pós-Graduação em Ciências Veterinária, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23.897-000, Brasil, E-mail: vetjulio@yahoo.com.br Intracranial neoplasms usually show their signals in a moderate way, revealing a long background of nonspecific signs, making the diagnosis more difficult. The meningioma is the most common intracranial neoplasm in dogs and cats. Along the years, the Veterinary Medicine has experienced important technological improvements, making it possible the diagnosis of a lot of diseases. Therefore, diseases considered not common in the past, started being diagnosed more frequently, for instance, brain lesions. The objective of this research is to report a case of intracranial meningioma in a Boxer dog that arrived at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro, highlighting its clinical improvement, diagnosis and treatment.

  4. Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak.

    Science.gov (United States)

    Brainard, Laura; Chen, Douglas A; Aziz, Khaled M; Hillman, Todd A

    2012-12-01

    To determine the incidence of intracranial hypertension in patients with spontaneous encephalocele with cerebrospinal fluid (CSF) leak. Retrospective case review. Tertiary care neurotology practice. Patients presenting between 2008 and 2011 with spontaneous encephalocele and CSF leak in the temporal bone. Lumbar puncture with opening pressure measurement after encephalocele repair. Patient age, sex, postoperative course, body mass index, and postoperative intracranial pressure. Of the 26 patients identified with spontaneous encephalocele with CSF leak, 9 patients had postoperative lumbar puncture data. Of those 9, 89% were female subjects, and 11% were male, with a mean age of 57 and a mean BMI of 41 kg/m (morbidly obese). The mean opening pressure was 24.5 cm H(2)O. Approximately 33% had normal intracranial pressure (mean, 15 cm H(2)O; range, 10-17 cm H(2)O); 67% had elevated intracranial pressure (mean, 29 cm H(2)O; range, 23.5-40 cm H(2)O). The incidence of BIH in the general population is 0.001%. Of the 6 with intracranial hypertension, 3 (50%) were placed on acetazolamide for fundoscopic findings, postoperative headache, and/or visual changes. Mean time to LP after repair of encephalocele was 13 months (range, 4 days to 75 months). This study shows that benign intracranial hypertension is prevalent in a significant number of patients presenting with spontaneous encephalocele with CSF otorrhea at a rate much higher than is found in the general population. This finding has direct clinical implications and suggests that all patients with spontaneous encephalocele/CSF leak warrant evaluation for benign intracranial hypertension.

  5. High-resolution ultrahigh-pressure long column reversed-phase liquid chromatography for top-down proteomics

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Yufeng; Tolic, Nikola; Piehowski, Paul D.; Shukla, Anil K.; Kim, Sangtae; Zhao, Rui; Qu, Yi; Robinson, E. W.; Smith, Richard D.; Pasa-Tolic, Ljiljana

    2017-05-01

    We report development of an approach providing high-resolution RPLC of proteins and its utility for mass spectrometry-based top-down proteomics. A chromatographic peak capacity of ~450 was achieved for proteins and large polypeptides having MWs up to 43 kDa in the context of proteomics applications. RPLC column lengths from 20 to 200 cm, particle sizes from 1.5 to 5 m, bonding alkyl chains from C1 to C2, C4, C8, and C18, and particle surface structures that spanned porous, superficially porous (porous shell, core-shell), and nonporous were investigated at pressures up to14K psi. Column length was found as the most important factor for >20 kDa proteins in gradient RPLC, and shortening column length degraded RPLC resolution and sensitivity regardless of the size and surface structure of the packing particles used. The alkyl chains bonded to the silica particle surface significantly affected the RPLC recovery and efficiency, and short alkyl C1-C4 phases provided higher sensitivity and resolution than C8 and C18 phases. Long gradient separations (e.g., >10 hours) with long columns (e.g., 100 cm) were particularly effective in conjunction with use of high accuracy mass spectrometers (e.g., the Orbitrap Elite) for top-down proteomics with improved proteoform coverage by allowing multiple HCD, CID, and ETD dissociation modes. It was also found that HCD produced small fragments useful for proteoform identification, while low energy CID and ETD often complemented HCD by providing large fragments.

  6. Effect of pressure on the selectivity of polymeric C18 and C30 stationary phases in reversed-phase liquid chromatography. Increased separation of isomeric fatty acid methyl esters, triacylglycerols, and tocopherols at high pressure.

    Science.gov (United States)

    Okusa, Kensuke; Iwasaki, Yuki; Kuroda, Ikuma; Miwa, Shohei; Ohira, Masayoshi; Nagai, Toshiharu; Mizobe, Hoyo; Gotoh, Naohiro; Ikegami, Tohru; McCalley, David V; Tanaka, Nobuo

    2014-04-25

    A high-density, polymeric C18 stationary phase (Inertsil ODS-P) or a polymeric C30 phase (Inertsil C30) provided improved resolution of the isomeric fatty acids (FAs), FA methyl esters (FAMEs), triacylglycerols (TAGs), and tocopherols with an increase in pressure of 20-70MPa in reversed-phase HPLC. With respect to isomeric C18 FAMEs with one cis-double bond, ODS-P phase was effective for recognizing the position of a double bond among petroselinic (methyl 6Z-octadecenoate), oleic (methyl 9Z-octadecenoate), and cis-vaccenic (methyl 11Z-octadecenoate), especially at high pressure, but the differentiation between oleic and cis-vaccenic was not achieved by C30 phase regardless of the pressure. A monomeric C18 phase (InertSustain C18) was not effective for recognizing the position of the double bond in monounsaturated FAME, while the separation of cis- and trans-isomers was achieved by any of the stationary phases. The ODS-P and C30 phases provided increased separation for TAGs and β- and γ-tocopherols at high pressure. The transfer of FA, FAME, or TAG molecules from the mobile phase to the ODS-P stationary phase was accompanied by large volume reduction (-30∼-90mL/mol) resulting in a large increase in retention (up to 100% for an increase of 50MPa) and improved isomer separation at high pressure. For some isomer pairs, the ODS-P and C30 provided the opposite elution order, and in each case higher pressure improved the separation. The two stationary phases showed selectivity for the isomers having rigid structures, but only the ODS-P was effective for differentiating the position of a double bond in monounsaturated FAMEs. The results indicate that the improved isomer separation was provided by the increased dispersion interactions between the solute and the binding site of the stationary phase at high pressure. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Analysis of Factors Related to Hypopituitarism in Patients with Nonsellar Intracranial Tumor.

    Science.gov (United States)

    Lu, Song-Song; Gu, Jian-Jun; Luo, Xiao-Hong; Zhang, Jian-He; Wang, Shou-Sen

    2017-09-01

    Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. Chart data were collected retrospectively from 83 patients with nonsellar intracranial tumors admitted to our hospital from May 2014 to April 2015. Pituitary function of each subject was determined based on results of preoperative serum pituitary hormone analysis. Univariate and multivariate logistic regression methods were used to analyze relationships between preoperative hypopituitarism and factors including age, sex, history of hypertension and secondary epilepsy, course of disease, tumor mass effect, site of tumor, intracranial pressure (ICP), cerebrospinal fluid content, and pituitary morphology. A total of 30 patients (36.14%) presented with preoperative hypopituitarism in either 1 axis or multiple axes; 23 (27.71%) were affected in 1 axis, and 7 (8.43%) were affected in multiple axes. Univariate analysis showed that risk factors for preoperative hypopituitarism in patients with a nonsellar intracranial tumor include an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H 2 O), and mass effect (P hypopituitarism in patients with nonsellar intracranial tumors (P hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H 2 O), and mass effect (P hypopituitarism. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Secondary Intracranial Hypertension in Pediatric Patients With Leukemia.

    Science.gov (United States)

    Fernández-García, Miguel Ángel; Cantarín-Extremera, Verónica; Andión-Catalán, Maitane; Duat-Rodríguez, Anna; Jiménez-Echevarría, Saioa; Bermejo-Arnedo, Ignacio; Hortigüela-Saeta, Montesclaros; Rekarte-García, Saray; Babín-López, Lara; Ruano Domínguez, David

    2017-12-01

    We investigated the clinical characteristics of a pediatric population with hemato-oncological disease and intracranial hypertension, analyze the therapeutic response and outcome, and compare its characteristics with respect to a control group with idiopathic intracranial hypertension. We retrospectively analyzed patients with hemato-oncological disease and secondary intracranial hypertension in our center during the past five years. We compared these individuals with a historical cohort with idiopathic intracranial hypertension from our institution (control group). We identified eight patients, all with leukemia, and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid was 35 cm H 2 O. All had headache, but only 28% complained of visual symptoms. Only 12.5% exhibited papilledema at the time of diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and all had a favorable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be difficult. Associated factors are diverse and do not show an obvious causal relationship. A high index of suspicion must be maintained for diagnosis, because a favorable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy and caused few side effects. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Radionuclide cisternographic findings in patients with spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Jung, Dong Jin; Kim, Jae Seung; Ryu, Jin Sook; Shin, Jung Woo; Im, Joo Hyuk; Lee, Myoung Chong; Jung, Sung Joo; Moon, Dae Hyuk; Lee, Hee Kyung

    1998-01-01

    Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternogrpahic findings of spontaneous intracranial hypotension. The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30min. Epidural blood patch was done in 11 patients and headache was improved in all cases. The characteristics findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration

  10. Intracranial germinoma: a clinical analysis of 33 cases

    International Nuclear Information System (INIS)

    Zhao Xiangfei; Kang Jingbo; Nie Qing; Zhang Jun; Jia Haiwei

    2012-01-01

    Objective: To analyze the characteristics of clinical symptoms, examinations, and treatments in patients with intracranial germinoma. Methods: Medical records of 33 cases with intracranial germinoma between January 2000 and January 2011 were retrospectively reviewed. Results: The study population consisted of 26 males and 7 females. Eighteen patients had a single tumor and 15 patients had multiple tumor. Twelve (36.4% ) were in the sellar region, 13 (39.4% ) in the pineal region, 5 cases (15.2% ) in basal ganglia and 9 cases in the periventricular region. Clinical manifestations: 21 patients (63.7% ) had headache, nausea and vomiting; 10 (30.3% ) had blurred vision and visual field damage; 11 (33.3% ) patients had diabetes insipidus and 7 patients (21.2% ) had limb weakness. Image study: MRI examination showed long T1, T2 or abnormal T1, T2 in MRI, which were enhanced equally by contrast medium. Diagnostic methods: 17 cases were confirmed by pathological diagnosis and 16 cases by diagnostic radiotherapy. Treatment: 3 cases underwent resection; 4 cases with obstructive hydrocephalus underwent ventriculoperitoneal shunt, and 10 patients underwent stereotactic surgery. All the patients underwent radiotherapy combined with chemotherapy. Symptoms were relieved obviously, but 2 patients had spinal cord metastasis. Conclusion: The increased intracranial pressure, polyuria, diplopia are the most common clinical symptoms of intracranial germ cell tumors. Common locations of lesions are the saddle area and pineal region. The whole brain + local radiotherapy combined with chemotherapy treatment is a common and effective modality for intracranial germinoma. Most patients have clinical symptoms remission and long survival. (authors)

  11. The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage

    International Nuclear Information System (INIS)

    Kirsch, C.; Iffy, L.; Zito, G.E.; McArdle, J.J.

    2001-01-01

    The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage. (orig.)

  12. The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, C. [Dept. of Radiology, University Hospital, Newark, NJ (United States); Iffy, L. [Dept. of Obstetrics, Gynecology and Womens Health, University Hospital, Newark, NJ (United States); Zito, G.E. [Dept. of Neurology, University Hospital, Newark, NJ (United States); McArdle, J.J. [Dept. of Pharmacology, University Hospital, Newark, NJ (United States)

    2001-04-01

    The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage. (orig.)

  13. Reversible cerebral vasconstriction syndrome: A case report

    International Nuclear Information System (INIS)

    Lee, Jeong Sub; Park, Ji Kang; Kim, Seung Hyoung; Jeong, Sun Young

    2013-01-01

    We report a 46-year-old woman patient with reversible cerebral vasoconstriction syndrome (RCVS). She presented with severe headache, multiple cerebral infarction, and multifocal severe stenosis in the intracranial arteries on magnetic resonance angiography (MRA). One month after the episode, a small bowel gastrointestinal stromal tumor (GIST) was incidentally detected during the evaluation of severe anemia and GIST was removed. Follow-up MRA was performed 3 months and 1 year after an initial attack of headache, and multifocal severe intracranial arterial stenotic lesions were completely resolved, she did not experience any episode of RCVS during the 2 years.

  14. Reversible cerebral vasconstriction syndrome: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Sub; Park, Ji Kang; Kim, Seung Hyoung; Jeong, Sun Young [Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2013-11-15

    We report a 46-year-old woman patient with reversible cerebral vasoconstriction syndrome (RCVS). She presented with severe headache, multiple cerebral infarction, and multifocal severe stenosis in the intracranial arteries on magnetic resonance angiography (MRA). One month after the episode, a small bowel gastrointestinal stromal tumor (GIST) was incidentally detected during the evaluation of severe anemia and GIST was removed. Follow-up MRA was performed 3 months and 1 year after an initial attack of headache, and multifocal severe intracranial arterial stenotic lesions were completely resolved, she did not experience any episode of RCVS during the 2 years.

  15. Intracranial MR imaging of achondroplasia

    International Nuclear Information System (INIS)

    Ueno, Shinichi; Ootsuka, Ryouichi; Hayashi, Yoshinori; Nishitani, Hiromu; Shirakawa, Norihisa; Hashimoto, Toshiaki

    1992-01-01

    Intracranial MR imaging was performed in five patients with achondroplasia. All patients had narrowing of the subarachnoid space at the level of the formen magnum that was mainly due to protrusion of the posterior aspect. Three patients had compressive deformities of the brainstem and/or upper cervical spine. Among them, two patients had deformities of the pons. Relative upward displacement of the brainstem was seen in all patients. Hydrocephalus was seen in three patients. (author)

  16. Intracranial MR imaging of achondroplasia

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, Shinichi; Ootsuka, Ryouichi; Hayashi, Yoshinori; Nishitani, Hiromu; Shirakawa, Norihisa; Hashimoto, Toshiaki (Tokushima Univ. (Japan). School of Medicine)

    1992-10-01

    Intracranial MR imaging was performed in five patients with achondroplasia. All patients had narrowing of the subarachnoid space at the level of the formen magnum that was mainly due to protrusion of the posterior aspect. Three patients had compressive deformities of the brainstem and/or upper cervical spine. Among them, two patients had deformities of the pons. Relative upward displacement of the brainstem was seen in all patients. Hydrocephalus was seen in three patients. (author).

  17. Computerized tomography of intracranial tumors

    International Nuclear Information System (INIS)

    Hungenberg, T.

    1982-01-01

    The author discusses the possibilities and limits of CT in the differential diagnosis of intracranial tumours. His discussion is based on a quantitative classification and a number of case studies selected under the following aspects: Misinterpretation of the CT image; specific diagnostic problems; uncommon CT image of the tumour; rare histological findings. 118 patients were examined between November 1976 and April 1979. (orig./MG) [de

  18. Benign Intracranial Hypertension with Particular Reference to Its Occurrence in Fat Young Women

    Science.gov (United States)

    Wilson, Donald H.; Gardner, W. James

    1966-01-01

    Benign intracranial hypertension (pseudotumor cerebri), a syndrome common to a number of disorders, is characterized by headaches and blurred vision. The patient is alert and has papilledema without localizing signs. Air studies show normal ventricles under increased pressure. The authors describe 61 consecutive cases of this pseudotumour, 48 of which were in fat young women, and propose that this group represents a clinical entity that has hitherto received little attention. In these 61 patients, 40 complete-exchange pneumoencephalograms showed normal ventricles, normal fluid volume and prominent cortical sulci. In 32, subtemporal decompression resulted in prompt and lasting relief. Three patients had late convulsive seizures after surgery. Seven patients had nasal quadrantanopsias, the implications of which are discussed. The authors believe that the high intracranial pressure in this condition is due to cerebral hyperemia, not brain edema. Further investigation will perhaps demonstrate a relationship between obesity, vascular dilatation and increased intracranial pressure. ImagesFig. 1 PMID:5296376

  19. Neonatal intracranial hemorrhages (perinatal onset)

    International Nuclear Information System (INIS)

    Ban, Sadahiko; Ogata, Masahiro; Yamamoto, Toyoshiro; Nakao, Satoshi; Mizue, Hidenari; Kobayashi, Yutaka.

    1982-01-01

    1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages. (author)

  20. Spontaneous intracranial hypotension syndrome: magnetic resonance findings in two patients

    International Nuclear Information System (INIS)

    Ortega, R.; Pastor, J.; Escamilla, F.; Romero, M. I.

    1999-01-01

    The postural headache syndrome associated with a decrease in the cerebrospinal fluid (CSF) pressure is generally secondary to the CSF leakage that usually occurs after diagnostic lumbar puncture. Spontaneous intracranial hypotension can not be attributed to any known cause or previous diagnostic or therapeutic intervention. The syndrome is characterized by severe headache that is relieved by lying supine. During lumbar puncture, the CSF pressure is normally low. We present two patients in whom gadolinium-enhanced magnetic resonance imaging showed widespread thickening and enhancement of the dura mater and subdural fluid collections. (Author) 13 refs

  1. Is there a relationship between obesity and intracranial hypertension?

    Science.gov (United States)

    Hannerz, J; Greitz, D; Ericson, K

    1995-04-01

    Intracranial hypertension and obesity have been reported in recent studies of patients with periorbital venous vasculitis. These findings indicate that obese patients should be investigated for signs of inflammation in serum and lumbar cerebrospinal fluid (CSF) pressure. Twenty obese females, aged 27-68 years participated in the study of associated symptoms, signs of inflammation in serum, intracranial hypertension and magnetic resonance imaging of the brain (MR). Twenty randomly selected age- and sex-matched females were also investigated for associated symptoms and MR as controls. There were no statistically significant differences in associated symptoms and diseases except for infertility (P rheumatic and antinuclear factors were significantly increased in the obese group compared with normal values at the hospital. The lumbar CSF pressure was increased above 20 cm water in 79% and above 25 cm water in 42% in the obese patients. MR showed that the subarachnoidal space in the obese patients were significantly smaller than in the controls. Signs of inflammation in serum, intracranial hypertension and decreased subarachnoidal space were statistically significantly more common in patients with obesity, than in controls.

  2. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases

    Science.gov (United States)

    Markey, Keira A; Uldall, Maria; Botfield, Hannah; Cato, Liam D; Miah, Mohammed A L; Hassan-Smith, Ghaniah; Jensen, Rigmor H; Gonzalez, Ana M; Sinclair, Alexandra J

    2016-01-01

    Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provides an overview of pathogenic factors that could result in IIH with particular focus on hormones and the impact of obesity, including its role in neuroendocrine signaling and driving inflammation. Despite occurring almost exclusively in obese women, there have been a few studies evaluating the mechanisms by which hormones and adipokines exert their effects on ICP regulation in IIH. Research involving 11β-hydroxysteroid dehydrogenase type 1, a modulator of glucocorticoids, suggests a potential role in IIH. Improved understanding of the complex interplay between adipose signaling factors such as adipokines, steroid hormones, and ICP regulation may be key to the understanding and future management of IIH. PMID:27186074

  3. Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk

    Science.gov (United States)

    Taddeo, Terrance A.

    2010-01-01

    During recent long duration missions to the International Space Station (ISS) crewmembers have reported changes in visual acuity or visual field defects. Exams in the postflight period revealed changes to the visual system and elevated intracranial pressures. As a result, NASA Space Medicine has added a number of tests to be performed in the preflight, inflight and postflight periods for ISS and shuttle missions with the goal of determining the processes at work and any potential mitigation strategies. This discussion will acquaint you with the changes that NASA has made to its medical requirements in order to address the microgravity induced intracranial hypertension and associated visual changes. Key personnel have been assembled to provide you information on this topic. Educational Objectives: Provide an overview of the current Medical Operations requirements and the mitigation steps taken to operationally address the issue.

  4. Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients.

    Science.gov (United States)

    Eide, Per K

    2008-11-01

    Data from intracranial pressure (ICP) recordings in patients with hydrocephalus were reviewed to determine whether intracranial pulsatility within the cerebrospinal fluid (CSF) of cerebral ventricles (ICP(LV)) may differ from that within the brain parenchyma (ICP(PAR)), and whether pulsatility may differ between noncommunicating ventricles. The authors retrieved data from recordings previously obtained in 7 patients with hydrocephalus (noncommunicating in 4 and communicating in 3) and shunt failure who received both an external ventricular drainage (EVD) and an ICP sensor as part of surveillance during intensive care. Simultaneous ICP(LV) and ICP(PAR) signals were available in 6 cases, and simultaneous signals from the lateral and fourth ventricles (ICP(LV) and ICP4V, respectively) were recorded in 1 case. The recordings with both signals were parsed into 6-second time windows. Pulsatility was characterized by the wave amplitude and rise time coefficient, and differences in pulsatility between the ICP(LV) and ICP(PAR) signals (6 cases) or ICP(LV) and ICP4V signals (1 case) were determined. There was uneven distribution of intracranial pulsatility in all 7 patients, shown as significantly elevated pulsatility (that is, higher wave amplitudes and rise time coefficients) within the ventricles (ICP(LV)) than within brain parenchyma (ICP(PAR)) in 6 patients, and significantly higher pulsatility in the fourth (ICP4V) than in the lateral (ICP(LV)) ventricles in 1 patient. Differences > or = 1 mm Hg in ICP wave amplitude were found in 0.5-100% (median 9.4%) of observations in the 7 patients (total number of 6-second time windows, 68,242). The present observations demonstrate uneven distribution of intracranial pulsatility in patients with hydrocephalus, higher pulse pressure amplitudes within the ventricular CSF (ICP(LV)) than within the brain parenchyma (ICP(PAR)). This may be one mechanism behind ventricular enlargement in hydrocephalus.

  5. Controlling the Molecular Weight of Lignosulfonates by an Alkaline Oxidative Treatment at Moderate Temperatures and Atmospheric Pressure: A Size-Exclusion and Reverse-Phase Chromatography Study

    Directory of Open Access Journals (Sweden)

    Chamseddine Guizani

    2017-11-01

    Full Text Available The molecular weights of lignosulfonates (LSs are modified by a rather simple process involving an alkaline oxidative treatment at moderate temperatures (70–90 °C and atmospheric pressure. Starting from LSs with an average molecular weight of 90,000 Da, and using such a treatment, one can prepare controlled molecular weight LSs in the range of 30,000 to 3500 Da based on the average mass molecular weight. The LS depolymerisation was monitored via reverse-phase and size-exclusion chromatography. It has been shown that the combination of O2, H2O2 and Cu as a catalyst in alkaline conditions at 80 °C induces a high LS depolymerisation. The depolymerisation was systemically accompanied by a vanillin production, the yields of which reached 1.4 wt % (weight percentage on LS raw basis in such conditions. Also, the average molecular weight and vanillin concentration were correlated and depended linearly on the temperature and reaction duration.

  6. Idiopathic intracranial hypertension: A typical presentation

    International Nuclear Information System (INIS)

    Algahtani, Hussein A.; Obeid, Tahir H.; Abuzinadah, Ahmad R.; Baeesa, Saleh S.

    2007-01-01

    Objective was to describe the clinical features of 5 patients with rare atypical presentation of idiopathic intracranial hypertension (IIH), and propose the possible mechanism of this atypical presentation. We carried out a retrospective study of 5 patients, admitted at King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia with IIH during the period from January 2001 to December 2005. All were females with their age ranges from 24 to 40 years. The clinical presentations, the laboratory and imaging studies were analyzed. The opening pressures of the lumbar puncture tests were documented. All patients were presented with headache. One had typical pain of trigeminal neuralgia and one with neck pain and radiculopathy. Facial diplegia was present in one patient and two patients had bilateral 6th cranial neuropathy. Papilledema was present in all patients except in one patient. Imaging study was normal in all patients, and they had a very high opening pressure during lumbar puncture, except in one patient. All patients achieved full recovery with medical therapy in 6 to 12 weeks with no relapse during the mean follow up of 2 years. Atypical finding in IIH are rare and require a high index of suspicion for early diagnosis. (author)

  7. Reverse Algols

    Science.gov (United States)

    Leung, K. C.

    1989-01-01

    Reverse Algols, binary systems with a semidetached configuration in which the more massive component is in contact with the critical equipotential surface, are examined. Observational evidence for reverse Algols is presented and the parameters of seven reverse Algols are listed. The evolution of Algols and reverse Algols is discussed. It is suggested that, because reverse Algols represent the premass-reversal semidetached phase of close binary evolution, the evolutionary time scale between regular and reverse Algols is the ratio of the number of confirmed systems of these two Algol types.

  8. Reverse Logistics

    OpenAIRE

    Kulikova, Olga

    2016-01-01

    This thesis was focused on the analysis of the concept of reverse logistics and actual reverse processes which are implemented in mining industry and finding solutions for the optimization of reverse logistics in this sphere. The objective of this paper was the assessment of the development of reverse logistics in mining industry on the example of potash production. The theoretical part was based on reverse logistics and mining waste related literature and provided foundations for further...

  9. Addison's disease presenting with idiopathic intracranial hypertension in 24-year-old woman: a case report

    Directory of Open Access Journals (Sweden)

    Moore Peter

    2010-02-01

    Full Text Available Abstract Introduction Idiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female. Case presentation A 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure. Conclusion Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state.

  10. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  11. Measurement of blood flow in the superior sagittal sinus in healthy volunteers, and in patients with normal pressure hydrocephalus and idiopathic intracranial hypertension with phase-contrast cine MR imaging

    DEFF Research Database (Denmark)

    Gideon, P; Thomsen, C; Gjerris, F

    1996-01-01

    PURPOSE: To measure blood flow and velocity in the superior sagittal ++sinus. MATERIAL AND METHODS: MR velocity mapping was used to examine 14 healthy volunteers, 15 patients with normal pressure hydrocephalus (NPH), 3 patients with high pressure hydrocephalus (HPH), and 11 patients with idiopathic...

  12. Stereotactic intracranial radiotherapy: Dose prescription

    International Nuclear Information System (INIS)

    Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

    2012-01-01

    The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

  13. Postoperative radiotherapy for intracranial meningioma

    International Nuclear Information System (INIS)

    Chun, Ha Chung; Lee, Myung Za

    2001-01-01

    To evaluate the effectiveness and tolerance of postoperative external radiotherapy for patients with intracranial meningiomas. The records of thirty three patients with intracranial meningiomas who were treated with postoperative external irradiation at our institution between Feb, 1988 and Nov, 1999 were retrospectively analyzed. Median age of patients at diagnosis was 53 years with range of 17 to 68 years. Sites of involvement were parasagital, cerebral convexity, sphenoid ridge, parasellar and tentorium cerebella. Of 33 evaluated patients, 15 transitional, 10 meningotheliomatous, 4 hemangiopericytic, 3 atypical and 1 malignant meningioma were identified. Four patients underwent biopsy alone and remaining 29 patients underwent total tumor resection. A dose of 50 to 60 Gy was delivered in 28-35 daily fractions over a period of 5 to 7 weeks. Follow-up period ranged from 12 months to 8 years. The actuarial survival rates at 5 and 7 years for entire group of patients were 78% and 67%, respectively. The corresponding disease free survival rates were 73% and 61 %, respectively. The overall local control rate at 5 years was 83%. One out of 25 patients in benign group developed local failure, while 4 out of 8 patients in malignant group did local failure (p <0.05), Of 4 patients who underwent biopsy alone, 2 developed local failure. There was no significant difference in 5 year actuarial survival between patients who underwent total tumor resection and those who did biopsy alone. Patients whose age is under 60 showed slightly better survival than those whose age is 60 or older, although this was not statistically significant. There was no documented late complications in any patients. Based on our study, we might conclude that postoperative external beam radiotherapy tends to improve survival of patients with intracranial meningiomas comparing with surgery alone

  14. MRI of intracranial meningeal malignant fibrous histiocytoma

    International Nuclear Information System (INIS)

    Ogino, A.; Ochi, M.; Hayashi, K.; Hirata, K.; Hayashi, T.; Yasunaga, A.; Shibata, S.

    1996-01-01

    We describe the CT and MRI findings in a patient with primary intracranial meningeal malignant fibrous histiocytoma (MFH). CT delineated the anatomical relations and MRI aided in tissue characterisation. To our knowledge, this is the first report describing the MRI findings in primary intracranial meningeal MFH. (orig.). With 1 fig

  15. Ultrasonographic Findings of Fetal Congenital Intracranial Teratoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho; Song, Mi Jin; Cho, Jeong Yeon; Min, Jee Yeon; Moon, Min Hwan; Kim, Jeong Ah [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2005-06-15

    To evaluate the sonographic findings of fetal congenital intracranial teratoma. From 1994 to 2002, of the 11 fetuses which had been diagnosed with fetal intracranial tumors after second level fetal ultrasonography, the six that were confirmed after autopsy as congenital intracranial teratomas were included in our study. The sonographic findings, including size, homogeneity, echogenicity compared with surrounding normal brain tissues, cystic components, and tumor related calcification, were retrospectively evaluated. The incidence of fetal congenital intracranial teratoma out of all fetal intracranial tumors was 54.5% (6 of 11 cases) during the 8-year period. The mean mass size was 7.4 cm (3.0-15.0 cm). Two thirds of (4/6) of the teratoma cases showed high echogenicity compared with normal brain tissues, and two thirds (4/6) showed heterogeneous echogenicity. Four teratoma cases (67%) showed cysts in the mass with a mean size of 1.9cm. One third (2/6) showed calcifications within the tumor. Out of the six cases, two had oropharyngeal teratoma with extension into the intracranial portion (so called epignathus) and showed homogenous mass without any cysts or calcifications. The typical sonographic appearance of intracranial teratoma was a heterogeneous, hyperechoic mass with cysts. In the epignathus cases, the sonographic appearances differed somewhat from the others. An understanding of the sonographic findings of fetal intracranial teratoma will help in the timely counseling of the parents and in obstetric decision making

  16. Intracranial alveolar echinococcosis: CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Bensaid, A.H. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Dietemann, J.L. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Filippi de la Palavesa, M.M. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Klinkert, A. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Kastler, B. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Gangi, A. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Jacquet, G. (Dept. of Neurosurgery, Univ. Hospital, Besancon (France)); Cattin, F. (Dept. of Radiology, Univ. Hospital, Besancon (France))

    1994-05-01

    Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension. (orig.)

  17. Intracranial alveolar echinococcosis: CT and MRI

    International Nuclear Information System (INIS)

    Bensaid, A.H.; Dietemann, J.L.; Filippi de la Palavesa, M.M.; Klinkert, A.; Kastler, B.; Gangi, A.; Jacquet, G.; Cattin, F.

    1994-01-01

    Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension. (orig.)

  18. Traumatic and alternating delayed intracranial hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-11-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  19. Traumatic and alternating delayed intracranial hematomas

    International Nuclear Information System (INIS)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-01-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma. (orig.)

  20. Intracranial Hemorrhage Following a 3-week Headache

    Directory of Open Access Journals (Sweden)

    John Jiao

    2017-01-01

    Full Text Available History of present illness: A 35-year-old female presented to the ED with a Glasgow Coma Scale (GCS of 11. Per her boyfriend, the patient was having headaches for the past 3 weeks. She was initially taken to an outside hospital where her GCS was reported as 13. A non-contrast head computed tomography (CT revealed a large lobar intraparenchymal hemorrhage within the left frontal parietal lobe with midline shift. Upon examination, vitals were notable for blood pressure of 209/88mmHg, and her left pupil was fixed and dilated. The patient had extension of her right arm to noxious stimuli, paralysis of her right leg, and purposeful movement of the left arm and left leg. The patient was started on a nicardipine drip in the ED and subsequently taken to the operating room for a decompressive craniectomy. Significant findings: The patient’s head CT showed a significant area of hyperdensity consistent with an intracranial hemorrhage located within the left frontal parietal lobe (red arrow. Additionally, there is rightward midline shift up to 1.1cm (green arrow and entrapment of the right lateral ventricle (blue arrow. Discussion: Intraparenchymal hemorrhage (IPH is associated with high morbidity and mortality. Although the mortality for subarachnoid hemorrhage (SAH has declined steadily over the past several decades, the mortality for IPH mortality has not significantly.1 One of the most serious considerations when treating a patient with IPH is the management of intracranial pressure (ICP.2 Once an IPH is identified, immediate steps should be taken to bring ICP within acceptable levels including elevating the head of the bed to 30 degrees, sedation, and controlling hypertension with medications.2-3 Even with early and aggressive care, the prognosis for IPH remains poor; the 30-day mortality rate for IPH is estimated to be less than 50%, and a 2010 systematic review estimated only 12-39% of IPH patients achieve independent function.4-5 Predictors of

  1. Intracranial metastases: spectrum of MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Kyoung; Lee, Eun Ja; Lee, Yong Seok [Department of Radiology, Dongguk University Ilsan Hospital, Goyang-shi (Korea, Republic of)], E-mail: ejl1048@hanmail.net; Kim, Mi Sung; Park, No Hyuck [Department of Radiology, Kwandong University, College of Medicine, Myongji Hospital, Goyang-shi (Korea, Republic of); Park, Hee-Jin [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); II, Sung Park [Department of Diagnostic Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2012-12-15

    Intracranial metastatic lesions arise through a number of routes. Therefore, they can involve any part of the central nervous system and their imaging appearances vary. Magnetic resonance imaging (MRI) plays a key role in lesion detection, lesion delineation, and differentiation of metastases from other intracranial disease processes. This article is a reasoned pictorial review illustrating the many faces of intracranial metastatic lesions based on the location - intra-axial metastases, calvarial metastases, dural metastases, leptomeningeal metastases, secondary invasion of the meninges by metastatic disease involving the calvarium and skull base, direct or perineural intracranial extension of head and neck neoplasm, and other unusual manifestations of intracranial metastases. We also review the role of advanced MRI to distinguish metastases from high-grade gliomas, tumor-mimicking lesions such as brain abscesses, and delayed post-radiation changes in radiosurgically treated patients.

  2. Desmopressin Acetate in Intracranial Haemorrhage

    Directory of Open Access Journals (Sweden)

    Thomas Kapapa

    2014-01-01

    Full Text Available Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function. Patients and Methods. The platelet function was analysed in 10 patients who had received single (N=4 or multiple (N=6 doses of acetylsalicylic acid and 3 patients (control group who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance of P≤0.05. Results. (1 Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2 The platelet function worsened again after three hours. (3 There were no complications related to electrolytes or fluid balance. Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients.

  3. Management of intracranial arteriovenous malformations

    International Nuclear Information System (INIS)

    Miyamoto, Susumu; Takahashi, Jun C.

    2008-01-01

    Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

  4. Management of intracranial arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Susumu; Takahashi, Jun C [National Cardiovascular Center, Suita, Osaka (Japan)

    2008-10-15

    Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

  5. A case of intracranial teratoma

    International Nuclear Information System (INIS)

    Shiota, Madoka; Ando, Yukinori; Takashima, Sachio; Hori, Tomokatsu; Hiramoto, Shinsuke.

    1985-01-01

    A case of neonatal intracranial teratoma was examined on ultrasonography (US), computed tomography (CT) and tumor markers in serum, CSF and tumor tissue. This 27-day-old male infant was pointed out a head enlargement by prenatal sonography at 39 weeks' gestation. He admitted to our hospital at the age of one day after cesarean section. His birth weight was 4430 g and head circumstance 47.5 cm. On admission, physical and neurological examinations reveled big head, weak crying, twiching and sun set phenomenon. The optic fundi were normal. The CT scan at 1 day demonstrated the marked enlargement of lateral ventricles and the supratentorial large polycystic mass with calcifications at midline area. Transfontanelle sonography also delineated the polycystic mass and enlarged ventricle. Ventricular tap showed bloody CSF. Alpha-Fetoprotein and carcinoembryonic antigen level in CSF was higher than those in serum. Postmortam tumor necropsy revealed a teratoma including mature squamous epithelium, muscle, cartilage, bone, lymphoid and nervous tissue. There were immature mesenchymal cells in some parts. The immune histochemical method showed positive staining to AFP in intestinal and respiratory epithelium, and to CEA in intestinal epithelium and immature mesenchymal cells. In summary, these characteristic findings of US, CT and tumor marker in CSF have a diagnostic value of intracranial teratoma. (author)

  6. A method for simultaneous analysis of phytosterols and phytosterol esters in tobacco leaves using non aqueous reversed phase chromatography and atmospheric pressure chemical ionization mass spectrometry detector.

    Science.gov (United States)

    Ishida, Naoyuki

    2014-05-02

    While numerous analytical methods for phytosterols have been reported, the similar polarity and large molecules of phytosterol esters have made the methods lengthy and complicated. For this reason, an analytical method that could completely separate phytosterol esters including the higher fatty acids such as palmitic acid, stearic acid, oleic acid, linoleic acid and linolenic acid in addition to phytosterols without preliminary separation was developed. The separation was accomplished by non-aqueous reversed phase chromatography technique using only acetone and acetonitrile. An atmospheric pressure chemical ionization/mass spectrometry detector configured at selected ion monitoring mode was hyphenated with the separation system to detect phytosterols and phytosterol esters. Twenty-four types of these were consequently separated and then identified with their authentic components. The calibration curve was drawn in the range of about 5 to 25,000 ng/mL with a regression coefficient over 0.999. The limit of detection and limit of quantification, respectively, ranged from 0.9 to 3.0 ng/mL and from 3.0 to 11.0 ng/mL. Recovery rates ranged from 80 to 120%. The quantification results were subjected to statistical analysis and hierarchical clustering analysis, and were used to determine the differences in the amounts of phytosterols and phytosterol esters across tobacco leaves. The newly developed method succeeded in clarifying the whole composition of phytosterols and phytosterol esters in tobacco leaves and in explaining compositional differences across the variety of tobacco leaves. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Characteristics of Symptomatic Intracranial Hemorrhage in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulant Therapy.

    Directory of Open Access Journals (Sweden)

    Hisanao Akiyama

    Full Text Available The first non-vitamin K antagonist oral anticoagulant (NOAC introduced to the market in Japan was dabigatran in March 2011, and three more NOACs, rivaroxaban, apixaban, and edoxaban, have since become available. Randomized controlled trials of NOACs have revealed that intracranial hemorrhage (ICH occurs less frequently with NOACs compared with warfarin. However, the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants, and we wanted to explore the incidence, clinical characteristics, and treatment course of patients with NOACs-associated ICH.We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014.ICH occurred in 6 patients (5 men, 1 woman; mean ± SD age, 72.8 ± 3.2 years. Mean time to onset was 146.2 ± 111.5 days after starting NOACs. Five patients received rivaroxaban and 1 patient received apixaban. None received dabigatran or edoxaban. Notably, no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma, activated prothrombin complex concentrate, recombinant activated factor VIIa or hemodialysis. When NOAC therapy was initiated, mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7, respectively. Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset.Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not expand in the absence of infusion of reversal agents or hemodialysis. The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control (137.8 ± 15.9 mmHg and HAS-BLED score ≤ 2. Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy.

  8. Reverse Osmosis

    Indian Academy of Sciences (India)

    many applications, one of which is desalination of seawater. The inaugural Nobel Prize in Chemistry was awarded in 1901 to van 't Hoff for his seminal work in this area. The present article explains the principle of osmosis and reverse osmosis. Osmosis and Reverse Osmosis. As the name suggests, reverse osmosis is the ...

  9. Fluid management in infants and children during intracranial surgery

    Directory of Open Access Journals (Sweden)

    Hemangi S Karnik

    2017-01-01

    Full Text Available Fluid management in neurosurgical paediatric patients can be a real challenge due to their different pathophysiology, sensitivity to fluid loss, inability to accurately judge the degree of abnormality and adequacy of replacement in face of limited monitoring. For infants and children undergoing neurosurgical procedures, isotonic fluids should be used for maintenance and replacement to avoid increase in intracranial pressure and maintain cerebral perfusion. Routine use of added dextrose is not needed, but blood glucose monitoring should be done in high risk population. Preoperative deficits and intraoperative blood loss should be closely monitored and treated. Hyponataemia and other electrolyte derangements are common and should be monitored.

  10. CO2 Effects in Space: Relationship to Intracranial Hypertension

    Science.gov (United States)

    Alexander, David J.

    2011-01-01

    This slide presentation reviews the effects of enhanced exposure to CO2 on Earth and in space. The effects of enhanced exposure to CO2 are experienced in almost all bodily systems. In space some of the effects are heightened due to the fluid shifts to the thorax and head. This fluid shift results in increased intracranial pressure, congested cerebral circulation, increased Cerebral Blood Flow (CBF) and Intravenous dilatation. The mechanism of the effect of CO2 on CBF is diagrammed, as is the Cerebrospinal Fluid (CSF) production. A listing of Neuroendocrine targets is included.

  11. Recovery of iron after Fenton-like secondary treatment of olive mill wastewater by nano-filtration and low-pressure reverse osmosis membranes

    Directory of Open Access Journals (Sweden)

    Ochando-Pulido, J. M.

    2016-09-01

    Full Text Available In this work, the performances of novel nano-filtration (NF and low-pressure reverse osmosis (RO polymeric membranes were examined with the aim of recovering the iron used as catalyst in former secondary treatment based on the Fenton-like advanced oxidation of olive mill wastewater (OMW. Results highlight that both membranes exhibit a good performance towards the rejection of iron (99.1% for the NF membrane vs. 100% for the low-pressure RO membrane in the secondary-treated OMW effluent, thus permitting the recovery of iron in the concentrate stream in order to recycle it back into the oxidation reactor to reduce catalyst consumption. Finally, the permeate streams could be re-used for irrigation. Major productivity was observed by the selected NF membrane, about 47.4 L/hm2 upon 9 bar, whereas 30.9 L/hm2 could be yielded with the RO membrane under an operating pressure of 8 bar. Moreover, a sensibly lower fouling index was measured on the NF membrane (0.0072 in contrast with 0.065, which ensures major steady-state performance on this membrane and a longer service lifetime. This also results in lower required membrane area and membrane plant over dimension (4 modules in case of RO operation whereas only 2 modules for NF.En este trabajo, se examinó el rendimiento de membranas modernas de nanofiltración (NF y ósmosis inversa (OI poliméricas con el objetivo de recuperar el hierro utilizado como catalizador en un tratamiento secundario previo de agua residual oleícola (OMW basado en oxidación avanzada tipo Fenton. Los resultados ponen de relieven que ambas membranas exhiben buen rendimiento en cuanto al rechazo de hierro (99.1 % para la membrana de NF vs. 100 % para la membrana de OI de bajas presiones en el efluente oleícola tras tratamiento secundario, permitiendo en consecuencia la recuperación de hierro en la corriente de concentrado para su recirculación de nuevo al reactor de oxidación para reducir el consumo de catalizador. Finalmente

  12. Intracranial stenosis in cognitive impairment and dementia.

    Science.gov (United States)

    Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

    2017-06-01

    Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

  13. Stent-assisted angioplasty for intracranial atherosclerosis

    International Nuclear Information System (INIS)

    Nakahara, Toshinori; Sakamoto, Shigeyuki; Hamasaki, Osamu; Sakoda, Katsuaki

    2002-01-01

    We report on two patients with intracranial atherosclerosis of the carotid artery or vertebral artery treated with stent-assisted angioplasty. Both patients have severe intracranial atherosclerosis (>70%) with refractory symptoms despite optimal medical treatment. In both patients, a coronary balloon-expandable stent was successfully placed using a protective balloon technique without procedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 13 months. Follow-up angiograms did not show restenosis 3 or 4 months after procedure, respectively. Stent-assisted angioplasty for intracranial atherosclerosis in the elective patient has proven effective, with an acceptable low rate of morbidity and mortality. (orig.)

  14. Headache following intracranial neuroendovascular procedures.

    Science.gov (United States)

    Baron, Eric P; Moskowitz, Shaye I; Tepper, Stewart J; Gupta, Rishi; Novak, Eric; Hussain, Muhammad Shazam; Stillman, Mark J

    2012-05-01

    Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting. We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH. We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield. Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.

  15. Osmolality of Cerebrospinal Fluid from Patients with Idiopathic Intracranial Hypertension (IIH)

    DEFF Research Database (Denmark)

    Wibroe, Elisabeth A; Yri, Hanne M; Jensen, Rigmor H

    2016-01-01

    INTRODUCTION: Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial fluid pressure (ICP) of unknown etiology. This study aims to investigate osmolality of cerebrospinal fluid (CSF) from patients with IIH. METHODS: We prospectively collected CSF from individuals referred...... significantly from patients with moderately elevated ICP from 26-45 cmH2O (n = 21) (p = 0.86) and patients with high ICP from 46-70 cmH2O (n = 4) (p = 0.32), respectively. There was no correlation between osmolality and ICP, BMI, age and body height, respectively. Mean CSF osmolality was 270 mmol/kg (± 1 SE, 95...

  16. Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial.

    Science.gov (United States)

    Friedman, Deborah I; Quiros, Peter A; Subramanian, Prem S; Mejico, Luis J; Gao, Shan; McDermott, Michael; Wall, Michael

    2017-09-01

    To characterize the phenotype, headache-related disability, medical co-morbidities, use of symptomatic headache medications, and headache response to study interventions in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Patients with untreated IIH and mild vision loss enrolled in the IIHTT and randomized to acetazolamide (ACZ) and weight loss or placebo (PLB) and weight loss had prospective assessment of headache disability using the Headache Impact Test-6 (HIT-6) questionnaire. Subjects with headache at the baseline visit were assigned a headache phenotype using the International Classification for Headache Disorders version 3 beta (ICHD-3b). Medication overuse was determined using the participants' reported medication use for the preceding month and ICHD-3b thresholds for diagnosing medication overuse headache. We investigated relationships between headache disability and various other clinical characteristics at baseline and at 6 months. Headache was present in 139 (84%) of the 165 enrollees at baseline. The most common headache phenotypes were migraine (52%), tension-type headache (22%), probable migraine (16%), and probable tension-type headache (4%). Fifty-one (37%) participants overused symptomatic medications at baseline, most frequently simple analgesics. A similar amount of improvement in the adjusted mean (± standard error) HIT-6 score occurred in the ACZ (-9.56 ± 1.05) and PLB groups (-9.11 ± 1.14) at 6 months (group difference -0.45, 95% CI -3.50 to 2.60, P = .77). Headache disability did not correlate with any of the studies, variables of interest, which included: the lumbar puncture opening pressure at baseline or at 6 months, body mass index, the amount of weight lost, papilledema grade, perimetric mean deviation, or the use of hormonal contraception. Headache disability was significantly associated with patient-reported quality of life in the physical, mental, and visual domains. Headache was common, of varied

  17. [Experimental study of acute brain swelling under acute intracranial hypertension (author's transl)].

    Science.gov (United States)

    Shigemori, M; Watanabe, M; Kuramoto, S

    1976-12-01

    There are many problems about the cause, pathophysiology and treatment of acute brain swelling under intracranial hypertension frequently encountered in the neurosurgical clinics. Generally, rapid increase of the cerebral vasoparesis caused by unknown etiology is thought to be the main cause of acute brain swelling under intracranial hypertension. Moreover, disturbance of the cerebral venous circulatory system is discussed recently by many authors. But, research from the point of systemic respiration and hemodynamics is necessary for resolving these problems. This experiment was designed to study the effects of respiration and hemodynamics on the cerebral vasoparesis. Using 22 adult dogs, acute intracranial hypertension was produced by epidural balloon inflation sustained at the level of 300 - 400 mmH2O. Simultaneously with measurement of intracranial pressure at the epidural space, superior sagittal sinus pressure, respirogram, systemic blood pressure (femoral artery), central venous pressure, common carotid blood flow, EKG and bipolar lead EEG were monitored continuously. The experimental group was divided by the respiratory loading into 5 groups as follows: control (6 cases), 10% CO2 hypercapnia (4 cases), 10% O2 hypoxia (4 cases), stenosis of airway (5 cases), 100% O2-controled respiration (3 cases). 1) Cerebral vasoparesis under acute intracranial hypertension took place earlier and showed more rapid progression in groups of stenosis of airway, hypercapnia and hypoxia than control group of spontaneous respiration in room air. No occurrence of cerebral vasoparesis was found out in a group of 100% O2 controlled respiration. It is proved that increased airway resistance or asphyxia, hypercapnia and hypoxia have strictly reference to the occurrence and progression of cerebral vasoparesis and for the prevention of cerebral vasoparesis, correct 100% O2 cont rolled respiration is effective. 2) From the hemodynamic change, the progression of rapid increase of cerebral

  18. MR angiography after coiling of intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion

  19. Atypical imaging appearances of intracranial meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    O' Leary, S. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Adams, W.M. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Parrish, R.W. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Mukonoweshuro, W. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom)]. E-mail: William.mukonoweshuro@phnt.swest.nhs.uk

    2007-01-15

    Meningiomas are the commonest primary, non-glial intracranial tumours. The diagnosis is often correctly predicted from characteristic imaging appearances. This paper presents some examples of atypical imaging appearances that may cause diagnostic confusion.

  20. Spontaneous Intracranial Hypotension without Orthostatic Headache

    Directory of Open Access Journals (Sweden)

    Tülay Kansu

    2009-03-01

    Full Text Available We report 2 cases of spontaneous intracranial hypotension that presented with unilateral abducens nerve palsy, without orthostatic headache. While sixth nerve palsies improved without any intervention, subdural hematoma was detected with magnetic resonance imaging. We conclude that headache may be absent in spontaneous intracranial hypotension and spontaneous improvement of sixth nerve palsy can occur, even after the development of a subdural hematoma

  1. Spontaneous intracranial epidural hematoma during rivaroxaban treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jeronimo Buzetti; Jung, Gustavo Simiano; Silva Junior, Luis Fernando; Ramina, Ricardo, E-mail: leonardoruschel@yahoo.com.br [Instituto de Neurologia de Curitiba (INC), Curitiba, PR (Brazil)

    2016-11-15

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto®. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban. (author)

  2. "Negative symptoms"secondary to intracranial tumor

    Directory of Open Access Journals (Sweden)

    Natasha Kate

    2014-01-01

    Full Text Available Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

  3. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors.

    Science.gov (United States)

    Arenillas, Juan F; Candell-Riera, Jaume; Romero-Farina, Guillermo; Molina, Carlos A; Chacón, Pilar; Aguadé-Bruix, Santiago; Montaner, Joan; de León, Gustavo; Castell-Conesa, Joan; Alvarez-Sabín, José

    2005-06-01

    Optimization of coronary risk evaluation in stroke patients has been encouraged. The relationship between symptomatic intracranial atherosclerosis and occult coronary artery disease (CAD) has not been evaluated sufficiently. We aimed to investigate the prevalence of silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis and to identify factors associated with its presence. From 186 first-ever transient ischemic attack or ischemic stroke patients with intracranial stenoses, 65 fulfilled selection criteria, including angiographic confirmation of a symptomatic atherosclerotic stenosis and absence of known CAD. All patients underwent a maximal-stress myocardial perfusion single-photon emission computed tomography (SPECT). Lipoprotein(a) [Lp(a)], C-reactive protein, and homocysteine (Hcy) levels were determined before SPECT. Stress-rest SPECT detected reversible myocardial perfusion defects in 34 (52%) patients. Vascular risk factors associated with a pathologic SPECT were hypercholesterolemia (P=0.045), presence of >2 risk factors (P=0.004) and high Lp(a) (P=0.023) and Hcy levels (P=0.018). Ninety percent of patients with high Lp(a) and Hcy levels had a positive SPECT. Existence of a stenosed intracranial internal carotid artery (ICA; odds ratio [OR], 7.22, 2.07 to 25.23; P=0.002) and location of the symptomatic stenosis in vertebrobasilar arteries (OR, 4.89, 1.19 to 20.12; P=0.027) were independently associated with silent myocardial ischemia after adjustment by age, sex, and risk factors. More than 50% of the patients with symptomatic intracranial atherosclerosis and not overt CAD show myocardial perfusion defects on stress-rest SPECT. Stenosed intracranial ICA, symptomatic vertebrobasilar stenosis and presence of high Lp(a) and Hcy levels may characterize the patients at a higher risk for occult CAD.

  4. Technique of ICP monitored stepwise intracranial decompression effectively reduces postoperative complications of severe bifrontal contusion

    Directory of Open Access Journals (Sweden)

    Guan eSun

    2016-04-01

    Full Text Available Background Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of ICP monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. Method A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an intracranial pressure (ICP monitored stepwise intracranial decompression group (68 patients each, to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs 6 months after the surgery were compared between the two groups.Results (1 The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05; (2 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05; the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05.Conclusions The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of intracranial pressure and was beneficial to the prognosis of

  5. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, B.J.; Kim, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Han, M.H.; Chang, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Institute of Radiation Medicine, Seoul National University Medical Research Centre, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Seoul National University College of Medicine (Korea); Oh, C.W. [Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea)

    2003-08-01

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  6. Parameter Optimization for Selected Correlation Analysis of Intracranial Pathophysiology

    Directory of Open Access Journals (Sweden)

    Rupert Faltermeier

    2015-01-01

    Full Text Available Recently we proposed a mathematical tool set, called selected correlation analysis, that reliably detects positive and negative correlations between arterial blood pressure (ABP and intracranial pressure (ICP. Such correlations are associated with severe impairment of the cerebral autoregulation and intracranial compliance, as predicted by a mathematical model. The time resolved selected correlation analysis is based on a windowing technique combined with Fourier-based coherence calculations and therefore depends on several parameters. For real time application of this method at an ICU it is inevitable to adjust this mathematical tool for high sensitivity and distinct reliability. In this study, we will introduce a method to optimize the parameters of the selected correlation analysis by correlating an index, called selected correlation positive (SCP, with the outcome of the patients represented by the Glasgow Outcome Scale (GOS. For that purpose, the data of twenty-five patients were used to calculate the SCP value for each patient and multitude of feasible parameter sets of the selected correlation analysis. It could be shown that an optimized set of parameters is able to improve the sensitivity of the method by a factor greater than four in comparison to our first analyses.

  7. Intracranial hypertension: A rare presentation of lupus nephritis.

    Science.gov (United States)

    Yadav, Praveen; Nair, Anishkumar; Cherian, Ajith; Sibi, N S; Kumar, Ashwini

    2010-07-01

    A 14-year-old male presented with bilateral papilledema, growth retardation and absent secondary sexual characters. He had a past history of fever, headache and fatigue of 6 months duration. The diagnosis of intracranial hypertension (IH) was confirmed by an increased intracranial pressure and normal neuroimaging studies of the brain, except for partial empty sella, prominent perioptic cerebrospinal fluid (CSF) spaces and buckling of optic nerves. Evaluation showed erythrocyte sedimentation rate (ESR) of 150 mm/hr, positive antinuclear antibody (ANA), anti dsDNA and anti ribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV S (A) confirming the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methyl prednisolone and cyclophosphamide was effective in normalizing the CSF pressure, resulting in express and dramatic resolution of symptomatology. In a case of IH, SLE must be considered. IH, growth retardation and absence of sexual characters may be presenting manifestations of a chronic systemic inflammatory disease like SLE. These manifestations may act as a pointer to associated advanced grades of LN, which can be totally asymptomatic and missed without a renal biopsy.

  8. Parameter Optimization for Selected Correlation Analysis of Intracranial Pathophysiology.

    Science.gov (United States)

    Faltermeier, Rupert; Proescholdt, Martin A; Bele, Sylvia; Brawanski, Alexander

    2015-01-01

    Recently we proposed a mathematical tool set, called selected correlation analysis, that reliably detects positive and negative correlations between arterial blood pressure (ABP) and intracranial pressure (ICP). Such correlations are associated with severe impairment of the cerebral autoregulation and intracranial compliance, as predicted by a mathematical model. The time resolved selected correlation analysis is based on a windowing technique combined with Fourier-based coherence calculations and therefore depends on several parameters. For real time application of this method at an ICU it is inevitable to adjust this mathematical tool for high sensitivity and distinct reliability. In this study, we will introduce a method to optimize the parameters of the selected correlation analysis by correlating an index, called selected correlation positive (SCP), with the outcome of the patients represented by the Glasgow Outcome Scale (GOS). For that purpose, the data of twenty-five patients were used to calculate the SCP value for each patient and multitude of feasible parameter sets of the selected correlation analysis. It could be shown that an optimized set of parameters is able to improve the sensitivity of the method by a factor greater than four in comparison to our first analyses.

  9. Astronaut Preflight Cardiovascular Variables Associated with Vascular Compliance are Highly Correlated with Post-Flight Eye Outcome Measures in the Visual Impairment Intracranial Pressure (VIIP) Syndrome Following Long Duration Spaceflight

    Science.gov (United States)

    Otto, Christian; Ploutz-Snyder, R.

    2015-01-01

    The detection of the first VIIP case occurred in 2005, and adequate eye outcome measures were available for 31 (67.4%) of the 46 long duration US crewmembers who had flown on the ISS since its first crewed mission in 2000. Therefore, this analysis is limited to a subgroup (22 males and 9 females). A "cardiovascular profile" for each astronaut was compiled by examining twelve individual parameters; eleven of these were preflight variables: systolic blood pressure, pulse pressure, body mass index, percentage body fat, LDL, HDL, triglycerides, use of anti-lipid medication, fasting serum glucose, and maximal oxygen uptake in ml/kg. Each of these variables was averaged across three preflight annual physical exams. Astronaut age prior to the long duration mission, and inflight salt intake was also included in the analysis. The group of cardiovascular variables for each crew member was compared with seven VIIP eye outcome variables collected during the immediate post-flight period: anterior-posterior axial length of the globe measured by ultrasound and optical biometry; optic nerve sheath diameter, optic nerve diameter, and optic nerve to sheath ratio- each measured by ultrasound and magnetic resonance imaging (MRI), intraocular pressure (IOP), change in manifest refraction, mean retinal nerve fiber layer (RNFL) on optical coherence tomography (OCT), and RNFL of the inferior and superior retinal quadrants. Since most of the VIIP eye outcome measures were added sequentially beginning in 2005, as knowledge of the syndrome improved, data were unavailable for 22.0% of the outcome measurements. To address the missing data, we employed multivariate multiple imputation techniques with predictive mean matching methods to accumulate 200 separate imputed datasets for analysis. We were able to impute data for the 22.0% of missing VIIP eye outcomes. We then applied Rubin's rules for collapsing the statistical results across our 200 multiply imputed data sets to assess the canonical

  10. Occurrence studies of intracranial tumours

    Energy Technology Data Exchange (ETDEWEB)

    Larjavaara, S.

    2011-07-01

    Intracranial tumours are a histopathologically heterogeneous group of tumours. This thesis focused on three types of intracranial tumours; gliomas, meningiomas and vestibular schwannomas (VS). The main objectives of the dissertation were to estimate the occurrence of intracranial tumours by different subtypes, and to assess the validity and completeness of the cancer registry data. The specific aims of the publications were to evaluate the validity of reported incidence rates of meningioma cases, to describe the trends of VS incidence in four Nordic countries, and to define the anatomic distribution of gliomas and to investigate their location in relation to mobile phone use. Completeness of meningioma registration was examined by comparing five separate sources of information, and by defining the frequencies of cases reported to the Finnish Cancer Registry (FCR). Incidence trends of VS were assessed in the four Nordic countries over a twenty-one-year period (1987 - 2007) using cancer registry data. The anatomic site of gliomas was evaluated using both crude locations in the cerebral lobes and, in more detail, a three-dimensional (3D) distribution in the brain. In addition, a study on specific locations of gliomas in relation to the typical position of mobile phones was conducted using two separate approaches: a case-case and a case-specular analysis. The thesis was based on four sets of materials. Data from the international Interphone study were used for the studies on gliomas, while the two other studies were register-based. The dataset for meningiomas included meningioma cases from the FCR and four clinical data sources in Tampere University Hospital (neurosurgical clinic, pathology database, hospital discharge register and autopsy register). The data on VS were obtained from the national cancer registries of Denmark, Finland, Norway and Sweden. The coverage of meningiomas was not comprehensive in any of the data sources. The completeness of FCR was

  11. An often unrecognized cause of thunderclap headache : reversible cerebral vasoconstriction syndrome

    NARCIS (Netherlands)

    Koopman, K; Teune, L K; ter Laan, M; Uyttenboogaart, M; Vroomen, P C; De Keyser, J; Luijckx, G J

    2008-01-01

    Thunderclap headache (TCH) can have several causes of which subarachnoid hemorrhage (SAH) is most common and well known. A rare cause of TCH is the reversible cerebral vasoconstriction syndrome (RCVS) which is characterized by a reversible segmental vasoconstriction of the intracranial vessels. We

  12. Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave Technical aspects of intracranial pressure monitoring by subarachnoid method in severe head injury

    Directory of Open Access Journals (Sweden)

    Venâncio Pereira Dantas Filho

    2001-12-01

    Full Text Available Foram analisados prospectivamente 206 pacientes com traumatismo craniencefálico (TCE grave (8 pontos ou menos na Escala de Coma de Glasgow, internados na Unidade de Terapia Intensiva do Hospital das Clínicas da Universidade Estadual de Campinas. Após avaliação por tomografia computadorizada de crânio (TC, 72 pacientes necessitaram de tratamento neurocirúrgico. Todos os pacientes foram submetidos à monitorização contínua da pressão intracraniana (PIC pelo método subaracnóideo (11 com parafuso metálico e 195 com cateter plástico. Os níveis de PIC foram registrados continuamente na tela do monitor, sendo os seus valores de final de hora anotados em ficha padronizada. Todos os pacientes foram tratados segundo um protocolo orientado pelos níveis da PIC. Não foram observadas complicações hemorrágicas ou hematomas intracranianos relacionados ao método de monitorização em TC de controle. Para controle de infecções intracranianas, foram colhidas amostras de líquido cefalorraquidiano através de punção lateral C1-C2 em 66 pacientes com PIC abaixo de 20 mm Hg, sendo positivas as culturas para Acinetobacter sp em 2 pacientes. O resultado final na alta hospitalar mostrou 75 (36,40% óbitos e 131 (63,6% sobreviventes. Os níveis de PIC influenciaram significativamente o resultado final (pTwo hundred and six patients with severe head injury (Glasgow Coma Scale of 8 points or less after nonsurgical resuscitation on admission, managed at Intensive Care Unit-Hospital das Clínicas - Universidade Estadual de Campinas were prospectively analysed. All patients were assessed by CT scan and 72 required neurosurgical intervention. All patients were continuously monitored to evaluate intracranial pressure (ICP levels by a subarachnoid device (11 with subarachnoid metallic bolts and 195 with subarachnoid polyvinyl catheters. The ICP levels were continuously observed in the bedside pressure monitor display and their end-hour values were

  13. [Efficiency of high-volume hemofiltration in patients with severe sepsis and intracranial hypertension].

    Science.gov (United States)

    Musaeva, T S; Berdnikov, A P; Goncharenko, S I; Denisova, E A

    2014-01-01

    We performed a retrospective study in 68 patients (144 procedures) with severe sepsis and intracranial hypertension measured by the pressure in the central retinal vein. The patients underwent high-volume hemofiltration (HV-HF) for extrarenal indications. Increased pressure in the central retinal vein was accompanied by critical points of cerebral perfusion pressure and the growth of neurological deficit with inhibition level of consciousness to coma 1. In this case, IHV-HF may be associated with the formation of the critical points of cerebral perfihsion and severe disorders of microcirculation and the lack of resolution of tissue hypoperfusion. In case of intracranial hypertension IHV-HF is not effective in the category of patients where there is a combination ΔpCO2 > 5.9 mm Hg level and GCS <10 points.

  14. Changes in intracranial morphology, regional cerebral water content and vital physiological variables during epidural bleeding

    International Nuclear Information System (INIS)

    Ganz, J.C.; Inst. of Surgical Research, National Hospital, Oslo; Thuomas, K.AA.; Inst. of Surgical Research, National Hospital, Oslo; Vlajkovic, S.; Inst. of Surgical Research, National Hospital, Oslo; Nilsson, P.; Inst. of Surgical Research, National Hospital, Oslo; Bergstroem, K.; Inst. of Surgical Research, National Hospital, Oslo; Ponten, U.; Inst. of Surgical Research, National Hospital, Oslo; Zwetnow, N.N.; Inst. of Surgical Research, National Hospital, Oslo

    1993-01-01

    Epidural bleeding was produced in 8 anaesthetised and heparinised dogs by an artificial system. Changes in vital physiological variables were related to intracranial shifts and tissue water content assessed with MR imaging. Six animals survived while 2 succumbed. In the surviving animals intracranial shifts and compressions remained unchanged from an early stage. The cerebral perfusion pressure was reduced from between 80 and 110 mm Hg to between 40 and 60 mm Hg. Some increase in supratentorial white matter tissue water was observed. In the lethal experiments cerebral perfusion pressure fell to less than 40 mm Hg. Moreover, secondary delayed anatomical changes were seen including hydrocephalus. Increase in cerebral tissue water was more intense and widespread than in the survivors. These findings indicate that the outcome of epidural bleeding is related to cerebral perfusion pressure with secondary deterioration resulting from additional volume loading from increased tissue water and hydrocephalus. (orig.)

  15. Spaceflight-Induced Intracranial Hypertension and Visual Impairment: Pathophysiology and Countermeasures.

    Science.gov (United States)

    Zhang, Li-Fan; Hargens, Alan R

    2018-01-01

    Visual impairment intracranial pressure (VIIP) syndrome is considered an unexplained major risk for future long-duration spaceflight. NASA recently redefined this syndrome as Spaceflight-Associated Neuro-ocular Syndrome (SANS). Evidence thus reviewed supports that chronic, mildly elevated intracranial pressure (ICP) in space (as opposed to more variable ICP with posture and activity on Earth) is largely accounted for by loss of hydrostatic pressures and altered hemodynamics in the intracranial circulation and the cerebrospinal fluid system. In space, an elevated pressure gradient across the lamina cribrosa, caused by a chronic but mildly elevated ICP, likely elicits adaptations of multiple structures and fluid systems in the eye which manifest themselves as the VIIP syndrome. A chronic mismatch between ICP and intraocular pressure (IOP) in space may acclimate the optic nerve head, lamina cribrosa, and optic nerve subarachnoid space to a condition that is maladaptive to Earth, all contributing to the pathogenesis of space VIIP syndrome. Relevant findings help to evaluate whether artificial gravity is an appropriate countermeasure to prevent this seemingly adverse effect of long-duration spaceflight. Copyright © 2018 the American Physiological Society.

  16. Relationship between intracranial hypertension and cerebral blood flow after craniotomy in cases with traumatic acute subdural hematoma

    International Nuclear Information System (INIS)

    Karibe, Hiroshi; Onuma, Takehide; Kameyama, Motonobu; Nimura, Taro; Hirano, Takayuki; Kubota, Keiichi

    2008-01-01

    The purpose of this study is to investigate relationship between the duration of initial intracranial hypertension and postoperative cerebral blood flow (CBF) changes in cases with traumatic acute subdural hematoma (ASDH). Intracerebral pressure (ICP) was monitored using ICP catheter in 17 cases with unilateral traumatic ASDH. ICP monitoring was started before craniotomy, and was continued for 7 days. CBF was quantitatively measured at 7 days after craniotomy with 123 I-infetamine (IMP) single photon emission computed tomography (SPECT). Clinical outcome was evaluated using Glasgow Outcome Scale (GOS) at the time of discharge. Patients were divided into 2 groups by the duration of intracranial hypertension: patients who presented with intracranial hypertension (>25 mmHg) and received surgical decompression within 6 hours after deterioration (group A, n=9), and patients who presented with intracranial hypertension and received surgical decompression more than 6 hours after deterioration (group B, n=6). In group A, 7 of 9 patients demonstrated ipsilateral hemispheric hyperperfusion, and the clinical outcome was relatively favorable: Good Recovery (GR) 4 cases, Moderately Disabled (MD) 4 cases, and Severely Disabled (SD) 1 case. In group B, 5 of 6 patients demonstrated ipsilateral hemispheric hypoperfusion, and the clinical outcome was unfavorable: SD 4 cases, and Dead 2 cases. These results suggest that the duration of intracranial hypertension affects on postoperative CBF changes. Duration of intracranial hypertension may also affect on clinical outcome directly, or secondary by altering postoperative CBF changes in patients with traumatic ASDH. (author)

  17. Genetic study of intracranial aneurysms.

    Science.gov (United States)

    Yan, Junxia; Hitomi, Toshiaki; Takenaka, Katsunobu; Kato, Masayasu; Kobayashi, Hatasu; Okuda, Hiroko; Harada, Kouji H; Koizumi, Akio

    2015-03-01

    Rupture of intracranial aneurysms (IAs) causes subarachnoid hemorrhage, leading to immediate death or severe disability. Identification of the genetic factors involved is critical for disease prevention and treatment. We aimed to identify the susceptibility genes for IAs. Exome sequencing was performed in 12 families with histories of multiple cases of IA (number of cases per family ≥3), with a total of 42 cases. Various filtering strategies were used to select the candidate variants. Replicate association studies of several candidate variants were performed in probands of 24 additional IA families and 426 sporadic IA cases. Functional analysis for the mutations was conducted. After sequencing and filtering, 78 variants were selected for the following reasons: allele frequencies of variants in 42 patients was significantly (PIA within ≥1 family; variants predicted damage to the structure or function of the protein by PolyPhen-2 (Polymorphism Phenotyping V2) and SIFT (Sorting Intolerance From Tolerant). We selected 10 variants from 9 genes (GPR63, ADAMST15, MLL2, IL10RA, PAFAH2, THBD, IL11RA, FILIP1L, and ZNF222) to form 78 candidate variants by considering commonness in families, known disease genes, or ontology association with angiogenesis. Replicate association studies revealed that only p.E133Q in ADAMTS15 was aggregated in the familial IA cases (odds ratio, 5.96; 95% confidence interval, 2.40-14.82; P=0.0001; significant after the Bonferroni correction [P=0.05/78=0.0006]). Silencing ADAMTS15 and overexpression of ADAMTS15 p.E133Q accelerated endothelial cell migration, suggesting that ADAMTS15 may have antiangiogenic activity. ADAMTS15 is a candidate gene for IAs. © 2015 American Heart Association, Inc.

  18. Predictors of severe complications in intracranial meningioma surgery

    DEFF Research Database (Denmark)

    Bartek, Jiri; Sjåvik, Kristin; Förander, Petter

    2015-01-01

    OBJECTIVE: To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events. METHODS: A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma perfo...

  19. MATHEMATICAL MODEL FOR CALCULATION OF MINIMUM PRESSURE PERTAINING TO DESTRUCTION OF SURFACE CORROSION LAYER DUE TO IMPACT OF WORKING LIQUID REVERSIVE STREAM

    Directory of Open Access Journals (Sweden)

    I. V. Kachanov

    2014-01-01

    Full Text Available Due to balance of external and internal force capacities a variation quasistatic problem has been solved in the paper. The problem allows to determine optimum values of α and β angles in the accepted field of sliding lines when destruction pressure takes on a minimum value pmin. It has been ascertained that the minimum pressure pmin which is necessary for destruction of a corrosion layer is registered at stream compression coefficient λ = 0,063 and the pressure is equal to 8-17 MPa for the investigated speed range v = 80-140 m/s.

  20. Acute intracranial hematoma formation following excision of a cervical subdural tumor: a report of two cases and literature review.

    Science.gov (United States)

    Ma, Xuexiao; Zhang, Yan; Wang, Ting; Li, Guizhi; Zhang, Guoqing; Khan, Hassan; Xiang, Hongfei; Chen, Bohua

    2014-01-01

    An intracranial hematoma is a rare, yet significant, complication following spinal surgery. The authors describe two cases with acute intracranial hematoma formation after excision of a cervical subdural schwannoma. One was a 14-year-old girl who developed bilateral intracranial extradural hematomas immediately following excision of the C4 subdural schwannoma. The other was a 59-year-old woman who had an acute cerebellar hematoma after removal of the C2-C5 subdural schwannoma. During the surgeries of both cases, spinal dura was partially removed together with the tumor and the dural sac could not be repaired, resulting in large amounts of intraoperative CSF loss and persistent postoperative CSF leakage. Both patients failed to regain consciousness from anesthesia after surgery, and a cranial CT scan identified large intracranial hematomas. Urgent hematoma evacuation was ultimately performed to save the patients. Based on the authors' experience and literature review, a conclusion was drawn that considerable CSF leakage and a sharp decrease of CSF pressure are common features during the excision of a spinal subdural tumor, which may lead to acute intracranial hematomas. Continual postoperative monitoring in patients with this condition should be of a very high priority. A CT or MRI should be immediately investigated to exclude intracranial hematomas for any patient with delayed emergence from anesthesia following spinal surgery. Hematoma evacuation is indispensable once an intracranial hematoma is identified in the patient who fails to regain consciousness from anesthesia post surgery. Furthermore, the possible pathophysiological mechanisms responsible for the formation of an intracranial hematoma after spinal procedures, particularly after manipulations of a cervical subdural tumor, are discussed.

  1. Role of membrane technology to achieve ALARA concept in reprocessing plant: utilization of low pressure reverse osmosis for treatment of delay tank solutions

    International Nuclear Information System (INIS)

    Pabby, Anil K.; Sonawane, J.V.; Rathore, N.S.; Gupta, S.K.; Roy, S.C.; Venugopalan, A.K.; Chagrani, R.D.; Dey, P.K.; Prabhakar, S.; Tiwari, P.K.

    2004-01-01

    Reverse osmosis is a well-developed technology. The systems have been used in industrial settings for many years with applications to separation, concentration of product streams and waste water treatment. The technology has been used for removal of the radionuclides from low-level liquid wastes, such as waste streams at nuclear power plants. Because reverse osmosis rejects nearly all contaminants from a solution the high purity product water may be recycled within the power plant, or is usually of such low activity that it is suitable for discharge to the environment. This technology will help in achieving ALARA concept which will be beneficial for the environment. In the present study, the removal of alpha and beta activities from delay tank solution is planned

  2. Parapharyngeal meningioma extending from the intracranial space

    International Nuclear Information System (INIS)

    Uchibori, M.; Odake, G.; Ueda, S.; Yasuda, N.; Hisa, I.

    1990-01-01

    A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach, and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated. (orig.)

  3. CT and MR features of the intracranial Schwannomas

    International Nuclear Information System (INIS)

    Jung, So Lyung; Ro, Hee Jeong; Lee, Hong Jae; Jung, Seung Eun; Byun, Jae Young; Yang, Il Kwon; Lee, Han Jin; Choi, Kyu Ho; Kim, Jong Woo; Shinn, Kyung Sub

    1996-01-01

    To evaluate CT and MR findings of the intracranial schwannomas arising from variable cranial nerves. The authors retrospectively analyzed CT (n=21) and MR (n=15) findings of 24 cases in 23 patients (M : 7, F : 16) who had suffered from surgically-proven intracranial schwannomas over the previous five years. Schwannomas arose from the acoustic nerve(n=18), the trigeminal nerve(n=2), the glossopha-ryngeal-vagal-accessory nerve complex (n=2), and the olfactory nerve(n=1). Intracranial schwannomas were well defined, ,lobulated and inhomogeneously or homogeneously enhancing masses on CT and MR, and were located along the course of the specific cranial nerve. Acoustic schwannomas involved both the internal auditory canal(IAC) and the cerebellopontive angle(CPA) in 14 case, the IAC in three, and the SPA in two. Two trigeminal schwannomas involved both middle and posterior cranial fossa and were in the shape of a dumbbell. One of the two schwannomas that invelved lower cranial nerve complex(9-11th) was located in the medullary cistern and jugular foramen ; the other was located in the central posterior cranial fossa. A case of olfactory schwannoma was located in the right cribriform plate. The precontrast CT scan showed low density in 13 cases (62%), isodensity in seven(33%) and high density in one(5%). on postcontrast CT scan, enhancement was seen in 20 cases(95%). Of the 15 cases with MR, 2 had low signal intensity on T1 weighted image and 14 had high signal intensity on T2 weighted image. MR imaging after Gd-DTPA infusion showed enhancement in 14 cases. Enhancement was inhomogeneous in 14 cases on CT and in 13 on MR. Of 24 cases, intratumoral necrosis was seen in 19, ring enhancement in five and severe cystic change in one. Other findings were in tratumoral calcification (21%), hemorrhage(8%), pressure bony erosion(70.8%), midline shift(58%), peritumoral edema(29%) and hydrocephalus(33%). On MR, there was in all 15 cases a peritumoral low signal intensity rim on T1-and

  4. MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Andreas Pomschar

    Full Text Available To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI and age- and gender-matched controls.Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years. A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP.Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01 compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03. Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007. Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007.mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging.

  5. Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk

    Science.gov (United States)

    Fogarty, Jennifer A.; Polk, J. D.; Tarver, W.; Gibson, C. R.; Sargsyan, A.; Taddeo, T.; Alexander, D.; Otto, C.

    2010-01-01

    What is the risk? Given that astronauts exposed to microgravity experience a cephalad fluid shift, and that both symptomatic and asymptomatic astronauts have exhibited optic nerve sheath edema on MRI, there is a high probability that all astronauts have some degree of increased intracranial pressure (ICP; intracranial hypertension), and that those susceptible (via eye architecture, anatomy, narrow optic disc) have a high likelihood of developing papilledema (optic disc edema, globe flattening), choroidal folds, and/or hyperopic shifts and that the degree of edema may determine long-term or permanent vision impairment or loss. Back to back panels on this topic have been developed to address this emerging risk. The first panel will focus on the 6 clinical cases with emphasis on ophthalmic findings and imaging techniques used pre-, in-, and post-flight. The second panel will discuss the operational mitigation and medical requirements, the potential role of CO2 on ISS, and the research approach being developed. In total these back to back panels will explore what is known about this risk, what has been done immediately to address it, and how an integrated research model is being developed.

  6. Idiopathic intracranial hypertension, hormones, and 11ß-hydroxysteroid dehydrogenases

    Directory of Open Access Journals (Sweden)

    Markey KA

    2016-04-01

    Full Text Available Keira A Markey,1 Maria Uldall,2 Hannah Botfield,1 Liam D Cato,1 Mohammed A L Miah,1 Ghaniah Hassan-Smith,1 Rigmor H Jensen,2 Ana M Gonzalez,1 Alexandra J Sinclair1 1Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; 2Danish Headache Center, Clinic of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark Abstract: Idiopathic intracranial hypertension (IIH results in raised intracranial pressure (ICP leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provides an overview of pathogenic factors that could result in IIH with particular focus on hormones and the impact of obesity, including its role in neuroendocrine signaling and driving inflammation. Despite occurring almost exclusively in obese women, there have been a few studies evaluating the mechanisms by which hormones and adipokines exert their effects on ICP regulation in IIH. Research involving 11ß-hydroxysteroid dehydrogenase type 1, a modulator of glucocorticoids, suggests a potential role in IIH. Improved understanding of the complex interplay between adipose signaling factors such as adipokines, steroid hormones, and ICP regulation may be key to the understanding and future management of IIH. Keywords: 11beta-hydroxysteroid dehydrogenase type 1, steroid and adipokines, obesity, leptin

  7. A case of idiopathic intracranial hypertension associated with PCOS.

    Science.gov (United States)

    Lee, Y J; Jeong, J E; Joo, J K; Lee, K S

    2015-01-01

    Idiopathic intracranial hypertension (IIH) is a rare neurologic disorder. It is also known as pseudotumor cerebri. The incidence of IIH is one to two per 100,000 population annually. The higher incidence is in obese women from 15 to 44 years. The main symptoms are headache and visual loss. It mostly affects women of childbearing age who are overweight or obese. There are many theories of pathogenesis of IIH, but precise pathogenesis is unknown. One of the causes of IIH is intracranial venous sinus thrombosis. It can cause increased cerebrospinal fluid (CSF) pressure by obstruction of venous outflow and blocking of CSF absorption. In polycystic ovary syndrome (PCOS) patients, thrombogenic tendency is increased due to increased aromatization of testosterone to estradiol which could induce estrogen-mediated thrombophilia. The authors present a 14-year-old girl with PCOS stigma who presented with a severe headache and papilledema. These symptoms were not improved by standard medical therapy of IIH and PCOS, but improved after laparoscopic ovarian drilling. The authors report it with a review of the literature.

  8. Fast FLAIR MR images of intracranial hemorrhage

    International Nuclear Information System (INIS)

    Chun, Eun Ju; Choi, Hye Young; Cho, Young A; Kim, Wha Young

    1998-01-01

    The purpose of this study is to evaluate the signal characteristics of intracranial hemorrhage, as seen on fluid attenuated inversion recovery (FLAIR) MR imaging according to various stages, and to compare FLAIR imaging with spin-echo T1- and T2-weighted MR imaging. We retrospectively evaluated fast FLAIR images along with spin-echo T1- and T2 weighted MR images of 32 lesions in 25 patients (12 males and 14 females, aged 3 - 84 yrs) with intracranial hemorrhagic lesions. For imaging, 1.5 T unit was used, and the nature of the lesions was found to be as follows : intracranial hemorrhage (n=15); tumor (n=9); infarction (n=4); arteriovenous malformation (n=3); and arachnoid cyst with hemorrhage (n=1). On the basis of spin-echo MR imaging, lesions were classified as acute, early subacute, late subacute, early chronic, or late chronic stage. The signal characteristics of intracranial hemorrhage were analysed in accordance with each staging, as seen on MR FLAIR imaging, and compared to the staging seen on spin-echo T1- and T-2 weighted MR imaging. The signal intensity of intracranial hemorrhage, as seen on FLAIR imaging, was not characteristic; it was similar to that of T2WI during the acute and subacute stages, and similiar to that of T1WI during the chronic stage. When used together with spin-echo T1- and T2-weighted MR imaging, however, FLAIR imaging may be useful for the classification of chronic intracranial hemorrhage as either early or late stage. (author). 20 refs., 2 tabs., 6 figs

  9. Spontaneous intracranial hemorrhage and multiple intracranial aneurysms in a patient with Roberts/SC phocomelia syndrome.

    Science.gov (United States)

    Wang, Anthony C; Gemmete, Joseph J; Keegan, Catherine E; Witt, Cordelie E; Muraszko, Karin M; Than, Khoi D; Maher, Cormac O

    2011-11-01

    Roberts/SC phocomelia syndrome (RBS) is a rare but distinct genetic disorder with an autosomal recessive inheritance pattern. It has been associated with microcephaly, craniofacial malformation, cavernous hemangioma, encephalocele, and hydrocephalus. There are no previously reported cases of RBS with intracranial aneurysms. The authors report on a patient with a history of RBS who presented with a spontaneous posterior fossa hemorrhage. Multiple small intracranial aneurysms were noted on a preoperative CT angiogram. The patient underwent emergency craniotomy for evacuation of the hemorrhage. A postoperative angiogram confirmed the presence of multiple, distal small intracranial aneurysms.

  10. Development of intracranial hypertension after surgical management of intracranial arachnoid cyst: report of three cases and review of the literature.

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2013-11-12

    To describe three cases of delayed development of intracranial hypertension (IH) after surgical treatment of intracranial arachnoid cyst, including the pathogenesis of IH and a review of the literature.

  11. Intracranial meningiomas in the present era of modern neuroimaging

    African Journals Online (AJOL)

    Background: Intracranial meningioma is the most common primary, intracranial, extra-axial neoplasm. It is mesenchymal in origin and arises from meningothelial cells of arachnoid villi of meninges. Objectives: To re-emphasize the regional anatomic localisation and diagnostic radiological features of intracranial ...

  12. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

    2009-02-15

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  13. Primary intracranial leiomyoma in renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Upasana Patel

    2017-01-01

    Full Text Available Leiomyoma, the benign tumor of smooth muscle cell origin, is commonly seen in genitourinary and gastrointestinal tracts. Primary intracranial leiomyoma, however, is extremely rare occurrence. We hereby report a case of Epstein-Barr negative primary intracranial leiomyoma in a middle-aged renal transplant recipient, which mimicked left frontal parasagittal meningioma on neuroimaging. The tumor was completely excised and diagnosis of leiomyoma was clinched on pathological analysis with immunohistochemistry. The patient improved after tumor removal, and no evidence of tumor recurrence was noted on follow-up study after 10 months postsurgically.

  14. Intracranial osteosarcoma after radiosurgery. Case report

    International Nuclear Information System (INIS)

    Sanno, Naoko; Hayashi, Shinkichi; Shimura, Toshiro; Maeda, Shotaro; Teramoto, Akira

    2004-01-01

    A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm. (author)

  15. Increased intracranial volume in Parkinson's disease

    DEFF Research Database (Denmark)

    Krabbe, Katja; Karlsborg, Merete; Hansen, Andreas

    2005-01-01

    segmentation and outlining of regions in order to identify regional volume changes that might be useful in the diagnosis of the two diseases. RESULTS: Patients with PD had significantly larger intracranial volumes (ICVs) and significantly smaller putaminal and sustantia nigra volumes than controls. MSA...... patients had significantly smaller substantia nigra and caudate volumes than controls but normal intracranial volume. In both patient groups there was a further trend towards smaller amygdala volumes. DISCUSSION: Increased ICV in PD patients is a new finding that may be explained by genetic factors...

  16. Traumatic rupture of an intracranial dermoid cyst

    Directory of Open Access Journals (Sweden)

    Raksha Ramlakhan, BMedSc, MBBCh

    2015-01-01

    Full Text Available Intracranial dermoid cysts are congenital tumors of ectodermal origin. Rupture of these cysts can occur spontaneously, but rupture in association with trauma is reported infrequently. The diagnosis of rupture is made by the presence of lipid (cholesterol droplets in the subarachnoid spaces and ventricles. Nonenhanced CT of the head demonstrates multiple foci of low attenuation that correspond with hyperintense signal on T1-weighted MRI. We present a case of an adult patient with rupture of an intracranial dermoid cyst, precipitated by minor trauma.

  17. Dynamic, in vivo, real-time detection of retinal oxidative status in a model of elevated intraocular pressure using a novel, reversibly responsive, profluorescent nitroxide probe.

    Science.gov (United States)

    Rayner, Cassie L; Gole, Glen A; Bottle, Steven E; Barnett, Nigel L

    2014-12-01

    Changes to the redox status of biological systems have been implicated in the pathogenesis of a wide variety of disorders including cancer, Ischemia-reperfusion (I/R) injury and neurodegeneration. In times of metabolic stress e.g. ischaemia/reperfusion, reactive oxygen species (ROS) production overwhelms the intrinsic antioxidant capacity of the cell, damaging vital cellular components. The ability to quantify ROS changes in vivo, is therefore essential to understanding their biological role. Here we evaluate the suitability of a novel reversible profluorescent probe containing a redox-sensitive nitroxide moiety (methyl ester tetraethylrhodamine nitroxide, ME-TRN), as an in vivo, real-time reporter of retinal oxidative status. The reversible nature of the probe's response offers the unique advantage of being able to monitor redox changes in both oxidizing and reducing directions in real time. After intravitreal administration of the ME-TRN probe, we induced ROS production in rat retina using an established model of complete, acute retinal ischaemia followed by reperfusion. After restoration of blood flow, retinas were imaged using a Micron III rodent fundus fluorescence imaging system, to quantify the redox-response of the probe. Fluorescent intensity declined during the first 60 min of reperfusion. The ROS-induced change in probe fluorescence was ameliorated with the retinal antioxidant, lutein. Fluorescence intensity in non-Ischemia eyes did not change significantly. This new probe and imaging technology provide a reversible and real-time response to oxidative changes and may allow the in vivo testing of antioxidant therapies of potential benefit to a range of diseases linked to oxidative stress. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Reversal of severe SPECT asymmetry after venous extra-intracranial high flow bypass in a patient submitted to therapeutic internal carotid occlusion: case report Reversão de importante assimetria ao SPECT após bypass venoso de alto fluxo extra-intracraniano em paciente submetido a oclusão terapêutica da carótida interna: relato de caso

    Directory of Open Access Journals (Sweden)

    Jorge Marcondes

    2001-09-01

    Full Text Available Therapeutic occlusion of the internal carotid artery is the main option for the treatment of the symptomatic intracavernous internal carotid artery aneurysms, but the issue of the best way of doing the balloon test occlusion (BTO regarding prediction of future ischemic events remains debatable. Single photon emission computerized tomography (SPECT has been offered as one of the best option of monitoring regional cerebral blood flow (rCBF during the BTO, where severe asymmetry is predictive of delayed ischemia. We describe a case of important SPECT asymmetry during BTO clinically negative and its complete reversal with carotid occlusion after extra-intracranial bypass with high flow safenous vein bypass between the cervical carotid artery and the middle cerebral artery.Oclusão terapêutica carotídea ainda é a principal escolha para o tratamento dos aneurismas sintomáticos da artéria carótida interna ao nível do seio cavernoso.Existem controvérsias em relação à obtenção de testes com maior valor preditivo em relação à complicações isquêmicas futuras durante a realização do teste de oclusão carotídeo por balão. A tomografia computorizada de emissão de fóton único (SPECT tem sido defendida como uma opção para a melhor avaliação do fluxo sanguíneo regional cerebral, onde evidente assimetria é indicativa de isquemia tardia. Descrevemos um caso de importante assimetria ao SPECT durante o teste clinicamente negativo e sua reversão completa após anastomose extra-intracraniana com interposição de veia safena magna (alto fluxo entre a artéria carótida cervical e a artéria cerebral média.

  19. Giant serpentine intracranial aneurysm: a case report

    International Nuclear Information System (INIS)

    Park, Jae Seong; Lee, Myeong Sub; Kim, Myung Soon; Kim, Dong Jin; Park, Joong Wha; Whang, Kum

    2001-01-01

    The authors present a case of giant serpentine aneurysm (a partially thrombosed aneurysm containing tortuous vascular channels with a separate entrance and outflow pathway). Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms, distinct from saccular and fusiform varieties, and in this case, too, the clinical presentation and radiographic features of CT, MR imaging and angiography were distinct

  20. [Intracranial plasmocytomas: biology, diagnosis, and treatment].

    Science.gov (United States)

    Belov, A I; Gol'bin, D A

    2006-01-01

    Intracranial plasmocytomas are a rare abnormality in a neurosurgeon's practice. The plasmocytomas may originate from the skull bones or soft tissue intracranial structures; they may be solitary or occur as a manifestation of multiple myeloma, this type being typical of most intracranial plasmocytomas. Progression of solitary plasmocytoma to multiple myeloma is observed in a number of cases. Preoperative diagnosis involves computed tomography or magnetic resonance imaging; angiography is desirable. The final diagnosis of plasmocytoma is chiefly based on a morphological study. Special immunohistochemical studies yield very promising results; these are likely to be of high prognostic value. Intracranial plasmocytomas require a differential approach and a meticulous examination since the presence or absence of multiple myeloma radically affects prognosis. There are well-defined predictors; however, it is appropriate that craniobasal plasmocytomas show a worse prognosis than plasmocytomas of the skull vault and more commonly progress to multiple myeloma. Plasmocytomas respond to radiotherapy very well. The gold standard of treatment for plasmocytoma is its total removal and adjuvant radiation therapy; however, there is evidence for good results when it is partially removed and undergoes radiotherapy or after radical surgery without subsequent radiation. The role of chemotherapy has not been defined today.

  1. Genetics of intracranial aneurysms and related diseases

    NARCIS (Netherlands)

    van 't Hof, F.N.G.

    2017-01-01

    Intracranial aneurysms (IA) are dilatations of the vessel walls of cerebral arteries. Some can rupture and result in a subarachnoid hemorrhage (SAH), a severe subtype of stroke. This thesis is set out to elucidate the pathophysiology of IA from a genetic perspective. The main conclusions are: 1.

  2. Computed tomography in intracranial malignant lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Naruse, S; Odake, G; Fujimoto, M; Yamaki, T; Mizukawa, N [Kyoto Prefectural Univ. of Medicine (Japan)

    1978-09-01

    Malignant lymphoma of the central nervous system has been found more and more often in recent years, partly because of the increased use of radiation and such drugs as steroids and antibiotics. However, the definite diagnosis of this disease is difficult until histological verification has been done by operation or autopsy. Since the revolutionary development of computed tomography, however, several reports have been presented, on the computed tomography of malignant lymphoma of the thorax and abdomen. Nevertheless, only a few cases of intracranial malignant lymphoma have been reported. The purpose of this paper, using four patients, is to emphasize the value of computed tomography in the diagnosis of intracranial malignant lymphoma. The characteristic CT findings of intracranial malignant lymphoma may be summarized follows: (1) the tumors are demonstrated to be well-defined, nodular-shaped, and homogenous isodensity - or slightly high-density - lesions in plain scans, and the tumors homogenously increase in density upon contrast enhancement; (2) the disease always has multifocal intracranial lesions, which are shown simultaneously or one after another, and (3) perifocal edema is prominent around the tumors in the cerebral hemisphere.

  3. Virtual Reality Surgical Simulation: Implications for Resection of Intracranial Gliomas.

    Science.gov (United States)

    Dakson, Ayoub; Hong, Murray; Clarke, David B

    2018-01-01

    Surgical simulation has the potential to play important roles in surgical training and preoperative planning. The advent of virtual reality (VR) with tactile haptic feedback has revolutionized surgical simulation, creating a novel environment for residents to learn manual skills without compromising patient safety. This concept is particularly relevant in neurosurgical training where the acquired skill set demands performance of technically challenging tasks under pressure and where the consequences of error are significant. The evolution of VR simulation is discussed here within the context of neurosurgical training and its implications for resection of intracranial gliomas. VR holds the promise of providing a useful educational tool for neurosurgical residents to hone their surgical skills and for neurosurgeons to rehearse specific segments of the surgery prior to the actual operation. Also discussed are several important issues related to simulation and simulation-based training that will need to be addressed before widespread adoption of VR simulation as a useful technology. © 2018 S. Karger AG, Basel.

  4. Medulla Oblongata Hemorrhage and Reverse Takotsubo Cardiomyopathy.

    Science.gov (United States)

    Gobeske, Kevin T; Sarano, Maurice E; Fugate, Jennifer E; Wijdicks, Eelco F

    2017-12-19

    Acute brain injury with strong surges of adrenergic outflow has resulted in takotsubo cardiomyopathy, but there are surprisingly few reports of takotsubo cardiomyopathy after intracranial hemorrhage, and none have been described from hemorrhage within the brainstem. We describe a patient with reverse and reversible cardiomyopathy following a hemorrhage in the lateral medulla oblongata. While it is limited in size, the location of the hemorrhage caused acute systolic failure with left ventricular ejection fraction of 27% and vasopressor requirement for cardiogenic shock and pulmonary edema. There was full recovery after 7 days. Detailed case report. Hemorrhage into medulla oblongata pressor centers may result in acute, reversible, stress-induced cardiomyopathy, affirming the adrenergic origin of this condition.

  5. Effect of Leaf Water Potential on Internal Humidity and CO2 Dissolution: Reverse Transpiration and Improved Water Use Efficiency under Negative Pressure.

    Science.gov (United States)

    Vesala, Timo; Sevanto, Sanna; Grönholm, Tiia; Salmon, Yann; Nikinmaa, Eero; Hari, Pertti; Hölttä, Teemu

    2017-01-01

    The pull of water from the soil to the leaves causes water in the transpiration stream to be under negative pressure decreasing the water potential below zero. The osmotic concentration also contributes to the decrease in leaf water potential but with much lesser extent. Thus, the surface tension force is approximately balanced by a force induced by negative water potential resulting in concavely curved water-air interfaces in leaves. The lowered water potential causes a reduction in the equilibrium water vapor pressure in internal (sub-stomatal/intercellular) cavities in relation to that over water with the potential of zero, i.e., over the flat surface. The curved surface causes a reduction also in the equilibrium vapor pressure of dissolved CO 2 , thus enhancing its physical solubility to water. Although the water vapor reduction is acknowledged by plant physiologists its consequences for water vapor exchange at low water potential values have received very little attention. Consequences of the enhanced CO 2 solubility to a leaf water-carbon budget have not been considered at all before this study. We use theoretical calculations and modeling to show how the reduction in the vapor pressures affects transpiration and carbon assimilation rates. Our results indicate that the reduction in vapor pressures of water and CO 2 could enhance plant water use efficiency up to about 10% at a leaf water potential of -2 MPa, and much more when water potential decreases further. The low water potential allows for a direct stomatal water vapor uptake from the ambient air even at sub-100% relative humidity values. This alone could explain the observed rates of foliar water uptake by e.g., the coastal redwood in the fog belt region of coastal California provided the stomata are sufficiently open. The omission of the reduction in the water vapor pressure causes a bias in the estimates of the stomatal conductance and leaf internal CO 2 concentration based on leaf gas exchange

  6. Management of Raised Intracranial Pressure in Head Injury

    African Journals Online (AJOL)

    hand, has the advantages of ease of insenion, simplicity of management and ... Its disadvantages include the diffi- culty of .... than neurosurgeons. with simultaneous administration of antacids to .... ble CSF withdrawal by the ventricular route.

  7. Noninvasive Intracranial Pressure Monitoring Using Advanced Machine Learning Techniques

    Science.gov (United States)

    2013-11-01

    the ICP sequences with assistance of nurse records. Using a 5-minute-long moving window, we smoothed the continuous VS waveform by averaging... hemodynamics have common mechanisms between individuals, with some individual variation. This assumption would imply that two patients with similar

  8. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  9. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Caranci, F.; Briganti, F.; Cirillo, L.; Leonardi, M.; Muto, M.

    2013-01-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  10. NASA's Spaceflight Visual Impairment and Intracranial Hypertension Research Plan: An accelerated Research Collaboration

    Science.gov (United States)

    Otto, Christian; Fogarty, J.; Grounds, D.; Davis, J.

    2010-01-01

    To date six long duration astronauts have experienced in flight visual changes and post flight signs of optic disc edema, globe flattening, choroidal folds, hyperoptic shifts and or raised intracranial pressure. In some cases the changes were transient while in others they are persistent with varying degrees of visual impairment. Given that all astronauts exposed to microgravity experience a cephalad fluid shift, and that both symptomatic and asymptomatic patients have exhibited optic nerve sheath edema on MRI, there is a high probability that all astronauts develop in-flight idiopathic intracranial hypertension to some degree. Those who are susceptible, have an increased likelihood of developing treatment resistant papilledema resulting in visual impairment and possible long-term vision loss. Such an acquired disability would have a profound mission impact and would be detrimental to the long term health of the astronaut. The visual impairment and increased intracranial pressure phenomenon appears to have multiple contributing factors. Consequently, the working "physiological fault bush" with elevated intracranial pressure at its center, is divided into ocular effects, and CNS and other effects. Some of these variables have been documented and or measured through operational data gathering, while others are unknown, undocumented and or hypothetical. Both the complexity of the problem and the urgency to find a solution require that a unique, non-traditional research model be employed such as the Accelerated Research Collaboration(TM) (ARC) model that has been pioneered by the Myelin Repair Foundation. In the ARC model a single entity facilitates and manages all aspects of the basic, translational, and clinical research, providing expert oversight for both scientific and managerial efforts. The result is a comprehensive research plan executed by a multidisciplinary team and the elimination of stove-piped research. The ARC model emphasizes efficient and effective

  11. Computed tomographic findings of intracranial pyogenic abscess

    International Nuclear Information System (INIS)

    Kim, S. J.; Suh, J. H.; Park, C. Y.; Lee, K. C.; Chung, S. S.

    1982-01-01

    The early diagnosis and effective treatment of brain abscess pose a difficult clinical problem. With the advent of computed tomography, however, it appears that mortality due to intracranial abscess has significantly diminished. 54 cases of intracranial pyogenic abscess are presented. Etiologic factors and computed tomographic findings are analyzed and following result are obtained. 1. The common etiologic factors are otitis media, post operation, and head trauma, in order of frequency. 2. The most common initial computed tomographic findings of brain abscess is ring contrast enhancement with surrounding brain edema. 3. The most characteristic computed tomographic finding of ring contrast enhancement is smooth thin walled ring contrast enhancement. 4. Most of thick irregular ring contrast enhancement are abscess associated with cyanotic heart disease or poor operation. 5. The most common findings of epidural and subdural empyema is crescentic radiolucent area with thin wall contrast enhancement without surrounding brain edema in convexity of brain

  12. Intracranial neurenteric cyst traversing the brainstem

    Directory of Open Access Journals (Sweden)

    Jasmit Singh

    2015-01-01

    Full Text Available Neurenteric cysts (NECs, also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem.

  13. Intracranial Infections: Clinical and Imaging Characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, B.R.; Thurnher, M.M.; Malani, P.N.; Petrou, M.; Carets-Zumelzu, F.; Sundgren, P.C. [Dept. of Radiology, and Divisions of Infectious Diseases and G eriatric Medicine, Dept. of Internal Medicine, Univ. of Michigan Medical Center, Ann Arbor, MI (United States)

    2007-10-15

    The radiologist plays a crucial role in identifying and narrowing the differential diagnosis of intracranial infections. A thorough understanding of the intracranial compartment anatomy and characteristic imaging findings of specific pathogens, as well incorporation of the clinical information, is essential to establish correct diagnosis. Specific types of infections have certain propensities for different anatomical regions within the brain. In addition, the imaging findings must be placed in the context of the clinical setting, particularly in immunocompromised and human immunodeficiency virus (HIV)-positive patients. This paper describes and depicts infections within the different compartments of the brain. Pathology-proven infectious cases are presented in both immunocompetent and immunocompromised patients, with a discussion of the characteristic findings of each pathogen. Magnetic resonance spectroscopy (MRS) characteristics for several infections are also discussed.

  14. Prognostic factors in childhood intracranial neoplasms

    International Nuclear Information System (INIS)

    Ampil, F.L.

    1987-01-01

    Thirty-six cases of primary intracranial neoplasm in children (over 1 year but under 13 years of age) seen at the university medical center between 1951 and 1982 were reviewed because of concern as to the results and after-effects of applied therapy. The overall 5-year actuarial survival rate was 17 %. Several factors of possible prognostic relevance, such as patient's age, intracranial location of the tumor, application or nonapplication of therapy, single or multiple modes of therapy, and extent of surgery, were analyzed. Completeness of surgical removal of the tumor proved to be the only statistically significant factor that correlated with survival. There was only one recorded case of severe learning disability and abnormal neuropsychologic development among the 12 living patients. The influence of patient's age (and technical factors) at the time of irradiation in correlation with the child's subsequent posttreatment functional performance, as reported in the literature, is reviewed. (author)

  15. Intracranial hemorrhage of the mature newborn infant

    International Nuclear Information System (INIS)

    Takemine, Hisao

    1983-01-01

    Concerning four mature newborn infants with intracranial hemorrhage diagnosed by CT, the labour course, treatment, and prognoses were discussed. Of intracranial hemorrhage, 70.7% was small hemorrhage along the cerebellar tentorium and the falx cerebri, 12.2% subdural hemorrhage in the posterior cranial fossa, and 9.8% subdural hemorrhage in the fornex. Intraventricular or extradural hemorrhage was rarely found. The prognosis is determined by severeness of neurotic symptoms due to cerebral hypoxia. Subdural hemorrhage of the posterior cranial fossa resulted in cerebral palsy in one fifth of the cases, and in slight enlargement of the ventricle in three fifths. Subdural hematoma left porencephaly in one fourth of the patients, but the remaining recovered to normal. (Ueda, J.)

  16. Drug-to-antibody determination for an antibody-drug-conjugate utilizing cathepsin B digestion coupled with reversed-phase high-pressure liquid chromatography analysis.

    Science.gov (United States)

    Adamo, Michael; Sun, Guoyong; Qiu, Difei; Valente, Joseph; Lan, Wenkui; Song, Hangtian; Bolgar, Mark; Katiyar, Amit; Krishnamurthy, Girija

    2017-01-20

    Antibody drug conjugates or ADCs are currently being evaluated for their effectiveness as targeted chemotherapeutic agents across the pharmaceutical industry. Due to the complexity arising from the choice of antibody, drug and linker; analytical methods for release and stability testing are required to provide a detailed understanding of both the antibody and the drug during manufacturing and storage. The ADC analyzed in this work consists of a tubulysin drug analogue that is randomly conjugated to lysine residues in a human IgG1 antibody. The drug is attached to the lysine residue through a peptidic, hydrolytically stable, cathepsin B cleavable linker. The random lysine conjugation produces a heterogeneous mixture of conjugated species with a variable drug-to-antibody ratio (DAR), therefore, the average amount of drug attached to the antibody is a critical parameter that needs to be monitored. In this work we have developed a universal method for determining DAR in ADCs that employ a cathepsin B cleavable linker. The ADC is first cleaved at the hinge region and then mildly reduced prior to treatment with the cathepsin B enzyme to release the drug from the antibody fragments. This pre-treatment allows the cathepsin B enzyme unrestricted access to the cleavage sites and ensures optimal conditions for the cathepsin B to cleave all the drug from the ADC molecule. The cleaved drug is then separated from the protein components by reversed phase high performance liquid chromatography (RP-HPLC) and quantitated using UV absorbance. This method affords superior cleavage efficiency to other methods that only employ a cathepsin digestion step as confirmed by mass spectrometry analysis. This method was shown to be accurate and precise for the quantitation of the DAR for two different random lysine conjugated ADC molecules. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Computed tomographic findings of traumatic intracranial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seong Wook; Kim, Il Young; Lee, Byung Ho; Kim, Ki Jeoung; Yoon, Il Gyu [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1985-10-15

    Traumatic intracranial lesion has been one of the most frequent and serious problem in neurosurgical pathology. Computed tomography made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospital for 15 months from October 1983 to December 1984. We have reviewed the computed tomographic scans of 264 patients which showed traumatic intracranial lesion. The result were as follows: 1. Head trauma was the most frequent diagnosed disease using computed tomographic scans (57.8%) and among 264 cases the most frequent mode of injury was traffic accident (73.9%). 2. Skull fracture was accompanied in frequency of 69.7% and it was detected in CT in 38.6%: depression fracture was more easily detected in 81%. 3. Conutercoup lesion (9.5%) was usually accompanied with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling (24.6%), subdural hematoma (22.3%), epidural hematoma (20.8%), intracerebral hematoma (6.1%), and subarachnoid hemorrhage (3.0%). 5. The shape of hematoma was usually biconvex (92.7%) in acute epidural hematoma and cresentic (100%) in acute subdural hematoma, but the most chronic the case became, they showed planoconvex and bicconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin level as single factor.

  18. Natural history of intracranial meningioma after radiotherapy

    International Nuclear Information System (INIS)

    Monzen, Yoshio

    1999-01-01

    The author examined the natural history of intracranial meningioma after radiotherapy using CT or MR imaging. Twenty patients with intracranial meningioma received radiotherapy from a high-energy linear accelerator (4-10 MV X rays) from 1980 to 1996. The total doses were 50 Gy to the tumor bed in single doses of 2 Gy in 5 weekly fractions. Meningiomas in 10 of 20 patients were reduced within 1 to 38 months after radiotherapy, the average being 11 months. The tumors were controlled for a median of 60 months after radiotherapy (range 19-126 months). Four other patients have shown no change in tumor size after radiotherapy. The tumors were controlled for a median of 70 months after radiotherapy (range 37-127 months). The other six patients have shown tumor growth within 3 to 25 months after radiotherapy, after which the tumors stopped growing for a median of 71 months (range 2-181 months). Neither tumor size nor histological type was related to response. The growth of tumors was controlled by radiotherapy for a median duration of 43 months in the meningothelial type, 52 months in the fibroblastic type, and 61 months in the transitional type. The median duration for all benign tumors was 52 months. A moderate correlation was noted between tumor response and functional outcome after radiotherapy in 9 patients with neurological deficits. The natural histories of intracranial meningiomas after radiotherapy were grouped into three categories. Some tumors showed no change in size over a long period. This was a characteristic response after radiotherapy that differed from that of other brain tumors. The results of this study provide important information for the follow-up of intracranial meningiomas after radiotherapy. (author)

  19. Computed tomographic findings of traumatic intracranial lesions

    International Nuclear Information System (INIS)

    Jeong, Seong Wook; Kim, Il Young; Lee, Byung Ho; Kim, Ki Jeoung; Yoon, Il Gyu

    1985-01-01

    Traumatic intracranial lesion has been one of the most frequent and serious problem in neurosurgical pathology. Computed tomography made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospital for 15 months from October 1983 to December 1984. We have reviewed the computed tomographic scans of 264 patients which showed traumatic intracranial lesion. The result were as follows: 1. Head trauma was the most frequent diagnosed disease using computed tomographic scans (57.8%) and among 264 cases the most frequent mode of injury was traffic accident (73.9%). 2. Skull fracture was accompanied in frequency of 69.7% and it was detected in CT in 38.6%: depression fracture was more easily detected in 81%. 3. Conutercoup lesion (9.5%) was usually accompanied with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling (24.6%), subdural hematoma (22.3%), epidural hematoma (20.8%), intracerebral hematoma (6.1%), and subarachnoid hemorrhage (3.0%). 5. The shape of hematoma was usually biconvex (92.7%) in acute epidural hematoma and cresentic (100%) in acute subdural hematoma, but the most chronic the case became, they showed planoconvex and bicconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin level as single factor

  20. A Case of Rivaroxaban Associated Intracranial Hemorrhage

    Directory of Open Access Journals (Sweden)

    Jean Chin-Yu Lo

    2014-07-01

    Full Text Available Rivaroxaban is a newer anticoagulant initially approved by the Food and Drug Administration to treat nonvalvular atrial fibrillation. Rivaroxaban has several characteristics that are more favorable than warfarin. One of the characteristics is decreased risk of hemorrhage. We report one of the first case reports of severe intracranial hemorrhage associated with rivaroxaban in an elderly patient with decreased renal function. We aim to alert emergency medicine providers regarding the likelihood of encountering these patient as newer anticoagulants rise in popularity.

  1. Computed tomography in intracranial hemorrhage in leukemia

    International Nuclear Information System (INIS)

    Hanyu, Haruo; Katsunuma, Hideyo; Yoshimura, Masahiro; Tomonaga, Masanori.

    1984-01-01

    In tracranial hemorrhage in leukemia was clinicopathologically studied in 62 cases of autopsy materials, with special attention paid to a morphological comparison of CT images with pathological findings. Intracranial hemorrhage was found in 32 of the 62 leukemic patients (51.6%), and in 13 of these patients (21.0%) it was responsible for death. Leukemic intracranial hemorrhage occurred more often in the acute leukemic type than in the chronic type, and even more often in younger leukemic patinents; it was pathologically characterized by multiple lesions in the white matter of the cerebral hemisphere, prone to combination with SAH or SDH. The hemorrhages could be divided into five types: (1) scattered small hemorrhagic type, (2) hematoma type, (3) fusion type (large hemorrhage composed of assembled small hemorrhages), (4) SAH type, and (5) SDH type. Among these types, the fusion type was considered to be characteristic of leukemia. CT was undertaken in 5 pathologically proven cases, with findings of the scattered small hemorrhagic type in 1, of the SDH type in 3, and of the fusion type in 1. Yet, one case with scattered small hemorrhages and two cases with SDH failed to be detected by CT. However, one case with a typical fusion hemorrhage was found to have multiple, irregular, high-density areas with surrounding edema and a mass effect as well as pathological findings. Therefore, a large-fusion hemorrhage, which is one of the most characteristic types of leukemic intracranial hemorrhage, could be demonstrated as distinctive CT images which reflected neuropathological findings. On the other hand, small parenchymal hemorrhages and relatively thin subdural hemorrhages could not be detected by CT. In conclusion, it seems that CT has value in the diagnosis of intracranial hemorrhage in leukemia. (J.P.N.)

  2. Intracranial phosphaturic mesenchymal tumor, mixed connective tissue variant presenting without oncogenic osteomalacia.

    Science.gov (United States)

    Bower, Regina S; Daugherty, Wilson P; Giannini, Caterina; Parney, Ian F

    2012-01-01

    Phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT) is a rare tumor typically occurring in soft tissues and bone, causing oncogenic (tumor-induced) osteomalacia (TIO) through secretion of the phosphaturic hormone, fibroblast growth factor-23 (FGF-23). Rare tumors identical to PMTMCT occur without known TIO. Intracranial localization of PMTMCT is extremely rare, with only two cases reported in the literature. We present a very unusual case of a patient with an intracranial PMTMCT that presented with neurologic changes without osteomalacia. A 67-year-old woman presented with progressive incontinence, apathy, and abulia after having undergone a total knee replacement 1 month earlier. Imaging disclosed a large left frontal anterior fossa mass. She underwent uncomplicated surgical resection of this tumor. Surprisingly, histopathology suggested PMTMCT. Reverse transcription polymerase chain reaction (RT-PCR) assay demonstrating FGF-23 expression in the tumor confirmed the diagnosis. Serum FGF-23 levels postoperatively were normal and she had no clinical or laboratory evidence of osteomalacia or phosphaturia. This report should serve to alert clinicians to the possibility that PMTMCT can be included in the differential diagnosis of intracranial masses even in the absence of tumor-induced osteomalacia.

  3. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  4. The Technique of Endovascular Intracranial Revascularization

    Directory of Open Access Journals (Sweden)

    John J. Connors

    2014-11-01

    Full Text Available Intracranial atherosclerosis was traditionally believed to carry a risk of stroke of 8% to 22% per annum. The annualized stroke rate in the recent Stenting and Aggressive Medical Management for Preventing Stroke in Intracranial Stenosis trial medical management arm was 12.2%. This trial was halted due to excessive periprocedural events in the stent arm. This stroke rate Is still Unacceptably high and a treatment strategy is still needed. SAMMPRIS has no bearing on angioplasty alone. Angioplasty alone has always been our primary intervention for intracranial atherosclerosis and remains so to this day due to its relative simplicity, low complication rate, and efficacy. We have, however, made adjustments to our patient management regimen based on the results of SAMMPRIS. This paper outlines our current patient selection, procedural technique, and post-procedure management. The complications we have encountered while developing our technique are described along with how to avoid them and how to manage them. Our most recent results (since previous publications are also discussed.

  5. Brain MRI findings of spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Kyu; Byun, Woo Mok; Cho, Jae Ho; Cho Kil Ho; Hwang, Mi Soo; Park, Bok Hwan [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of); Joo, Yang Gu [Keimyoung Univ. College of Medicine, Taegu (Korea, Republic of); Lee, Sang Jin [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    To evaluate brain MRI findings of spontaneous intracranial hypotension. A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension; no patient had a history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radio-nuclide cisternography(n=3D5), myelography(n=3D1), and MR myelography(n=3D1) were performed. On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of the cerebellar tonsil in two, downward displacement of the iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of the dura mater accompanied by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.=20.

  6. Abciximab for thrombolysis during intracranial aneurysm coiling

    International Nuclear Information System (INIS)

    Gralla, Jan; Rennie, Adam T.M.; Corkill, Rufus A.; Lalloo, Shivendra T.; Molyneux, Andrew; Byrne, James V.; Kuker, Wilhem

    2008-01-01

    Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, ±12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke. (orig.)

  7. CT and MRI diagnosis of intracranial chondroma

    International Nuclear Information System (INIS)

    Liu Xuejun; Sui Qinglan

    2006-01-01

    Objective: To summarize and study the features of intracranial chondroma on CT and MRI imaging. Methods: CT and MRI findings of ten cases of intracranial chondroma proved by surgery and pathology from 1994. 1 to 2004.9 were retrospectively analyzed. Results: Among 10 cases, 4 cases were located at the skull base, 4 cases at convexity, 1 case at the region of falx cerebri, and 1 case within the brain parenchyma. CT scans showed obvious calcification and clear border of the tumors in 10 cases, mixed attenuation in 9 eases, and adjacent bone invasion in 5 cases. 4 cases of MRI scans showed hypointense signal on T 1 and T 2 -weighted images in calcified element of the tumor, intermediate to hypointense signal intensity on T 1 -weighted image, and hyperintense signal intensity on T 2 -weighted image in parenchyma of the tumor. 4 cases of CT scans showed slightly enhancement. Conclusion: Intracranial chondroma are often originated from synchondrosis of the skull base, convexity of brain and region of falx cerebri. Obvious calcification may be seen in most cases. Slightly enhancement and marked delayed contrast enhancement were characteristic. The accurate diagnosis still depends on pathology. (authors)

  8. Eleven cases of neonatal intracranial hemorrhage

    International Nuclear Information System (INIS)

    Matsuda, Tadashi; Asao, Toyohiko; Shibata, Takeo

    1981-01-01

    Eleven cases of neonatal intracranial hemorrhage were diagnosed and followed up by CT scanning. By CT, hemorrhagic lesions were shown as high density areas in an acute stage and imaged as low density areas after the hemorrhage was absorbed. The time of absorption varies depending upon the site and the severity of hemorrhage. Intraventricular hemorrhage, petechial hemorrhage and subdural hematoma were absorbed rapidly in more than 70% of the exanimed cases, CT scanning 1 - 2 weeks after the onset revealed absorption of hemorrhage. However, the absorption delayed in intracerebral hematoma; CT scan taken after one month showed hemorrhagic lesions remaining in 75% of the cases. In nine cases who survived, following the absorption of the hemorrhagic lesions, cerebral atrophy was observed in 4 cases (44%), ventricular enlargement in 3 cases (33%), and complete recovery in 2 cases (22%). From these results, CT scanning for diagnosis of neonatal intracranial hemorrhage should be done before the hemorrhagic lesion is absorbed (within 7 days of the onset). Follow-up study by CT is important for observing changes and predicting prognosis of intracranial hemorrhage. (Ueda, J.)

  9. Primary brain tumor presenting as intracranial hemorrhage

    International Nuclear Information System (INIS)

    Tsunoda, Shigeru; Sakaki, Toshisuke; Miyamoto, Seiji; Kyoi, Kikuo; Utsumi, Shozaburo; Kamada, Kitaro; Inui, Shoji; Masuda, Akio.

    1989-01-01

    Ten cases of primary brain tumor presenting as intracranial hemorrhage were studied in terms of the radiological and histological findings. The cases having hemorrhage in the tumor, as established through CT or histologically, were excluded if their onsets were not sudden due to intracranial hemorrhages. The results obtained may be summarized as follows: 1) From an anatomical point of view, cerebral subcortical hemorrhages account for 80%; hemorrhages in the cerebellopontine angle, 10%, and hemorrhages in the basal ganglia, 10%. 2) Plain CT findings showed perifocal low-density areas within 24 hours after onset in all 10 cases. 3) Enhanced CT findings showed enhanced areas in 4 or 6 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 5) From a histological point of view, glioblastomas account for 30%; malignant astrocytomas, 20%; astrocytomas, 20%; malignant ependymomas, 10%; hemangioblastoma, 10%, and transitional meningiomas, 10%. In conclusion, a perifocal low-density area on CT within 24 hours after onset is the most meaningful indication of intracranial hemorrhage originating from a brain tumor. A histological 'perinuclear halo' in an astrocytoma as an artifact due to hemorrhage may often be misleading in diagnosing mixed oligo-astrocytomas. (author)

  10. Posterior Reversible Encephalopathy (PRES)

    International Nuclear Information System (INIS)

    Moron E, Fanny E; Diaz Marchan, Pedro

    2005-01-01

    The Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical Syndrome composed of cephalea, alteration in vision and convulsions, usually observed in patients with sudden elevation of arterial pressure. The imagenologic evidence shows reversible vasogenic brain edema without stroke. Its location is predominantly posterior; it affects the cortex and the subcortical white matter of the occipital, parietal and temporal lobes. The treatment with antihypertensive drugs and the removing of immunosupressor medication are generally associated with complete neurological recovery; this is reflected also in the images which return to their basal condition. The untreated hypertension, on the other side, can result in a progressive defect of the autoregulation system of the central nervous system with cerebral hemorrhage, irreversible brain stroke, coma and death

  11. Non-Invasive Electromagnetic Skin Patch Sensor to Measure Intracranial Fluid–Volume Shifts

    Directory of Open Access Journals (Sweden)

    Jacob Griffith

    2018-03-01

    Full Text Available Elevated intracranial fluid volume can drive intracranial pressure increases, which can potentially result in numerous neurological complications or death. This study’s focus was to develop a passive skin patch sensor for the head that would non-invasively measure cranial fluid volume shifts. The sensor consists of a single baseline component configured into a rectangular planar spiral with a self-resonant frequency response when impinged upon by external radio frequency sweeps. Fluid volume changes (10 mL increments were detected through cranial bone using the sensor on a dry human skull model. Preliminary human tests utilized two sensors to determine feasibility of detecting fluid volume shifts in the complex environment of the human body. The correlation between fluid volume changes and shifts in the first resonance frequency using the dry human skull was classified as a second order polynomial with R2 = 0.97. During preliminary and secondary human tests, a ≈24 MHz and an average of ≈45.07 MHz shifts in the principal resonant frequency were measured respectively, corresponding to the induced cephalad bio-fluid shifts. This electromagnetic resonant sensor may provide a non-invasive method to monitor shifts in fluid volume and assist with medical scenarios including stroke, cerebral hemorrhage, concussion, or monitoring intracranial pressure.

  12. Reverse Osmosis

    Indian Academy of Sciences (India)

    Osmosis is a phenomenon which regulates many biological functions in plants and animals. That the plants stand upright, or the water reaches the tip of every leaf of a plant is due to osmotic pressure. The fact that we cannot survive by drinking seawater is also linked to this same phenomenon. J H van 't. Hoff showed in ...

  13. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury

    DEFF Research Database (Denmark)

    Cnossen, Maryse C; Huijben, Jilske A; van der Jagt, Mathieu

    2017-01-01

    BACKGROUND: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management......, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. RESULTS: The survey was completed by 66 centers (97% response rate). Centers were mainly academic....... There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas...

  14. Vascular endothelial growth factor A protein level and gene expression in intracranial meningiomas with brain edema

    DEFF Research Database (Denmark)

    Nassehi, Damoun; Dyrbye, Henrik; Andresen, Morten

    2011-01-01

    Meningiomas are the second most common primary intracranial tumors in adults. Although meningiomas are mostly benign, more than 50% of patients with meningioma develop peritumoral brain edema (PTBE), which may be fatal because of increased intracranial pressure. Vascular endothelial growth factor....... Forty-three patients had primary, solitary, supratentorial meningiomas with PTBE. In these, correlations in PTBE, edema index, VEGF-A protein, VEGF gene expression, capillary length, and tumor water content were investigated. DNA-branched hybridization was used for measuring VEGF gene expression...... in tissue homogenates prepared from frozen tissue samples. The method for VEGF-A analysis resembled an ELISA assay, but was based on chemiluminescence. The edema index was positively correlated to VEGF-A protein (p = 0.014) and VEGF gene expression (p

  15. Intravenous digital subtraction angiography investigation of reversible cerebral ischemia

    International Nuclear Information System (INIS)

    Pistolesi, G.F.; Maso, R.; Filosto, L.; Piovan, E.; Morgante, D.; Taddei, G.; Tonegutti, M.; Portuese, A.

    1986-01-01

    The brachio-cephalic, carotid, vertebral and intra-cranial vessels of 497 patients presenting reversible ischemic attacks (R.I.A) were evaluated with venous digital subtraction angiography (V.D.S.A.). Alterations of the vascular wall were observed in 289/497 (58.2%) patients, of whom 60% presented multiple locations (539 lesions): obstruction (12%), stenosis >50% (29%), stenosis 50%. The incidence of vascular lesions was higher (p [fr

  16. Tratamento da hipertensão intracraniana Treatment of intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Katia M. Giugno

    2003-08-01

    Full Text Available OBJETIVO: revisar a abordagem terapêutica atual nos pacientes pediátricos com hipertensão intracraniana, internados em unidade de terapia intensiva. FONTE DE DADOS: revisão bibliográfica sobre o tema, utilizando como base de dados o Medline. SÍNTESE DOS DADOS: a partir da literatura levantada pode-se observar a existência de medidas de monitorização e tratamento da hipertensão intracraniana aceitas como consenso pelos diferentes autores, assim como abordagens que ainda motivam controvérsias. CONCLUSÕES: os objetivos no manejo do paciente pediátrico com hipertensão intracraniana incluem a normalização da pressão intracraniana, a otimização do fluxo sangüíneo cerebral e pressão de perfusão cerebral, prevenindo o segundo insulto que exacerba a lesão secundária, evitando as complicações associadas com as várias modalidades de tratamento empregadas.OBJECTIVE: to review the current therapeutic approach of intracranial hypertension in pediatric patients admitted to intensive care unit. SOURCES OF DATA: bibliographic review of the subject based on Medline. SUMMARY OF THE FINDINGS: the authors noticed that some measures to control intracranial hypertension are consensual, and others remain controversial. CONCLUSIONS: the goals of management of pediatric patients with intracranial hypertension include: normalizing the intracranial pressure, optimizing cerebral blood flow and cerebral perfusion pressure, preventing second insults that exacerbate secondary injury, and avoiding complications associated with the various treatment modalities employed.

  17. Supercritical fluid reverse micelle separation

    Science.gov (United States)

    Fulton, J.L.; Smith, R.D.

    1993-11-30

    A method of separating solute material from a polar fluid in a first polar fluid phase is provided. The method comprises combining a polar fluid, a second fluid that is a gas at standard temperature and pressure and has a critical density, and a surfactant. The solute material is dissolved in the polar fluid to define the first polar fluid phase. The combined polar and second fluids, surfactant, and solute material dissolved in the polar fluid is maintained under near critical or supercritical temperature and pressure conditions such that the density of the second fluid exceeds the critical density thereof. In this way, a reverse micelle system defining a reverse micelle solvent is formed which comprises a continuous phase in the second fluid and a plurality of reverse micelles dispersed in the continuous phase. The solute material is dissolved in the polar fluid and is in chemical equilibrium with the reverse micelles. The first polar fluid phase and the continuous phase are immiscible. The reverse micelles each comprise a dynamic aggregate of surfactant molecules surrounding a core of the polar fluid. The reverse micelle solvent has a polar fluid-to-surfactant molar ratio W, which can vary over a range having a maximum ratio W[sub o] that determines the maximum size of the reverse micelles. The maximum ratio W[sub o] of the reverse micelle solvent is then varied, and the solute material from the first polar fluid phase is transported into the reverse micelles in the continuous phase at an extraction efficiency determined by the critical or supercritical conditions. 27 figures.

  18. Reversible Statistics

    DEFF Research Database (Denmark)

    Tryggestad, Kjell

    2004-01-01

    The study aims is to describe how the inclusion and exclusion of materials and calculative devices construct the boundaries and distinctions between statistical facts and artifacts in economics. My methodological approach is inspired by John Graunt's (1667) Political arithmetic and more recent work...... within constructivism and the field of Science and Technology Studies (STS). The result of this approach is here termed reversible statistics, reconstructing the findings of a statistical study within economics in three different ways. It is argued that all three accounts are quite normal, albeit...... in different ways. The presence and absence of diverse materials, both natural and political, is what distinguishes them from each other. Arguments are presented for a more symmetric relation between the scientific statistical text and the reader. I will argue that a more symmetric relation can be achieved...

  19. Phase-contrast MR angiography of intracranial dural arteriovenous fistulae

    International Nuclear Information System (INIS)

    Cellerini, M.; Mascalchi, M.; Mangiafico, S.; Ferrito, G.P.; Scardigli, V.; Pellicano, G.; Quilici, N.

    1999-01-01

    MRI and phase-contrast MR angiography (PC MRA) were obtained in 13 patients with angiographically confirmed intracranial dural arteriovenous fistulae (DAVF). Three- and two-dimensional PC MRA was obtained with low (6-20 cm/s) and high (>40 cm/s) velocity encoding along the three main body axes. MRI showed focal or diffuse signal abnormalities in the brain parenchyma in six patients, dilated cortical veins in seven, venous pouches in four with type IV DAVF and enlargement of the superior ophthalmic vein in three patients with DAVF of the cavernous sinus. However, it showed none of the fistula sites and did not allow reliable identification of feeding arteries. 3D PC MRA enabled identification of the fistula and enlarged feeding arteries in six cases each. Stenosis or occlusion of the dural sinuses was detected in six of eight cases on 3D PC MRA with low velocity encoding. In six patients with type II DAVF phase reconstruction of 2D PC MRA demonstrated flow reversal in the dural sinuses or superior ophthalmic vein. (orig.)

  20. Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH

    Directory of Open Access Journals (Sweden)

    Ruben H Willemsen

    2016-11-01

    Full Text Available An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118–120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes.

  1. Distinction of synthetic dl-α-tocopherol from natural vitamin E (d-α-tocopherol) by reversed-phase liquid chromatography. Enhanced selectivity of a polymeric C18 stationary phase at low temperature and/or at high pressure.

    Science.gov (United States)

    Yui, Yuko; Miyazaki, Shota; Ma, Yan; Ohira, Masayoshi; Fiehn, Oliver; Ikegami, Tohru; McCalley, David V; Tanaka, Nobuo

    2016-06-10

    Separation of diastereomers of dl-α-tocopherol was studied by reversed-phase liquid chromatography using three types of stationary phases, polymeric ODS, polymeric C30, and monomeric ODS. Polymeric ODS stationary phase (Inertsil ODS-P, 3mmID, 20cm) was effective for the separation of the isomers created by the presence of three chiral centers on the alkyl chain of synthetic dl-α-tocopherol. Considerable improvement of the separation of isomers was observed on ODS-P phase at high pressure and at low temperature. Complete separation of four pairs of diastereomers was achieved at 12.0°C, 536bar, while three peaks were observed when the separation was carried out either at 12.0°C at low pressure or at 20°C at 488bar. Higher temperature (30.0°C) with the ODS-P phase resulted in only partial separation of the diastereomers even at high pressure. Only slight resolution was observed for the mixture of diastereomers with the C30 stationary phase (Inertsil C30) at 12.0°C and 441bar, although the stationary phase afforded greater resolution for β- and γ-tocopherol than ODS-P. A monomeric C18 stationary phase did not show any separation at 12.0°C and 463bar. The results suggest that the binding site of the polymeric ODS-P phase is selective for flexible alkyl chains that provided the longest retention for the natural form, (R,R,R) form, and the enantiomer, (S,S,S) form, of dl-α-tocopherol. Copyright © 2016. Published by Elsevier B.V.

  2. New Insights on Different Response of MDMA-Elicited Serotonin Syndrome to Systemic and Intracranial Administrations in the Rat Brain.

    Science.gov (United States)

    Shokry, Ibrahim M; Callanan, John J; Sousa, John; Tao, Rui

    2016-01-01

    In spite of the fact that systemic administration of MDMA elicits serotonin syndrome, direct intracranial administration fails to reproduce the effect. To reconcile these findings, it has been suggested that the cause of serotonin syndrome is attributed mainly to MDMA hepatic metabolites, and less likely to MDMA itself. Recently, however, this explanation has been challenged, and alternative hypotheses need to be explored. Here, we tested the hypothesis that serotonin syndrome is the result of excessive 5HT simultaneously in many brain areas, while MDMA administered intracranially fails to cause serotonin syndrome because it produces only a localized effect at the delivery site and not to other parts of the brain. This hypothesis was examined using adult male Sprague Dawley rats by comparing 5HT responses in the right and left hemispheric frontal cortices, right and left hemispheric diencephalons, and medullar raphe nucleus. Occurrence of serotonin syndrome was confirmed by measuring change in body temperature. Administration routes included intraperitoneal (IP), intracerebroventricular (ICV) and reverse microdialysis. First, we found that IP administration caused excessive 5HT in all five sites investigated and induced hypothermia, suggesting the development of the serotonin syndrome. In contrast, ICV and reverse microdialysis caused excessive 5HT only in regions of delivery sites without changes in body-core temperature, suggesting the absence of the syndrome. Next, chemical dyes were used to trace differences in distribution and diffusion patterns between administration routes. After systemic administration, the dyes were found to be evenly distributed in the brain. However, the dyes administered through ICV or reverse microdialysis injection still remained in the delivery sites, poorly diffusing to the brain. In conclusion, intracranial MDMA administration in one area has no or little effect on other areas, which must be considered a plausible reason for the

  3. New Insights on Different Response of MDMA-Elicited Serotonin Syndrome to Systemic and Intracranial Administrations in the Rat Brain.

    Directory of Open Access Journals (Sweden)

    Ibrahim M Shokry

    Full Text Available In spite of the fact that systemic administration of MDMA elicits serotonin syndrome, direct intracranial administration fails to reproduce the effect. To reconcile these findings, it has been suggested that the cause of serotonin syndrome is attributed mainly to MDMA hepatic metabolites, and less likely to MDMA itself. Recently, however, this explanation has been challenged, and alternative hypotheses need to be explored. Here, we tested the hypothesis that serotonin syndrome is the result of excessive 5HT simultaneously in many brain areas, while MDMA administered intracranially fails to cause serotonin syndrome because it produces only a localized effect at the delivery site and not to other parts of the brain. This hypothesis was examined using adult male Sprague Dawley rats by comparing 5HT responses in the right and left hemispheric frontal cortices, right and left hemispheric diencephalons, and medullar raphe nucleus. Occurrence of serotonin syndrome was confirmed by measuring change in body temperature. Administration routes included intraperitoneal (IP, intracerebroventricular (ICV and reverse microdialysis. First, we found that IP administration caused excessive 5HT in all five sites investigated and induced hypothermia, suggesting the development of the serotonin syndrome. In contrast, ICV and reverse microdialysis caused excessive 5HT only in regions of delivery sites without changes in body-core temperature, suggesting the absence of the syndrome. Next, chemical dyes were used to trace differences in distribution and diffusion patterns between administration routes. After systemic administration, the dyes were found to be evenly distributed in the brain. However, the dyes administered through ICV or reverse microdialysis injection still remained in the delivery sites, poorly diffusing to the brain. In conclusion, intracranial MDMA administration in one area has no or little effect on other areas, which must be considered a plausible

  4. Cerebral blood flow autoregulation during intracranial hypertension in hypoxic lambs

    International Nuclear Information System (INIS)

    Borel, C.O.; Backofen, J.E.; Koehler, R.C.; Jones, M.D. Jr.; Traystman, R.J.

    1987-01-01

    The authors tested the hypothesis that hypoxic hypoxia interferes with cerebral blood flow (CBF) autoregulation when intracranial pressure (ICP) is elevated in pentobarbital-anesthetized lambs (3 to 9 days old). Cerebral perfusion pressure (CPP) was lowered stepwise from 73 to 23 mmHg in eight normoxic lambs and from 65 to 31 mmHg in eight other hypoxic lambs by ventricular infusion of artificial cerebrospinal fluid. In normoxic lambs, CBF measured by microspheres labeled with six different radioisotopes was not significantly changed over this range of CPP. In animals made hypoxic, base-line CBF was twice that of normoxic lambs. CBF was unchanged as CPP was reduced to 31 mmHg. Lower levels of CPP were not attained because a pressor response occurred with further elevations of ICP. No regional decrements in blood flow to cortical arterial watershed areas or to more caudal regions, such as cerebellum, brain stem, or thalamus, were detected with elevated ICP. Cerebral O 2 uptake was similar in both groups and did not decrease when CPP was reduced. These results demonstrate that normoxic lambs have a considerable capacity for effective autoregulation of CBF when ICP is elevated. Moreover, cerebral vasodilation in response to a level of hypoxia approximating that normally seen prenatally does not abolish CBF autoregulation when ICP is elevated during the first postnatal week

  5. Asymmetry of critical closing pressure following head injury

    OpenAIRE

    Kumar, A; Schmidt, E; Hiler, M; Smielewski, P; Pickard, J; Czosnyka, M

    2005-01-01

    Objective: Critical closing pressure (CCP) is the arterial pressure below which the vessels collapse. Hypothetically it is the sum of intracranial pressure (ICP) and vessel wall tension in the cerebral circulation. This study investigated transhemispherical asymmetry of CCP by studying its correlation with radiological findings on computed tomography (CT) scans in head injury patients.

  6. The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Wei Ting Chiu

    Full Text Available The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT, which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.Medical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH and symptomatic ICH after r-tPA. The differences were analyzed using Fisher's exact or Mann-Whitney U tests, and p < 0.05 was defined as the statistical significance.A total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%. No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively. The bleeding risk was not significant different between aneurysm group (2 out of 11, 18% with nonaneurysm group (7 out of 133, 5.3% (p = 0.14. None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.The presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they

  7. IIH with normal CSF pressures?

    Directory of Open Access Journals (Sweden)

    Soh Youn Suh

    2013-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a condition of raised intracranial pressure (ICP in the absence of space occupying lesions. ICP is usually measured by lumbar puncture and a cerebrospinal fluid (CSF pressure above 250 mm H 2 O is one of the diagnostic criteria of IIH. Recently, we have encountered two patients who complained of headaches and exhibited disc swelling without an increased ICP. We prescribed acetazolamide and followed both patients frequently; because of the definite disc swelling with IIH related symptoms. Symptoms and signs resolved in both patients after they started taking acetazolamide. It is generally known that an elevated ICP, as measured by lumbar puncture, is the most important diagnostic sign of IIH. However, these cases caution even when CSF pressure is within the normal range, that suspicion should be raised when a patient has papilledema with related symptoms, since untreated papilledema may cause progressive and irreversible visual loss.

  8. Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

    Science.gov (United States)

    ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

    2018-01-01

    A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

  9. Magnetic resonance imaging (MRI) of intracranial chordomas

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Teruo; Inoue, Yuichi; Shakudo, Miyuki and others

    1988-03-01

    MR images of 5 patients with intracranial chordoma were evaluated and compared with those of other clival lesions (1 clival osteomyelitis, 1 metastatic clival tumor, 3 clival meningiomas). The MR examination was performed using a 0.5 T superconductive magnet, with approximately 10 mm section thickness, one average and a 256 x 256 matrix. T1 weighted images were obtainned by inversion recovery (IR) with TR 2100 - 2500 msec, TI 600 msec and TE 40 msec. T2 weighted images were obtained by spin echo pulse sequence with TR 1800 - 2500 msec and TE 120 msec (long SE). In several cases, the spin echo pulse sequences with TR 1000 msec and TE 40 msec (short SE) were also done. Multiplaned images were obtained. Four of 5 intracranial chordomas were low in intensity compared to cerebral gray matter on T1 weighted images, and all of 5 chordomas were as high in intensity as cerebrospinal fluid or higher than that of cerebrospinal fluid on T2 weighted images. Clival fatty marrow is high intensity on T1 weighted images. Clival involvement by a tumor was a clearly demonstrated as disappearance of this high intensity in all cases. In two cases, the tumor extended to the retropharyngeal space and this was detected clearly on short SE image. Although clival fatty marrow was disappeared, osteomyelitis and metastatic tumor in clivus were iso-intense to cerebral gray matter on both T1 and T2 weighted images. All of 3 clival meningiomas showed iso-intensity to cerebral gray matter on T1 weighted images and slightly high intensity to brain on T2 weighted images, and clival fatty marrow was normal in all 3 cases. Although our experiences are limited in number, intracranial chordoma appeared to be differentiated from other clival lesions.

  10. Intracranial Aneurysms of Neuro-Ophthalmologic Relevance.

    Science.gov (United States)

    Micieli, Jonathan A; Newman, Nancy J; Barrow, Daniel L; Biousse, Valérie

    2017-12-01

    Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians

  11. Chemotherapy for intracranial ependymoma in adults

    International Nuclear Information System (INIS)

    Gramatzki, Dorothee; Roth, Patrick; Felsberg, Jörg; Hofer, Silvia; Rushing, Elisabeth J.; Hentschel, Bettina; Westphal, Manfred; Krex, Dietmar; Simon, Matthias; Schnell, Oliver; Wick, Wolfgang; Reifenberger, Guido; Weller, Michael

    2016-01-01

    Ependymal tumors in adults are rare, accounting for less than 4 % of primary tumors of the central nervous system in this age group. The low prevalence of intracranial ependymoma in adults limits the ability to perform clinical trials. Therefore, treatment decisions are based on small, mostly retrospective studies and the role of chemotherapy has remained unclear. We performed a retrospective study on 17 adult patients diagnosed with intracranial World Health Organisation grade II or III ependymoma, who were treated with chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by applying Macdonald criteria. Progression-free (PFS) and overall survival (OS) were calculated from start of chemotherapy, using the Kaplan-Meier method. Eleven patients had supratentorial and 6 infratentorial tumors. Ten patients were treated with temozolomide (TMZ), 3 with procarbazine/lomustine/vincristine (PCV), 3 with platinum-based chemotherapy and 1 patient received epirubicin/ifosfamide. Response rates were as follows: TMZ 8/10 stable disease; PCV 3/3 stable disease; platinum-based chemotherapy 1/3 partial response; epirubicin/ifosfamide 1/1 complete response. PFS rates at 6, 12 and 24 months were 52.9, 35.3 and 23.5 %. OS rates at 6, 12 and 24 months were 82.4, 82.4 and 70.1 %. There was no indication for a favourable prognostic role of O 6 -methylguanyl-DNA-methyltransferase (MGMT) promoter methylation which was detected in 3/12 investigated tumors. Survival outcomes in response to chemotherapy in adult intracranial ependymoma patients vary substantially, but individual patients may respond to any kind of chemotherapy. There were too few patients to compare survival data between chemotherapeutic subgroups. The online version of this article (doi:10.1186/s12885-016-2323-0) contains supplementary material, which is available to authorized users

  12. A case of intracranial malignant fibrous histiocytoma

    Directory of Open Access Journals (Sweden)

    Amir Hossein Sarrami

    2011-01-01

    Full Text Available We describe a case of intracranial malignant fibrous histiocytoma which had infiltrated pons, cerebellum and basal surface of left temporal lobe without any visible mass. The patient presented with a sudden loss of consciousness and vomiting. Clinical findings, laboratory tests, imaging and examination of the cerebrospinal fluid tended to establish the diagnosis of an infectious condition than a malignancy. Without any response to the antibiotics and with a progressive deterioration of neurologic and mental condition, the patient died after 20 days. In the autopsy, histological and immunohistochemical study of the brain revealed the diagnosis of malignant fibrous histiocytoma (MFH.

  13. CT-assisted localisation of intracranial processes

    Energy Technology Data Exchange (ETDEWEB)

    Luft, C.; Trenkler, J.; Hammer, B.; Valencak, E.

    1986-01-01

    With the software developed for the SOMATOM DRH computerized tomograph it is possible to mix a ROI into the digital radiogram (topogram) for projection of a lesion, such as a tumor, onto the topogram plane; the software also allows an image reconstruction taking the topogram as a reference image (topogram-initiated reconstruction). Combining these two relatively simple methods, and adding distance measurements in two planes, the neurosurgeon has at his disposal an objective CT-assisted means of precisely localising intracranial processes before surgery.

  14. CT-assisted localisation of intracranial processes

    International Nuclear Information System (INIS)

    Luft, C.; Trenkler, J.; Hammer, B.; Valencak, E.

    1986-01-01

    With the software developed for the SOMATOM DRH computerized tomograph it is possible to mix a ROI into the digital radiogram (topogram) for projection of a lesion, such as a tumor, onto the topogram plane; the software also allows an image reconstruction taking the topogram as a reference image (topogram-initiated reconstruction). Combining these two relatively simple methods, and adding distance measurements in two planes, the neurosurgeon has at his disposal an objective CT-assisted means of precisely localising intracranial processes before surgery. (orig.) [de

  15. Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

    International Nuclear Information System (INIS)

    Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui; Tamrakar, Karuna

    2012-01-01

    Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

  16. Intracranial extramedullary hematopoiesis in beta-thalassemia.

    Science.gov (United States)

    Karki, Bivek; Xu, Yi-Kai; Tamrakar, Karuna; Wu, Yuan-Kui

    2012-01-01

    Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

  17. Embolisation of intracranial meningiomas without subsequent surgery

    International Nuclear Information System (INIS)

    Bendszus, M.; Solymosi, L.; Martin-Schrader, I.; Schlake, H.P.

    2003-01-01

    In an open, prospective study, we embolised intracranial meningiomas in seven patients, without subsequent surgery. Follow-up over a mean of 20 months included serial neurological examination, MRI and MR spectroscopy. Clinically, embolisation had no adverse effects. Symptomatic patients showed clinical improvement. On MRI marked tumour shrinkage occurred after embolisation in six patients, and was most pronounced during the first 6 months. In a young boy the tumour was unchanged despite complete angiographic devascularisation. Embolisation without subsequent surgery may cause substantial tumour shrinkage and thus be used in selected in patients. However, thorough follow-up is mandatory to ascertain the effects of embolisation. (orig.)

  18. Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

    Energy Technology Data Exchange (ETDEWEB)

    Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui [Nan fang Hospital, Southern Medical University, Guangzhou (China); Tamrakar, Karuna [Zhujiang Hospital, Southern Medical University, Guangzhou (China)

    2012-03-15

    Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

  19. THE DIAGNOSIS AND TREATMENT OF INTRACRANIAL ARACHNOID CYSTS

    NARCIS (Netherlands)

    GO, KG

    Intracranial arachnoid cysts have been found in 0.3% of computed tomography (CT) scans and in 0.1% of brain autopsy specimens, more often in children than in adults. Intracranial arachnoid cysts occur prevalently in males, on the left side, and in the temporal fossa. Their occasional association

  20. Intracranial Convexity Lipoma with Massive Calcification: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eung Tae; Park, Dong Woo; Ryu, Jeong Ah; Park, Choong Ki; Lee, Young Jun; Lee, Seung Ro [Dept. of Radiology, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Intracranial lipoma is a rare entity, accounting for less than 0.5% of intracranial tumors, which usually develops in the callosal cisterns. We report a case of lipoma with an unusual location; in the high parietal convexity combined with massive calcification, and no underlying vascular malformation or congenital anomaly.

  1. Intracranial vessel wall imaging at 7.0 tesla MRI

    NARCIS (Netherlands)

    van der Kolk, A.G.

    2014-01-01

    Intracranial atherosclerosis is one of the main causes of ischemic stroke. Current conventional imaging techniques assessing intracranial arterial disease in vivo only visualize the vessel wall lumen instead of the pathological vessel wall itself. Therefore, not much is known about the imaging

  2. Starling forces drive intracranial water exchange during normal and pathological states.

    Science.gov (United States)

    Linninger, Andreas A; Xu, Colin; Tangen, Kevin; Hartung, Grant

    2017-12-31

    To quantify the exchange of water between cerebral compartments, specifically blood, tissue, perivascular pathways, and cerebrospinal fluid-filled spaces, on the basis of experimental data and to propose a dynamic global model of water flux through the entire brain to elucidate functionally relevant fluid exchange phenomena. The mechanistic computer model to predict brain water shifts is discretized by cerebral compartments into nodes. Water and species flux is calculated between these nodes across a network of arcs driven by Hagen-Poiseuille flow (blood), Darcy flow (interstitial fluid transport), and Starling's Law (transmembrane fluid exchange). Compartment compliance is accounted for using a pressure-volume relationship to enforce the Monro-Kellie doctrine. This nonlinear system of differential equations is solved implicitly using MATLAB software. The model predictions of intraventricular osmotic injection caused a pressure rise from 10 to 22 mmHg, followed by a taper to 14 mmHg over 100 minutes. The computational results are compared to experimental data with R2=0.929. Moreover, simulated osmotic therapy of systemic (blood) injection reduced intracranial pressure from 25 to 10 mmHg. The modeled volume and intracranial pressure changes following cerebral edema agree with experimental trends observed in animal models with R2=0.997. The model successfully predicted time course and the efficacy of osmotic therapy for clearing cerebral edema. Furthermore, the mathematical model implicated the perivascular pathways as a possible conduit for water and solute exchange. This was a first step to quantify fluid exchange throughout the brain.

  3. MRI diagnosis of intracranial tuberculosis (73 cases report)

    International Nuclear Information System (INIS)

    Zeng Qingyong; Li Xin; He Zhihui; Cheng Chuanhu; Deng Kaijun; Deng Ming

    2008-01-01

    Objective: To assess the MRI features, classification and diagnostic value for intracranial tuberculosis. Methods MRI findings of 73 patients suffering from intracranial tuberculosis proved by pathology or clinic were analyzed respectively. Among the total 73 patients, 39 cases were tuberculosis meningitis, 12 cases simple intracranial tuberculoma, while 22 cases were tuberculoma combining with meningitis. Results: The MRI features of tuberculous meningitis are cerebral infarction, hydrocephalus, abnormal meningeal and cerebral cistern enhancement. 12 cases mature tuberculoma demon- strated typical features with high or low density on T 2 WI images and ring contrast enhancement; 22 cases non-mature tuberculoma showed focal nodular contrast enhancement with evident cerebral edema. FLAIR is more sensitive to find out focus than T 2 WI. Small lesions could be showed definitively by contrast-enhanced scan. Conclusion: MRI possess typical features in the diagnosis of intracranial tuberculosis. It plays an important role in evaluating location, range, classification of intracranial tuberculosis, and is helpful to clinical treatment. (authors)

  4. Diagnosis of ruptured intracranial aneurysm in acute stage

    International Nuclear Information System (INIS)

    Yoshiyama, Masataka; Nakagawa, Toshifumi

    1980-01-01

    Subarachnoid hemorrhage at an acute stage within one day from the onset to the first CT scan was classified into subarachnoid hemorrhage secondary to intracranial aneurysm, subarachnoid hemorrhage of unknown origin and subarachnoid hemorrhage of which angiography could not be carried out, and the first CT findings, the severity, and the prognosis of these subarachnoid hemorrhage were compared and discussed. CT findings of subarachnoid hemorrhage secondary to intracranial aneurysm showed various changes according to progress in the severity with time, and intracranial hematoma, intraventricular clots and ventricular dilatation increased according to progress in the severity. Ruptured intracranial aneurysm in middle cerebral artery, anterior cerebral artery and anterior communicating artery could be found easily by CT, but that in internal carotid artery and vertabral basilar artery was difficult to be detected by CT. When cerebral angiography was carried out repeatedly for ruptured intracranial aneurysm of unknown origin, the time of performance must be consifered with attention to angiospasms or hematoma. (Tsunoda, M.)

  5. F2-isoprostanes and F4-neuroprostanes as markers of intracranial aneurysm development.

    Science.gov (United States)

    Syta-Krzyżanowska, Anna; Jarocka-Karpowicz, Iwona; Kochanowicz, Jan; Turek, Grzegorz; Rutkowski, Robert; Gorbacz, Krzysztof; Mariak, Zenon; Skrzydlewska, Elżbieta

    2018-04-24

    Intracranial aneurysms are common, occurring in about 1-2% of the population. Saccular aneurysm is a pouch-like pathological dilatation of an intracranial artery that develops when the cerebral artery wall becomes too weak to resist hemodynamic pressure and distends. The aim of this study was to determine whether the development of intracranial aneurysms and subarachnoid hemorrhage (SAH) affects neuronal phospholipid metabolism, and what influence different invasive treatments have on brain free radical phospholipid metabolism. The level of polyunsaturated fatty acid (PUFA) cyclization products - F2-isoprostanes and F4-neuroprostanes - was examined using liquid chromatography - mass spectrometry (LC-MS) in the plasma of patients with brain aneurysm and resulting subarachnoid hemorrhage. It was revealed that an aneurysm leads to the enhancement of lipid peroxidation with a significant increase in plasma F2-isoprostanes and F4-neuroprostanes (more than 3-fold and 11-fold, respectively) in comparison to healthy subjects. The rupture of an aneurysm results in hemorrhage and an additional increase in examined prostaglandin derivatives. The embolization and clipping of aneurysms contribute to a gradual restoration of metabolic homeostasis in brain cells, which is visible in the decrease in PUFA cyclization products. The results indicate that aneurysm development is associated with enhanced inflammation and oxidative stress, factors which favor lipid peroxidation, particularly in neurons, whose membranes are rich in docosahexaenoic acid, a precursor of F4-neuroprostanes.

  6. Flurbiprofen and hypertension but not hydroxyethyl starch are associated with post-craniotomy intracranial haematoma requiring surgery.

    Science.gov (United States)

    Jian, M; Li, X; Wang, A; Zhang, L; Han, R; Gelb, A W

    2014-11-01

    Post-craniotomy intracranial haematoma is one of the most serious complications after neurosurgery. We examined whether post-craniotomy intracranial haematoma requiring surgery is associated with the non-steroidal anti-inflammatory drugs flurbiprofen, hypertension, or hydroxyethyl starch (HES). A case-control study was conducted among 42 359 patients who underwent elective craniotomy procedures at Beijing Tiantan Hospital between January 2006 and December 2011. A one-to-one control group without post-craniotomy intracranial haematoma was selected matched by age, pathologic diagnosis, tumour location, and surgeon. Perioperative blood pressure records up to the diagnosis of haematoma, the use of flurbiprofen and HES were examined. The incidence of post-craniotomy intracranial haematoma and the odds ratios for the risk factors were determined. A total of 202 patients suffered post-craniotomy intracranial haematoma during the study period, for an incidence of 0.48% (95% CI=0.41-0.55). Haematoma requiring surgery was associated with an intraoperative systolic blood pressure of >160 mm Hg (OR=2.618, 95% CI=2.084-2.723, P=0.007), an intraoperative mean blood pressure of >110 mm Hg (OR=2.600, 95% CI=2.312-3.098, P=0.037), a postoperative systolic blood pressure of >160 mm Hg (OR=2.060, 95% CI= 1.763-2.642, P=0.022), a postoperative mean blood pressure of >110 mm Hg (OR=3.600, 95% CI= 3.226-4.057, P=0.001), and the use of flurbiprofen during but not after the surgery (OR=2.256, 95% CI=2.004-2.598, P=0.005). The intraoperative infusion of HES showed no significant difference between patients who had a haematoma and those who did not. Intraoperative and postoperative hypertension and the use of flurbiprofen during surgery are risk factors for post-craniotomy intracranial haematoma requiring surgery. The intraoperative infusion of HES was not associated with a higher incidence of haematoma. © The Author 2014. Published by Oxford University Press on behalf of the British

  7. CT findings of solitary intracranial metastasis

    International Nuclear Information System (INIS)

    Suh, Dae Chul; Lee, Kyung Soo; Chang, Kee Hyun

    1987-01-01

    The authors retrospectively reviewed and analyzed CT scans of fifty patients with solitary intracranial lesion selected from 118 patients who had been confirmed to have intracranial metastasis from 1979 to 1985. The results were as follows: 1. The most common primary tumors with solitary metastasis, in order of frequency, were lung cancer, breast cancer, choriocarcinoma, colon cancer, lymphoma and others. 2. Precontrast scans obtained in 35 cases showed cystic very low density in 20%, slightly low density in 9%, isodensity in 20%, high density in 51% when he densities of the lesions were compared with that of the normal brain tissue. 3. After contrast enhancement 43 out of 50 showed one of 4 patterns of enhancement. Homogeneous enhancement without necrosis were found in 26%, homogeneous enhancement with necrosis in 18%, ring-enhancement in 26% and irregular enhancement in 16%. No enhancement was found in 14%. 4. The locations of the metastatic lesions were intra axial in 45 and extra axial in 5. Among the intra axial lesions, the parietal lobe was the most common location. Extra axial metastases were epidural, calvarial and leptomeningeal. 5. Degrees of surrounding edema were mild in 32%, moderate in 19% and severe in 49%

  8. Genome screen in familial intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Langefeld Carl

    2009-01-01

    Full Text Available Abstract Background Individuals with 1st degree relatives harboring an intracranial aneurysm (IA are at an increased risk of IA, suggesting genetic variation is an important risk factor. Methods Families with multiple members having ruptured or unruptured IA were recruited and all available medical records and imaging data were reviewed to classify possible IA subjects as definite, probable or possible IA or not a case. A 6 K SNP genome screen was performed in 333 families, representing the largest linkage study of IA reported to date. A 'narrow' (n = 705 definite IA cases and 'broad' (n = 866 definite or probable IA disease definition were used in multipoint model-free linkage analysis and parametric linkage analysis, maximizing disease parameters. Ordered subset analysis (OSA was used to detect gene × smoking interaction. Results Model-free linkage analyses detected modest evidence of possible linkage (all LOD Conclusion These data suggest it is unlikely that there is a single common variant with a strong effect in the majority of the IA families. Rather, it is likely that multiple genetic and environmental risk factors contribute to the susceptibility for intracranial aneurysms.

  9. Intracranial lipoma in the sylvian fissure

    International Nuclear Information System (INIS)

    Ogasawara, Kuniaki; Kinjo, Toshihiko; Onuma, Takehide

    1988-01-01

    An experience with an operation on a case of intracranial lipoma in the sylvian fissure is reported. A 14-year-old man had complained of attacks of abnormal behavior for 2 years and was diagnosed by a psychiatrist as suffering from temporal epilepsy. A computed tomography (CT) scan indicated an abnormal shadow on the brain, and so he was admitted to our hospital. On admission, the results of physical and neurological examinations were normal. An electroencephalogram recorded irregular δ waves and sharp waves over the right frontotemporal region, however. A CT scan showed a round-shaped, extremely low-density area, with calcification of the wall and without contrast-enhancement, in the left sylvian fissure. No abnormal finding was seen in plain skull X-P or in left-carotid angiography. Left-frontotemporal craniotomy was performed to remove the tumor. A solid yellowish tumor was found in the sylvian fissure and totally removed. Histologically, it proved to be a lipoma. The postoperative course was uneventful, and the patient was discharged without any neurological deficit. We discussed the neuroradiological findings of sylvian lipomas. As far as we have learned in an extensive review of the literature, there have been nine reports on intracranial lipomas in the sylvian fissure; as for sylvian lipomas which were detected on a CT scan during life, there have been only six cases other than the present one. (author)

  10. Longterm surgery of posttraumatic intracranial hematoma

    Directory of Open Access Journals (Sweden)

    Babochkin D.S.

    2012-03-01

    Full Text Available Purpose. Research objective — studying of consequences of the operated traumatic intracranial hematomas in the remote period. Material. The nearest and remote results of the operated traumatic intracranial hematomas at 105 patients in terms from 6 months till 3 years are analyzed. During research the anamnesis was studied, neurologic investigation, and also research cognitive functions by means of scale MMSE, the test of drawing of hours, a scale of studying of alarm/depression HADS, learning of 5 words, scale quality of life SF-36. Results. It is established, that in the remote period the condition of the majority of patients gradually improves, at the same time, frequent enough and expressed consequences which are necessary for analyzing with the purpose of optimization of outcomes and the forecast at the given disease are observed. The special attention should be given again developing complications to which it is possible to carry epileptic seizures and behavioral-memorable infringements. Conclusion. Studying of the remote consequences of this heavy kind of craniocereberal trauma allows to optimize results of treatment and to provide complex medical, labor, social and family adaptation

  11. MRI and CT findings of intracranial neurosyphilis

    International Nuclear Information System (INIS)

    Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won; Cho, Hyeun Cha

    1999-01-01

    To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory

  12. MRI and CT findings of intracranial neurosyphilis

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won [Hallym University College of Medicine, Seoul (Korea, Republic of); Cho, Hyeun Cha [Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory.

  13. Intracranial solitary fibrous tumor: Imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic, E-mail: fredclare5@msn.com [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Bonneville, Fabrice [Department of Neuroradiology, Hopital Rangueil, Toulouse University Hospital, 31000 Toulouse (France); Rousseau, Audrey [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Galanaud, Damien [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Kujas, Michele [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Naggara, Olivier [Department of Neuroradiology, St Anne Hospital, 75014 Paris (France); Cornu, Philippe [Department of Neurosurgery, Pitie-Salpetriere Hospital (France); Chiras, Jacques [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France)

    2011-11-15

    Objective: To study the neuroimaging features of intracranial solitary fibrous tumors (ISFTs). Materials and methods: Retrospective study of neuroimaging features of 9 consecutive histopathologically proven ISFT cases. Location, size, shape, density, signal intensity and gadolinium uptake were studied at CT and MRI. Data collected from diffusion-weighted imaging (DWI) (3 patients), perfusion imaging and MR spectroscopy (2 patients), and DSA (4 patients) were also analyzed. Results: The tumors most frequently arose from the intracranial meninges (7/9), while the other lesions were intraventricular. Tumor size ranged from 2.5 to 10 cm (mean = 6.6 cm). They presented multilobular shape in 6/9 patients. Most ISFTs were heterogeneous (7/9) with areas of low T2 signal intensity that strongly enhanced after gadolinium administration (6/8). Erosion of the skull was present in about half of the cases (4/9). Components with decreased apparent diffusion coefficient were seen in 2/3 ISFTs on DWI. Spectroscopy revealed elevated peaks of choline and myo-inositol. MR perfusion showed features of hyperperfusion. Conclusion: ISFT should be considered in cases of extra-axial, supratentorial, heterogeneous, hypervascular tumor. Areas of low T2 signal intensity that strongly enhance after gadolinium injection are suggestive of this diagnosis. Restricted diffusion and elevated peak of myo-inositol may be additional valuable features.

  14. The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension.

    Science.gov (United States)

    Watane, Gaurav Vishwasrao; Patel, Bhumi; Brown, Derek; Taheri, M Reza

    The aim of this article was to study the significance of arachnoid granulations (AGs) in patients with idiopathic intracranial hypertension (IIH). In an institutional review board-approved retrospective chart review study, 79 patients with clinical diagnosis of idiopathic increased intracranial pressure were compared with 63 patients with a diagnosis of multiple sclerosis. Inclusion criteria also included available magnetic resonance imaging (MRI) of the brain, older than 18 years, and female sex. Patients with elevated intracranial pressure due to other causes were excluded. The electronic medical records were mined for presence of the following: body mass index, age, headache, vision changes, tinnitus, and vertigo. The MRI of the brain was reviewed for the presence of the following features: empty sella, prominent cerebrospinal fluid space in the optic sheaths, tortuosity of the optic nerves and enlarged Meckel cave. In addition, the number, size, and location of AGs associated with major venous drainage sinuses were documented in all patients. Using statistical analysis, association between various imaging and clinical signs were evaluated. The association between AG and various imaging and clinical signs were evaluated. The percentage of patients with AG were significantly higher in patients with IIH. Patients with IIH tended to have 0 to 3 AG. The most common imaging findings observed in MRI of the brain of patients with IIH were empty sella and prominent cerebrospinal fluid space in the optic sheaths. The prevalence of these MRI findings in patients with IIH was inversely proportional to the number of AG. A similar inverse trend was also noted with the opening pressure of patients with IIH and number of AG. The study establishes that there is a relationship between presence of AG and IIH. Arachnoid granulation seems to act in a compensatory mechanism in patients with IIH.

  15. Osmolality of Cerebrospinal Fluid from Patients with Idiopathic Intracranial Hypertension (IIH.

    Directory of Open Access Journals (Sweden)

    Elisabeth A Wibroe

    Full Text Available Idiopathic intracranial hypertension (IIH is a disorder of increased intracranial fluid pressure (ICP of unknown etiology. This study aims to investigate osmolality of cerebrospinal fluid (CSF from patients with IIH.We prospectively collected CSF from individuals referred on suspicion of IIH from 2011-2013. Subjects included as patients fulfilled Friedman and Jacobson's diagnostic criteria for IIH. Individuals in whom intracranial hypertension was refuted were included as controls. Lumbar puncture with ICP measurement was performed at inclusion and repeated for patients after three months of treatment. Osmolality was measured with a Vapor Pressure Osmometer.We collected 90 CSF samples from 38 newly diagnosed patients and 28 controls. At baseline 27 IIH-samples and at 3 months follow-up 35 IIH-samples were collected from patients. We found no significant differences in osmolality between 1 patients at baseline and controls (p = 0. 86, 2 patients at baseline and after 3 months treatment (p = 0.97, and 3 patients with normalized pressure after 3 months and their baseline values (p = 0.79. Osmolality in individuals with normal ICP from 6-25 cmH2O (n = 41 did not differ significantly from patients with moderately elevated ICP from 26-45 cmH2O (n = 21 (p = 0.86 and patients with high ICP from 46-70 cmH2O (n = 4 (p = 0.32, respectively. There was no correlation between osmolality and ICP, BMI, age and body height, respectively. Mean CSF osmolality was 270 mmol/kg (± 1 SE, 95% confidence interval 267-272 for both patients and controls.CSF osmolality was normal in patients with IIH, and there was no relation to treatment, ICP, BMI, age and body height. Mean CSF osmolality was 270 mmol/kg and constitutes a reference for future studies. Changes in CSF osmolality are not responsible for development of IIH. Other underlying pathophysiological mechanisms must be searched.

  16. POST-NOAC: Portuguese observational study of intracranial hemorrhage on non-vitamin K antagonist oral anticoagulants.

    Science.gov (United States)

    Marques-Matos, Cláudia; Alves, José Nuno; Marto, João Pedro; Ribeiro, Joana Afonso; Monteiro, Ana; Araújo, José; Silva, Fernando; Grenho, Fátima; Viana-Baptista, Miguel; Sargento-Freitas, João; Pinho, João; Azevedo, Elsa

    2017-08-01

    Background There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. Aims To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. Methods We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals. Clinical and demographic data were obtained from individual medical records. Intracranial hemorrhage was classified as intracerebral, extra-axial, or multifocal using brain computed tomography. Three-month functional outcome was assessed using the modified Rankin Scale. Results Among 246 patients included, 24 (9.8%) were anticoagulated with a non-vitamin K antagonist oral anticoagulants and 222 (90.2%) with a vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants patients were older (81.5 vs. 76 years, p = 0.048) and had intracerebral hemorrhage more often (83.3% vs. 63.1%, p = 0.048). We detected a non-significant trend for larger intracerebral hemorrhage volumes in vitamin K antagonists patients ( p = 0.368). Survival analysis adjusted for age, CHA 2 DS 2 VASc, HAS-BLED, and anticoagulation reversal revealed that non-vitamin K antagonist oral anticoagulants did not influence three-month mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.39-1.80, p = 0.638). Multivariable ordinal regression for three-month functional outcome did not show a significant shift of modified Rankin Scale scores in non-vitamin K antagonist oral anticoagulants patients (odds ratio (OR) 1.26, 95%CI 0.55-2.87, p = 0.585). Conclusions We detected no significant differences in the three-month outcome between non-vitamin K antagonist oral anticoagulants

  17. An autopsy case of methanol induced intracranial hemorrhage.

    Science.gov (United States)

    Kim, Hye-Jeong; Na, Joo-Young; Lee, Young-Jik; Park, Jong-Tae; Kim, Hyung-Seok

    2015-01-01

    The major component of car washer fluid is a methanol. Intracranial hemorrhage is a rare but lethal complication in methanol poisoning. We report a case of massive bilateral basal ganglia hematoma in a 32-year-old man with methanol poisoning. He drank car washer solution twice time (about 500 ml), and was admitted to a territorial hospital 10 hours post-ingestion for depressed mental status, lower blood pressure, and high anion gap metabolic acidosis. Computed tomographic (CT) scan showed lesions in both putamen and cerebral deep white matter. Twenty-one days after methanol exposure, he suddenly developed cardiorespiratory arrest. In autopsy, external examination revealed moderate cerebral edema, but no evidence of herniation. Coronal sections of the brain showed softening and about 34 g hematoma in the bilateral putamen and 3rd ventricles. The toxic effect of methanol on the visual system has been noted in the absence of neurologic manifestations; however, there have also been a report of concomitant brain in Korea.

  18. Assessment of the role of intracranial hypertension and stress on hippocampal cell apoptosis and hypothalamic-pituitary dysfunction after TBI.

    Science.gov (United States)

    Tan, Huajun; Yang, Weijian; Wu, Chenggang; Liu, Baolong; Lu, Hao; Wang, Hong; Yan, Hua

    2017-06-19

    In recent years, hypopituitarism caused by traumatic brain injury (TBI) has been explored in many clinical studies; however, few studies have focused on intracranial hypertension and stress caused by TBI. In this study, an intracranial hypertension model, with epidural hematoma as the cause, was used to explore the physiopathological and neuroendocrine changes in the hypothalamic-pituitary axis and hippocampus. The results demonstrated that intracranial hypertension increased the apoptosis rate, caspase-3 levels and proliferating cell nuclear antigen (PCNA) in the hippocampus, hypothalamus, pituitary gland and showed a consistent rate of apoptosis within each group. The apoptosis rates of hippocampus, hypothalamus and pituitary gland were further increased when intracranial pressure (ICP) at 24 hour (h) were still increased. The change rates of apoptosis in hypothalamus and pituitary gland were significantly higher than hippocampus. Moreover, the stress caused by surgery may be a crucial factor in apoptosis. To confirm stress leads to apoptosis in the hypothalamus and pituitary gland, we used rabbits to establish a standard stress model. The results confirmed that stress leads to apoptosis of neuroendocrine cells in the hypothalamus and pituitary gland, moreover, the higher the stress intensity, the higher the apoptosis rate in the hypothalamus and pituitary gland.

  19. Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management.

    Science.gov (United States)

    Davidson, Benjamin; Nassiri, Farshad; Mansouri, Alireza; Badhiwala, Jetan H; Witiw, Christopher D; Shamji, Mohammed F; Peng, Philip W; Farb, Richard I; Bernstein, Mark

    2017-05-01

    Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid volume and pressure caused by a leak of cerebrospinal fluid through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, because they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH. We review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Stent-assisted recanalization of atherosclerotic intracranial stenosis

    International Nuclear Information System (INIS)

    Soo Mee Lim; Dae Chul Suh

    2006-01-01

    Intracranial atherosclerosis is a major cause of ischemic stroke, and depending on the studied population, it accounts for 8%-15% of all strokes that are due to cerebral atherosclerosis. The prognosis of patients with symptomatic intracranial stenoses seems to depend on the location and extent of intracranial atherosclerosis. Currently, the primary treatment in intracranial atherosclerosis is the control of vascular risk factors such as hypertension, diabetes, hypercholesterolemia, and smoking. Secondary prevention with antiplatelet therapy has been shown to reduce the risk of subsequent vascular events in patients who have suffered a recent ischemic stroke or transient ischemic attack (TIA). Unfortunately, a significant number of patients with intracranial atherosclerosis continue to suffer from repeated strokes or TIA despite maximal medical treatment. Although endovascular revascularization for symptomatic intracranial stenoses remains at the investigational stage and much of the pertinent information is anecdotal, intracranial angioplasty and stenting are being increasingly performed to treat stenotic lesions. This article reviews basic principles involved in the patient selection, premedication, angio-interventional procedures, angiographic and clinical results, periprocedural complication, patients aftercare. (authors)

  1. Intracranial subdural hematoma coexisting with improvement in spontaneous intracranial hypotension after an epidural blood patch

    Directory of Open Access Journals (Sweden)

    Cheng-Hsi Chang

    2012-11-01

    Full Text Available A 36-year-old male had spontaneous intracranial hypotension (SIH presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH. Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient’s headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage. Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.

  2. 3D printing of intracranial aneurysm based on intracranial digital subtraction angiography and its clinical application.

    Science.gov (United States)

    Wang, Jian-Li; Yuan, Zi-Gang; Qian, Guo-Liang; Bao, Wu-Qiao; Jin, Guo-Liang

    2018-06-01

    The study aimed to develop simulation models including intracranial aneurysmal and parent vessel geometries, as well as vascular branches, through 3D printing technology. The simulation models focused on the benefits of aneurysmal treatments and clinical education. This prospective study included 13 consecutive patients who suffered from intracranial aneurysms confirmed by digital subtraction angiography (DSA) in the Neurosurgery Department of Shaoxing People's Hospital. The original 3D-DSA image data were extracted through the picture archiving and communication system and imported into Mimics. After reconstructing and transforming to Binary STL format, the simulation models of the hollow vascular tree were printed using 3D devices. The intracranial aneurysm 3D printing simulation model was developed based on DSA to assist neurosurgeons in aneurysmal treatments and residency training. Seven neurosurgical residents and 15 standardization training residents received their simulation model training and gave high assessments for the educational course with the follow-up qualitative questionnaire. 3D printed simulation models based on DSA can perfectly reveal target aneurysms and help neurosurgeons select therapeutic strategies precisely. As an educational tool, the 3D aneurysm vascular simulation model is useful for training residents.

  3. A Case Of Ollier′s Disease With Intracranial Enchondroma

    Directory of Open Access Journals (Sweden)

    Sidharthan Neeraj

    2005-01-01

    Full Text Available The syndrome of multiple enchondromas is known as Ollier′s disease. Enchondromas are benign tumours of hyaline cartilage arising within the medullary cavity of tubular bones. We are reporting the case of a 16 year old girl with Ollier′s disease who presented with seizures and brainstem compression. A MRI scan of brain showed an intracranial space-occupying lesion in the region of clivus. The intracranial tumour was surgically removed and the histopathology confirmed the diagnosis of enchondroma. Intracranial enchondroma is an extremely rare situation and reported for the first time from south India.

  4. Intracranial developmental venous anomaly: is it asymptomatic?

    Science.gov (United States)

    Puente, A Bolívar; de Asís Bravo Rodríguez, F; Bravo Rey, I; Romero, E Roldán

    2018-03-16

    Intracranial developmental venous anomalies are the most common vascular malformation. In the immense majority of cases, these anomalies are asymptomatic and discovered incidentally, and they are considered benign. Very exceptionally, however, they can cause neurological symptoms. In this article, we present three cases of patients with developmental venous anomalies that presented with different symptoms owing to complications derived from altered venous drainage. These anomalies were located in the left insula, right temporal lobe, and cerebellum. The exceptionality of the cases presented as well as of the images associated, which show the mechanism through which the symptoms developed, lies in the low incidence of symptomatic developmental venous anomalies reported in the literature. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Cognitive function in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne Maria; Fagerlund, Birgitte; Forchhammer, Hysse Birgitte

    2014-01-01

    -up. At the time of testing, none of the patients took medication potentially affecting cognitive function. Controls were 31 healthy age-matched and sex-matched volunteers from the local community. OUTCOME MEASURES: Executive function, working memory, visuospatial memory, processing speed, attention and reaction......OBJECTIVE: To explore the extent and nature of cognitive deficits in patients with idiopathic intracranial hypertension (IIH) at the time of diagnosis and after 3 months of treatment. DESIGN: Prospective case-control study. SETTING: Neurological department, ophthalmological department...... time assessed by a comprehensive neuropsychological test battery consisting of validated computerised (Cambridge neuropsychological test automated battery) and paper-and-pencil tests. RESULTS: Patients with IIH performed significantly worse than controls in four of six cognitive domains (p≤0...

  6. Brain edema associated with intracranial meningiomas

    International Nuclear Information System (INIS)

    Asahi, Minoru; Kikuchi, Haruhiko; Hirai, Osamu

    1992-01-01

    Brain edema associated with intracranial meningiomas was investigated on 80 patients, excluding recurrent cases. Statistically significant positive correlations with the degree of edema were found with large tumors, the convexity or parasagittal locations, the venous outflow disturbance, and the evidence of cortical disruption or peritumoral enhancement visualized on computed tomography or magnetic resonance imagings. Patients with a short clinical history and with angiographic evidence of hypervascularity tended to have edema, but there was no statistical significance. It is concluded that various factors are responsible for the edema associated with meningiomas and that it would be hard to determine the most important cause, since each factor plays a part edema production, spread, and resolution. (author)

  7. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms....... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated...

  8. Intracranial drug delivery for subarachnoid hemorrhage.

    Science.gov (United States)

    Macdonald, Robert Loch; Leung, Ming; Tice, Tom

    2012-01-01

    Tice and colleagues pioneered site-specific, sustained-release drug delivery to the brain almost 30 years ago. Currently there is one drug approved for use in this manner. Clinical trials in subarachnoid hemorrhage have led to approval of nimodipine for oral and intravenous use, but other drugs, such as clazosentan, hydroxymethylglutaryl CoA reductase inhibitors (statins) and magnesium, have not shown consistent clinical efficacy. We propose that intracranial delivery of drugs such as nimodipine, formulated in sustained-release preparations, are good candidates for improving outcome after subarachnoid hemorrhage because they can be administered to patients that are already undergoing surgery and who have a self-limited condition from which full recovery is possible.

  9. Intracranial arteriovenous malformation. Contralateral steal phenomena

    Energy Technology Data Exchange (ETDEWEB)

    Batjer, H H; Devous, M D; Seibert, G B; Purdy, P D; Ajmani, A K; Delarosa, M; Bonte, F J [Texas Univ., Dallas, TX (USA). Southwestern Medical Center

    1989-05-01

    Sixty-two patients with radiographically proven intracranial arteriovenous malformations underwent preoperative regional cerebral blood flow measurement with {sup 133}Xe signal-photon emission computed tomography. Contralateral regions of hypoperfusion were deteceted in all cases. Steal severity was assessed according to the contralateral steal index (ISteal(c)). ISteal(c) was < 0.7 (severe) in 22 (35%), 0.7-0.8 (intermediate) in 18 (29%), and > 0.8 (mild) in 22 (35%). ISteal(c) was more frequently severe or mild in females and more often intermediate in males in males (p < 0.05). Hyperemic complications were encountered more frequently in patients with intermediate ISteal(c) (p = 0.086). An unfavorable outcome was associated with less severe contralateral steal (p = 0.12). A detailed clinical, radiographic, and hemodynamic profile may help to preperatively identify patients at high risk for a poor surgical outcome. (author).

  10. Effect of radiation therapy against intracranial hemangiopericytoma

    Energy Technology Data Exchange (ETDEWEB)

    Uemura, Shozaburo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro; Yoshioka, Susumu; Kochi, Masato; Ushio, Yukitaka [Kumamoto Univ. (Japan). School of Medicine; Nakahara, Tadashi; Kishida, Katsuaki

    1992-06-01

    Seven cases of intracranial hemangiopericytoma were studied retrospectively to investigate the efficacy of radiation therapy. Tumor response evaluated by computed tomography and magnetic resonance imaging was obvious after 20-30 Gy irradiation. The total reduction rate was 80-90% and continued as long as 5-7 months after treatment. In five patients receiving radiation therapy before radical removal, the tumors were easily removed without massive hemorrhage. Histological inspection of specimens after irradiation showed a significant disappearance of tumor cells. Pyknosis frequently occurred in endothelial cells, and proliferating vessels with hyalinoid degeneration were also seen. Reticulin fibers between tumor cells were fewer, split, or absent. Preoperative radiation therapy is useful in the treatment of hemangiopericytoma involving considerable surgical risk. Postoperative radiation therapy should be given even if removal is complete. (author).

  11. Traumatic intracranial aneurysm: a case report

    International Nuclear Information System (INIS)

    Kang, Si Won; Chun, Kyung Ah; Baik, Joon Hyun; Shin, Kyung Sub

    1994-01-01

    The occurrence of traumatic aneurysm is rare in head injury, but this complication is important as it is a potentially treatable cause delayed onset of intracranial hemorrhage. Authors report one case of traumatic aneurysm involving A1 and A2 junction of anterior cerebral artery. A-28-year-old man with traffic accident was examined with brain CT and cerebral angiography. 1) Brain CT: Initial scan shows multiple skull fractures involving right frontal bones with subarachnoid hemorrhage and pneumocephalus. Follow-up scan shows intracerebral hemorrhage at bilateral frontal lobes. 2) Cerebral angiography: A traumatic aneurysm which is slowly filling and delayed emptying is noted at the junctional portion of A1 and A2 segment of the anterior cerebral artery. This report demonstrates radiologic findings of traumatic aneurysm at anterior cerebral artery with the brief review of the literatures

  12. Computer tomography of intracranial tumours and hematomas

    International Nuclear Information System (INIS)

    Tans, J.T.J.

    1978-01-01

    The value of computed tomography (CT) for the diagnosis of intracranial tumors and hematomas was investigated in a retrospective study comprising 220 patients. All C.T.scans are reviewed and described in detail. To assess the diagnostic accuracy, the original interpretation of the C.T.scans was compared with that of conventional neuroradiological and neurophysiological examinations. The aspect on C.T. of the various types of tumors and hematomas proved to vary widely and specific features were seldom seen. This holds particularly for the malignant tumors. Benign tumors such as meningeomas, adenomas and neurilemmomas showed a rather easily identifiable and almost identical picture of the C.T.scan, and diagnosis had to be based mainly on differences in localization. The hematomas, with the exception of the older intracerebral ones, showed the most characteristic C.T.abnormalities. (Auth.)

  13. Converging intracranial markers of conscious access.

    Directory of Open Access Journals (Sweden)

    Raphaël Gaillard

    2009-03-01

    Full Text Available We compared conscious and nonconscious processing of briefly flashed words using a visual masking procedure while recording intracranial electroencephalogram (iEEG in ten patients. Nonconscious processing of masked words was observed in multiple cortical areas, mostly within an early time window (<300 ms, accompanied by induced gamma-band activity, but without coherent long-distance neural activity, suggesting a quickly dissipating feedforward wave. In contrast, conscious processing of unmasked words was characterized by the convergence of four distinct neurophysiological markers: sustained voltage changes, particularly in prefrontal cortex, large increases in spectral power in the gamma band, increases in long-distance phase synchrony in the beta range, and increases in long-range Granger causality. We argue that all of those measures provide distinct windows into the same distributed state of conscious processing. These results have a direct impact on current theoretical discussions concerning the neural correlates of conscious access.

  14. MRI of intracranial germ cell tumours

    International Nuclear Information System (INIS)

    Sumida, M.; Uozumi, T.; Kiya, K.; Mukada, K.; Arita, K.; Kurisu, K.; Sugiyama, K.; Onda, J.; Satoh, H.; Ikawa, F.; Migita, K.

    1995-01-01

    We reviewed MRI findings in proven intracranial germ cell tumours in 22 cases, 12 of whom received Gd-DTPA. On T1-weighted images, the signal intensity of the tumour parenchyma was moderately low in 19 cases and isointense in 3; on T2-weighted images, it was high in all cases. Regions of different intensity thought to be cysts were found in 17 (77 %): 7 of 12 patients with germinoma (58 %) and in all other cases. Of the 13 patients with pineal lesions T1-weighted sagittal images showed the aqueduct to be obstructed in 5, stenotic in 7 and normal in 1. Strong contrast enhancement was observed in all 12 cases. Of the 14 patients with suprasellar lesions, 5 were found to have an intrasellar extension, and in 3 of these, the normal pituitary gland, which could be distinguished from the tumour, was displaced anteriorly. Ten patients (45 %) had multiple lesions. (orig.)

  15. Current management of symptomatic intracranial stenosis.

    Science.gov (United States)

    Taylor, Robert A; Weigele, John B; Kasner, Scott E

    2011-08-01

    Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

  16. Effect of radiation therapy against intracranial hemangiopericytoma

    International Nuclear Information System (INIS)

    Uemura, Shozaburo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro; Yoshioka, Susumu; Kochi, Masato; Ushio, Yukitaka; Nakahara, Tadashi; Kishida, Katsuaki.

    1992-01-01

    Seven cases of intracranial hemangiopericytoma were studied retrospectively to investigate the efficacy of radiation therapy. Tumor response evaluated by computed tomography and magnetic resonance imaging was obvious after 20-30 Gy irradiation. The total reduction rate was 80-90% and continued as long as 5-7 months after treatment. In five patients receiving radiation therapy before radical removal, the tumors were easily removed without massive hemorrhage. Histological inspection of specimens after irradiation showed a significant disappearance of tumor cells. Pyknosis frequently occurred in endothelial cells, and proliferating vessels with hyalinoid degeneration were also seen. Reticulin fibers between tumor cells were fewer, split, or absent. Preoperative radiation therapy is useful in the treatment of hemangiopericytoma involving considerable surgical risk. Postoperative radiation therapy should be given even if removal is complete. (author)

  17. Intracranial calcification on paediatric computed tomography

    International Nuclear Information System (INIS)

    Kendall, B.; Cavanagh, N.

    1986-01-01

    An analysis of the computed tomograms of 18000 children examined consecutively form the basis of an assessment of the diagnostic significance of intracranial calcification. The low incidence of physiological calcification in the pineal and choroid of about 2% up to the age of 8 years, but increasing 5-fold by the age of 15 years, is confirmed. Pathological calcification occurred in 1.6%, the commonest causes being neoplasms (43%), neuroectodermal syndromes (20%) and infections (12%). Diffuse basal ganglia calcification (15%) bore little relation to the diverse clinical symptomatology, and routine bio-chemical studies showed a disorder of metabolism to be present in only 6 cases. Calcification has not been previously noted in acute haemorrhagic leukoencephalitis, Pertussis or Cocksackie encephalitis, infantile neuraxonal dystrophy, Marinesco-Sjoegren syndrome or in the basal ganglia in neurofibromatosis. (orig.)

  18. Vascular Variations Associated with Intracranial Aneurysms.

    Science.gov (United States)

    Orakdogen, Metin; Emon, Selin Tural; Somay, Hakan; Engin, Taner; Is, Merih; Hakan, Tayfun

    2017-01-01

    To investigate the vascular variations in patients with intracranial aneurysm in circle of Willis. We used the data on 128 consecutive intracranial aneurysm cases. Cerebral angiography images were analyzed retrospectively. Arteries were grouped as anterior cerebral arterial system (ACS), posterior cerebral arterial system (PCS) and middle cerebral arterial system (MCS) for grouping vascular variations. Lateralization, being single/multiple, gender; and also any connection with accompanying aneurysms" number, localization, dimension, whether bleeding/incidental aneurysm has been inspected. Variations were demonstrated in 57.8% of the cases. The most common variation was A1 variation (34.4%). The rate of variations was 36.7%, 24.2% and 10.2% respectively in ACS, PCS and MCS. MCS variations were significantly higher in males. Anterior communicating artery (ACoA) aneurysm observance rates were significantly higher and posterior communicating artery (PCoA) aneurysm and middle cerebral artery (MCA) aneurysm observance rates were significantly lower when compared to "no ACS variation detected" cases. In "PCS variation detected" cases, PCoA aneurysm observance rates and coexistence of multiple variations were significantly higher. The rate of vascular variations in patients with aneurysms was 57.8%. Arterial hypoplasia and aplasia were the most common variations. ACS was the most common region that variations were located in; they were mostly detected on the right side. Coexistence of ACoA aneurysm was higher than PCoA and MCA aneurysms. In the PCS variations group, PCoA aneurysms were the most common aneurysms that accompanying the variation and multiple variations were more common than in the other two groups. The variations in MCS were most common in males.

  19. MRI findings of intracranial cystic meningiomas

    International Nuclear Information System (INIS)

    Zhang, D.; Hu, L.-B.; Zhen, J.W.; Zou, L.-G.; Feng, X.-Y.; Wang, W.-X.; Wen, L.

    2009-01-01

    Aim: To report the magnetic resonance imaging (MRI) features of intracranial cystic meningiomas and compare these features in intra- and peritumoural cyst groups. Materials and methods: Fourteen cases of peritumoural cystic meningiomas were compared with 18 cases of intratumoural cystic meningiomas. All patients were examined using non-enhanced and contrast-enhanced MRI. Tumour location, tumour size, signal intensity, enhancement characteristics, and cystic changes were assessed. The MRI features were compared between the intra- and peritumoural cyst groups. Results: Most cystic meningiomas comprised two or more cysts. The solid parts of the tumours showed moderate or marked enhancement after the injection of contrast material. An enhanced cyst wall was found in six out of 14 cases in the peritumoural cyst group, but not in the intratumoural cyst group. Peritumoural cystic meningiomas were predominately located in the cerebral falx, whereas the intratumoural cystic meningiomas were predominantly found in frontal convexity (X 2 = 7.434, p = 0.024). The cysts were larger in the peritumoural cyst group than in the intratumoural cyst group (t = 5.274, p = 0.0258). Peritumoural oedema was more commonly found in the intratumoural cyst group (X 2 = 6.863, p = 0.008). Cystic meningiomas with solid parts located inside the cyst are reported for the first time. Conclusion: Cystic meningiomas, although uncommon, should be differentiated from other cystic intracranial lesions. Peri- and intratumoural cystic meningiomas have distinct MRI features. The present study provides the first report of two lesions with solid parts located inside the cyst, as well as one lesion with a calcified solid nodule and haemorrhage within the cyst.

  20. Imaging features of intracranial solitary fibrous tumors

    International Nuclear Information System (INIS)

    Yu Shuilian; Man Yuping; Ma Longbai; Liu Ying; Wei Qiang; Zhu Youkai

    2012-01-01

    Objective: To summarize the imaging features of intracranial solitary fibrous tumors (ISFT). Methods: Ten patients with ISFT proven histopathologically were collected. Four cases had CT data and all cases had MR data. The imaging features and pathological results were retrospectively analyzed. Results: All cases were misdiagnosed as meningioma at pre-operation. All lesions arose from intracranial meninges including 5 lesions above the tentorium, 4 lesions beneath the tentorium and 1 lesion growing around the tentorium. The margins of all the masses were well defined, and 8 lesions presented multilobular shape. CT demonstrated hyerattenuated masses in all 4 lesions, smooth erosion of the basicranial skull in 1 lesion, and punctiform calcification of the capsule in 1 lesion. T 1 WI showed most lesions with isointense or slight hyperintense signals including homogeneous in 4 lesions and heterogeneous in 6 lesions. T 2 WI demonstrated isointense or slight hyperintense in 2 lesions, mixed hypointense and hyperintense signals in 4, cystic portion in 2, and two distinct portion of hyperintense and hypointense signal, so called 'yin-yang' pattern, in 2. Strong enhanced was found in all lesions, especially in 8 lesion with heterogeneous with the low T 2 signal. 'Dural tail' was found in 4 lesions. Conclusions: ISFI has some specific CT and MR features including heterogeneous signal intensity on T 2 WI, strong enhancement of areas with low T 2 signal intensity, slight or no 'dural tail', without skull thickening, and the typical 'yin-yang' pattern. (authors)